Reactive Attachment Disorder (RAD)—

Reactive attachment disorder (RAD) is the broad term used to
describe the severe and relatively uncommon disorders of attachment
characterized by markedly disturbed and developmentally
inappropriate ways of relating socially in most contexts, beginning
before the age of five. It can either take the form of a persistent
failure to initiate most social interactions or respond to them in a
developmentally appropriate way, or present as indiscriminate
sociability, such as excessive familiarity with relative strangers.

Reactive attachment disorder is a disturbance of social interaction
caused by neglect of a child's basic physical and emotional needs,
particularly during infancy. Babies placed in orphanages at birth and
raised by multiple caretakers without primary parent-figures can also
develop this disorder, even if physical care was adequate.

RAD arises from a failure to form normal attachments to primary
caregiving figures in early childhood. Such a failure would result from
severe early experiences of neglect, abuse, abrupt separation from
caregivers between the ages of six months and three years, frequent
change of caregivers, or a lack of caregiver responsiveness to a child's
communicative efforts. Not all, or even a majority of such experiences
result in the disorder.

Reactive attachment disorder is a rare but serious mental health
condition in which infants and young children don't establish healthy
bonds to parents or caregivers. Children with reactive attachment
disorder typically were neglected or abused in infancy, passed through
many foster homes, or lived in orphanages where their emotional
needs weren't well met.

Because their basic needs for comfort, affection, nurturing and
stimulation weren't met, these infants and children didn't learn how
to create loving and caring attachments with other people. They can't
give or receive affection.

Reactive attachment disorder is often enmeshed in controversy. Both
its diagnosis and treatment are difficult, and parents and caregivers
are commonly distressed as they try to cope with the disorder and a
seemingly uncaring child. Some non-conventional treatment methods
have been associated with the deaths of several children, escalating
the controversy. Despite the challenges, a commitment to proven
psychiatric treatment may help these children enjoy a better quality
of life and develop more stable relationships.

Attachment Styles—

There are four attachment 'styles' known as secure, anxious-
ambivalent, anxious-avoidant, (all organized) and disorganized.
The latter three are characterized as insecure.

A securely attached toddler will explore freely while the caregiver is
present, engage with strangers, be visibly upset when the caregiver
departs, and happy to see the caregiver return.

The anxious-ambivalent toddler is anxious of exploration, extremely
distressed when the caregiver departs but ambivalent when the
caregiver returns.

The anxious avoidant toddler will not explore much, avoid or ignore
the parent - showing little emotion when the parent departs or
returns - and treat strangers much the same as caregivers with little
emotional range shown.

The disorganized/disoriented toddler shows a lack of a coherent style
or pattern for coping. Evidence suggests this occurs when the care-
giving figure is frightening thus putting the child in an irresolvable
situation regarding approach and avoidance. On reunion with the
caregiver children can look dazed or frightened, freezing in place,
backing toward the caregiver or approaching with head sharply
averted, or showing other behaviors that seem to imply fearfulness
of the person who is being sought. It is thought to represent a
breakdown of an inchoate attachment strategy and it appears to
affect the capacity to regulate emotions.

Signs and symptoms—

Child:
· Avoids caregiver
· Avoids physical contact
· Difficult to comfort
· Indiscriminate sociability with strangers
· Resists social interaction
· Seeks isolation

Caregiver:
· Disregard for child's basic emotional needs for comfort, stimulation,
and affection
· Disregard for child's basic physical needs like food, toileting, and play

Reactive attachment disorder is broken into two types — inhibited and
disinhibited. While some children have signs and symptoms of just
one type, many children have both.

Inhibited type:
In inhibited reactive attachment disorder, children shun relationships
and attachments to virtually everyone. This may happen when a baby
never has the chance to develop an attachment to any caregiver.

Signs and symptoms of the inhibited type may include:
·        Appearing to be on guard or wary
·        Appearing to seek contact but then turning away
·        Avoiding eye contact
·        Avoiding physical contact
·        Difficulty being comforted
·        Engaging in self-soothing behavior
·        Failing to initiate contact with others
·        Preferring to play alone
·        Resisting affection from parents or caregivers

Disinhibited type:
In disinhibited reactive attachment disorder, children form
inappropriate and shallow attachments to virtually everyone, including
strangers. This may happen when a baby has multiple caregivers or
frequent changes in caregivers.

Signs and symptoms of the disinhibited type may include:
·    Appearing anxious
·    Exaggerating needs for help doing tasks
·    Inappropriately childish behavior
·    Readily going to strangers, rather than showing stranger anxiety
·    Seeking comfort from strangers

Causes—

Although increasing numbers of childhood mental health problems
are being attributed to genetic defects, reactive attachment disorder
is almost by definition based on a problematic history of care and
social relationships. However, reactive attachment disorder may
resemble many other emotional disorders with an etiology in which
a predisposition or constitutional weakness is affected by an
environmental stressor. It has been suggested that types of
temperament, or constitutional response to the environment, may
make some individuals susceptible to the stress of unpredictable or
hostile relationships with caregivers in the early years. In the absence
of available and responsive caregivers it appears that some children
are particularly vulnerable to developing attachment disorders.

Abuse can occur alongside the required factors, but on its own does
not explain attachment disorder. Abuse is associated with developed,
albeit disorganized attachment. This style is a risk factor for a range
of psychological disorders although it is not in itself considered an
attachment disorder under the current classification.

There is as yet no explanation for why similar abnormal parenting
produces two distinct forms of the disorder. The issue of
temperament and its influence on the development of attachment
disorders has yet to be resolved. RAD has never been reported in
the absence of serious environmental adversity yet outcomes for
children raised in the same environment vary widely.

Reactive attachment disorder is caused by neglect of an infant's
needs for physical safety, food, touching, and emotional bonds
with a primary and/or secondary caretaker.

The risk of neglect to the infant or child is increased with parental
isolation, lack of parenting skills, teen parents, or a caregiver who
is mentally retarded. A frequent change in caregivers (for example,
orphanages or foster care) is another cause of reactive attachment
disorder.

Children adopted from foreign orphanages are commonly affected,
particularly if they were removed from their birth parents during the
first weeks of life.

Most children are naturally resilient, and even those who have been
neglected, have lived in orphanages or have had multiple caregivers
develop healthy relationships and strong bonds. It's not known what
causes some babies and children to develop reactive attachment
disorder. But a variety of theories about attachment may help explain
some of the emotional processes that give rise to the disorder.

Traditional attachment theory says that to feel safe and develop
trust, infants and young children need a stable, nurturing
environment. Their basic emotional and physical needs must be
consistently met. In addition, interactions with babies must be caring
and positive, not harsh or negative. For instance, when a baby cries,
his or her need for a meal or a diaper must be met promptly with a
shared emotional exchange that may include eye contact, smiling and
caressing.

A child whose bottle is propped up on his or her chest to self-feed or
whose diaper is changed roughly without kind words and warm facial
expressions may feel rejected and insecure. When this happens
repeatedly, the baby learns that he or she can't rely on adults for
nurture and love. The baby becomes distrustful and unattached.
Babies who seek comfort from a caregiver but are met with hostility
or abuse become confused and conflicted — wanting closeness but
turning away from it for fear of rejection or harm.

Some attachment theories suggest that emotional interactions
between babies and caregivers actually shape neurological
development in the brain. They say that interactions cause the
formation of neural networks within the brain that ultimately influence
a baby's personality and relationships throughout life. In babies
whose needs aren't met with caring and love, these neural networks
don't form properly, creating attachment problems.

Risk factors—

Reactive attachment disorder is considered uncommon. However,
there are no accurate statistics on how many babies and children
have the condition. It can affect children of any race or either sex.
By definition, reactive attachment disorder begins before age 5,
although its roots start in infancy.

Factors that may increase the chance of developing reactive
attachment disorder include:
·   Extreme poverty
·   Forced removal from a neglectful or abusive home
·   Frequent changes in foster care or caregivers
·   Inexperienced parents
·   Institutional care
·   Living in an orphanage
·   Parents who have a mental illness, anger management problems,
or drug or alcohol abuse
·   Physical, sexual or emotional abuse
·   Postpartum depression in the baby's mother
·   Prolonged hospitalization
·   Significant family trauma, such as death or divorce

When to seek medical advice—

This disorder is usually identified when a parent (or prospective
parent) is identified as being at high risk for neglect or when an
adoptive parent has difficulty coping with a newly adopted child.

If you have recently adopted a child from a foreign orphanage or
another situation where neglect may have occurred and your child
exhibits these symptoms, see your health care provider.

If you think your baby or child may have reactive attachment disorder
or you feel that a strong bond isn't developing, consider seeking a
medical or psychological evaluation.

Consider getting an evaluation if your baby or child:
·        Avoids you
·        Doesn't seek out physical contact
·        Prefers not to be held
·        Seems uninterested in you
·        Usually likes to play alone
·        Will readily go to strangers

Screening and diagnosis—

RAD is one of the least researched and most poorly-understood
disorders in the DSM. There is little systematically gathered
epidemiologic information on RAD, its course is not well established
and it appears difficult to diagnose accurately. Several other
disorders, such as conduct disorders, oppositional defiant disorder,
anxiety disorders, post traumatic stress disorder and social phobia
share many symptoms and are often comorbid with or confused with
RAD leading to over and under diagnosis.

RAD can also be confused with neuropsychiatric disorders such as
autism spectrum disorders, pervasive developmental disorder,
childhood schizophrenia and some genetic syndromes. Some children
simply have very different temperamental dispositions. Because of
these diagnostic complexities, careful diagnostic evaluation by a
trained mental health expert with particular expertise in differential
diagnosis is considered essential.

While RAD is likely to occur in relation to neglectful and abusive
childcare, automatic diagnoses on this basis alone cannot be made as
children can form stable attachments and social relationships despite
marked abuse and neglect.

A thorough medical and psychological evaluation is in order when it's
thought that a baby or child may have reactive attachment disorder.
The disorder can be similar to other disorders, including autism,
developmental disorders, social phobia, conduct disorders and
attention-deficit/hyperactivity disorder. In fact, a child with reactive
attachment disorder may also have other disorders as well.

A complete and thorough evaluation should include:
·   Examples of behavior in a variety of situations
·   Parenting and caregiver styles and abilities
·   The baby's or child's pattern of behavior over time
·   The baby's or child's relationship with parents or caregivers as well
as others, including other family members, peers, teachers and child
care providers
·   The home and living situation

To be diagnosed with reactive attachment disorder, a baby or child
must meet criteria spelled out in the Diagnostic and Statistical Manual
of Mental Disorders (DSM). This manual is published by the American
Psychiatric Association and is used by mental health providers to
diagnose mental conditions and by insurance companies to reimburse
for treatment.

The main criteria for the diagnosis of reactive attachment disorder
include:
·   Disturbed and developmentally inappropriate social relationships
beginning before age 5
·   Failure of early care to meet the baby's or child's emotional needs
for comfort and affection, failure of early care to attend to the child's
physical needs, or repeated changes in the primary caregiver
·   Failure to respond to or initiate social interactions, or being
inappropriately friendly and familiar with strangers

Consider getting a second opinion if you have questions or concerns
about the diagnosis or treatment plan.

Complications—

Without treatment for reactive attachment disorder, a child's social
and emotional development may be permanently affected.

Complications and related conditions may include:
·        Academic problems
·        Aggression
·        Anxiety
·        Bullying or being bullied
·        Depression
·        Developmental delays
·        Drug and alcohol addiction
·        Eating problems
·        Growth delays
·        Inappropriate sexual behavior
·        Lack of empathy
·        Malnutrition
·        Relationship problems in adulthood
·        Temper or anger problems
·        Trouble relating to classmates or peers
·        Unemployment or frequent job changes

Treatment—

All mainstream prevention programs and treatment approaches for
attachment disorder for infants and younger children are based on
attachment theory and concentrate on increasing the responsiveness
and sensitivity of the caregiver, or if that is not possible, placing the
child with a different caregiver. These approaches are mostly in the
process of being evaluated. The programs invariably include a detailed
assessment of the attachment status or caregiving responses of the
adult caregiver as attachment is a two-way process involving
attachment behavior and caregiver response.

Some of these treatment or prevention programs are specifically
aimed at foster carers rather than parents, as the attachment
behaviors of infants or children with attachment difficulties often do
not elicit appropriate caregiver responses. Approaches include 'Watch,
wait and wonder,' manipulation of sensitive responsiveness, modified
'Interaction Guidance,' 'Preschool Parent Psychotherapy,' 'Circle of
Security', Attachment and Biobehavioral Catch-up (ABC), the New
Orleans Intervention, and Parent-Child psychotherapy. Other
treatment methods include Developmental, Individual-difference, and
Relationship-based therapy (DIR, also referred to as Floor Time) by
Stanley Greenspan, although DIR is primarily directed to treatment of
pervasive developmental disorders.

The relevance of these approaches to intervention with fostered and
adopted children with RAD or older children with significant histories
of maltreatment is unclear.

In 2005 the American Academy of Child and Adolescent Psychiatry
laid down guidelines (devised by N.W.Boris and C.H.Zeanah) based
on its published parameters for the diagnosis and treatment of RAD.
Recommendations in the guidelines include the following:

1.        "Although the diagnosis of reactive attachment disorder is
based on symptoms displayed by the child, assessing the caregiver's
attitudes toward and perceptions about the child is important for
treatment selection."

2.        "Children who meet criteria for reactive attachment disorder
and who display aggressive and oppositional behavior require
adjunctive (additional) treatments."

3.        "Children with reactive attachment disorder are presumed to
have grossly disturbed internal models for relating to others. After
ensuring that the child is in a safe and stable placement, effective
attachment treatment must focus on creating positive interactions
with caregivers."

4.        "The most important intervention for young children
diagnosed with reactive attachment disorder and who lack an
attachment to a discriminated caregiver is for the clinician to advocate
for providing the child with an emotionally available attachment figure."

Treatment is twofold. The first priority is to make sure the child is
currently in a safe environment where emotional and physical needs
are met.

Once that has been established, the next step is to alter the
relationship between the caregiver and the child, if the caregiver has
caused the problem. Parenting skills classes can help with this. These
skills give the caregiver an ability to meet the child's needs and help
them bond with their child.

The caregiver should also undergo counseling to work on any current
problems, such as drug abuse or family violence. Social Services
should follow the family to make sure the child remains in a safe,
stable environment.

Parents who adopt babies or young children from foreign orphanages
should be aware that this condition may occur and be sensitive to the
needs of the child for consistency, physical affection, and love.

These children may be frightened of people and find physical affection
overwhelming at first, and parents should try not to see this as
rejection. It is a normal response in someone who has been
maltreated to avoid contact. Hugs should be offered frequently, but
not forced.

Treatment of reactive attachment disorder often involves a mix of
psychotherapy, medications and education about the disorder. It may
involve a team of medical and mental health providers with expertise
in attachment disorders. Treatment usually includes both the baby or
child and the parents or caregivers.

Goals of treatment are to help ensure that the baby or child has a
safe and stable living situation and that he or she develops positive
interactions with parents and caregivers. Treatment can also boost
self-esteem and improve peer relationships.

There's no standard treatment for reactive attachment disorder.

However, treatment often includes:
·   Education of parents and caregivers about the condition
·   Family therapy
·   Individual psychotherapy
·   Medication for other conditions that may be present, such as
depression, anxiety or hyperactivity
·   Parenting skills classes
·   Recreation therapy or occupational therapy
·   Residential or inpatient treatment for children with more serious
problems or who put themselves or others at risk of harm
·   Special education services

Because symptoms of reactive attachment disorder can last for years,
treatment may be long term. Parents and caregivers also may want to
consider seeking professional treatment or counseling for themselves
or other family members to help cope with the stress of having a child
with reactive attachment disorder.

Nonconventional treatments:
Some forms of treatment of reactive attachment disorder remain
highly controversial, and this has heightened in the last several years
after the deaths of several children were attributed to these methods.
Some of these methods are sometimes called re-parenting, re-
birthing, and compression or holding treatment, and they often
involve physical restraint. However, not all of these methods are used
the same way by all practitioners.

The American Academy of Child and Adolescent Psychiatry, the
American Psychiatric Association, and the American Professional
Society on the Abuse of Children have all denounced as dangerous
and unproven any practices that involve tightly wrapping, binding or
holding children while forcing eye contact, intentionally triggering a
rage, or ignoring pleas about breathing difficulties.

Prevention—

Early recognition is very important for the child. Once a parent is
identified as being at high risk for neglect, parenting skills should be
taught. The patient should be followed by either a social worker or
doctor to make sure the child's needs are being met.

While it's not known if reactive attachment disorder can be
prevented with certainty, there may be ways to reduce the risk
of its development:

·        Be actively engaged with babies and children in your care by
playing with them, talking to them, making eye contact or smiling at
them, for example.

·        Don't miss opportunities to provide warm, nurturing interaction
with your baby or child, such as during feeding, bathing or diapering.

·        If you lack experience or skill with babies or children, take
classes or volunteer with children so that you can learn how to
interact in a nurturing manner.

·        If your baby or child has a background that includes
orphanages or foster care, educate yourself about attachment and
develop specific skills to help your child bond.

·        If you're an adult with attachment problems, it's not too late
to get professional help. Getting help may prevent you from having
attachment problems with your children, who otherwise may also be
at risk.

·        Learn to interpret your baby's cues, such as different types
of cries, so that you can meet his or her needs quickly and effectively.

·        Teach children how to express feelings and emotions with
words. Lead by example, and offer both verbal and nonverbal
responses to the child's feelings through touch, facial expressions
and tone of voice.

Coping skills—

If you're a parent or caregiver whose baby or child has reactive
attachment disorder, it's easy to become angry, frustrated and
distressed. You may feel like your child doesn't love you — or that
it's hard to like your child sometimes.

You may find it helpful to:
·   Acknowledge that the strong or ambivalent feelings you may have
about your child are natural
·   Be willing to call for emergency help if your child becomes violent
·   Continue friendships and social engagements
·   Find respite care so that you can periodically have downtime if
caring for your child is particularly troublesome
·   If your child was adopted, reach out to your adoption agency for
attachment resources
·   Join a support group to connect with others facing the same issues
·   Practice stress management skills
·   Take time for yourself through hobbies or exercise
Reactive Attachment Disorder
Ask The Parent Coach—




Hi Mark,


I am the adoptive mother of a child with
RAD. He is a hand-full to say the least.
Can you give me some suggestions
(in addition to what you discuss in your
eBook) on how to deal with Reactive
Attachment Disorder behavior and the
accompanying parental-stress?

Thank you!

J.H.

````````````````````````````````````````````````````````

Hi J.,

Many foster and adoptive families of
Reactive Attachment Disordered
children live in a home that has become
a battleground. In the beginning, the
daily struggles can be expected. After
all, we knew that problems would occur.
Initially, stress can be so subtle that we
lose sight of a war, which others do not
realize is occurring. We honestly believe
that we can work through the problems.
Outbursts, rages, and strife become a
way of life (an emotionally unhealthy way
of life). We set aside our own needs and
focus on the needs of our children. But
what does it cost us?

The majority of the population does not
understand the dynamics of parenting a
RAD child. Family and friends may think
that you -- the parent are the one with the
problem. Families are frequently turned
in on false abuse allegations. Support is
non-existent, because outsiders can't
even begin to imagine that children can
be so destructive.  

It is a known fact that kids diagnosed
with RAD tend to target their Moms, play
it cool around their Dads, and charm
strangers. Where does that leave a
parent? Without strong support and
understanding, the parent will become
isolated, demoralized, hurt, confused,
and often held accountable for the
actions of their child.  

Families are simply not prepared for
the profound anger that lives in the
heart and soul of our RAD children.
It's heartbreaking, frustrating, mind
boggling, and extremely stressful. In
essence, we're fighting to teach our
children how to love and trust. Intimacy
frightens our children; they have lost
the ability to love, to trust, and to feel
remorse for hurtful actions. They see
us as the enemy. Small expectations
on our part can set our children off in
ways that are not only indescribable,
but also often unbelievable.

Your home becomes a war zone and
you feel totally inadequate. You begin to
question your parenting abilities, and
your own sanity. You know that your child
has been hurt beyond words; you ache
for them. Despite your loving intentions
and actions, it's thrown in your face.  
Your heart's desire is to provide your
child with untold opportunities, a future,
and all the love in the world. You want to
soothe your child.  You want your child to
have a fulfilling childhood and to grow up
to be a responsible adult. Yet, you are
met with hatred and fierce anger.

In war, the battle lines are drawn;
an antagonism exists between two
enemies. In our homes, we are not
drawing battle lines; we are not
prepared for war. We are prepared for
parenting. Consequently, the ongoing
stress can result in disastrous affects
on our well being literally causing our
emotional and physical health to
deteriorate.

In parenting a child with Reactive
Attachment disorder, you will not
escape adverse effects. It is essential
to recognize that your feelings are
typical under stressful conditions. It is
just as essential to accept the fact that
extensive stress is unhealthy.

By recognizing the symptoms and
seeking support, you will strengthen
your abilities to cope. Counseling is
readily available to families and
individuals. Take advantage of
resources that will help you put the
traumatic experiences into perspective,
enabling you to let go of past feelings
by replacing them with positive skills
for recovery.

The strains a Reactive Attachment Child
puts on your family can be enormous.

Effects on the family of a RAD Child:

·        A RAD child will play one parent
off the other, which could result in a rift
between parents.

·        Dreams of the perfect loving, caring
family are squashed. There is no such
thing as perfect family, but a RAD family
can become quite dysfunctional.

·        Due to child’s disruptive behavior,
parents often withdraw from social
functions.

·        Family events, like Christmas, can
be filled with anger and frustration due
to RAD behavior.

·        Friends, family, church members
become critical of parenting and attitude.

·        Parents appear to be unfair, strict
and sometimes hostile, as parenting
skills used with healthy children do not
work with RAD children.

·        Siblings and pets can often be
targeted and threatened. It is extremely
important for RAD children to have their
own room - for their own good as well
as the safety of siblings.

·        Siblings often feel ignored or
overlooked as the RAD child takes up
so much of the parent’s time. Schedule,
daily or weekly, one-on-one quality time
for each child in the family.

Mother’s Stress—

SELF-BLAME: Many moms have the
misconception that they should be able
to solve their child’s problems - super-
mom syndrome. The worst of all
feelings! We are angels, not gods.

GUILT: On many levels.

1.        About how we often feel toward
our child. Let’s face it, their disorder
makes them hard to “like” let alone
“love” sometimes.

2.        That “we” let our family fall apart
(the god thing again).

3.        That we are angry with God for
this tremendous challenge.

4.        That we are having trouble
forgiving our child for past behaviors -
BIG ONE!

5.        That we don’t spend enough
quality time with our other children, our
spouse, and, in taking care of ourselves.

6.        Without knowing any better most
of us have lost our tempers or worse
with our child.

ANGER: Or betrayal or feeling frustrated.

1.        At everyone you had to “explain”
the disorder to and that you had to
explain the disorder to so many.

2.        At family and friends for saying
things like, “All kids do that!” And for not
understanding what our life was like.

3.        At God - Why me?

4.        At our Attachment Disordered
child. For doing this “to us”. We took it
personally and saw the child “as” the
disorder, instead of a child “with” an
emotional disorder.

5.        At our husbands for not believing
us or noticing the child’s strange
manipulations, for not understanding,
for not supporting us emotionally, for
counter-mining our new parenting
techniques (usually by loosing their
temper), for not being as committed in
using the new parenting techniques or
reading the materials. For “saving” the
child when he/she didn’t need saving,
for not helping us when we needed
helped, for leaving it all to us.

6.        At ourselves for not being our
“old self” or fun anymore.

7.        At the system or adoption agency.
Cries for help went out for years - bad
advice and blame were given in return.

DISTRUST:

1.        Of helping professionals. We
have been given so much “bad” advice
we question even “good” advice.

2.        Of other supports.

3.        Of ourselves, our abilities --
feeling un-empowered.

4.        Of the system.

DESPAIR AND LOSS OF HOPE:

1.        “Will it ever get better?”

2.        “Why read another book - nothing
helps.” “I’m tired.”

ISOLATED and ALONE:

No one understands and we “believe”
we can’t get respite from our problem
child.

OVERWHELMED:

Many moms suffer from Depression,
Post Traumatic Stress Disorder, and
secondary Post Traumatic Stress
Disorder

Your child’s therapist may be your
best resource. Request a separate
session, this is not for your child’s
ears. I encourage therapists to initiate
a session for this purpose.

Parenting a Reactive Attachment
Disorder child, who has not learned to
trust, is difficult. Without trust there is no
respect, honesty or real affection.

Parenting Tips—

Lectures, warnings, hollering, bribes,
second chances and reminders do NOT
work. You are wasting your time and
breath. Your child knows the rules he or
she just refuses to obey your rules!

Remember – his or her actions are
often automatic responses learned
from infancy. Your child is in their
element when you have lost your
control!

Natural Consequences:

·        Did not bring homework home –
go back and get it or assign your own
homework.

·        Room not cleaned – stay in your
room until it is clean.

·        Does not want to eat – no problem,
they will not starve, but they will sit at the
table while the family eats (NO snack
before next meal).

·        Misbehaving at dinnertime –
remove them from the table. They can go
to their room until dinner is over– so the
rest of the family can enjoy a peaceful
meal.

·        Broken object – they must replace
it with their own money or with chores.

·        Foul mouth, raised voice,
rudeness, and back talk – can be
rewarded with chores, exercise
(jumping jacks, sit ups, running on
the spot) or payment to money jar.

·        Hurt someone – they must
apologize and lose privileges (having
friends over, watching TV, playing video
games, using the telephone, etc.). Most
likely, they will not mean the apology, but
it is a habit-forming process.

Avoid control battles! Your child wants to
control you, even if it means making you
angry and them being disciplined. No
one wins and you will end up frustrated.
Try, “When you clean your room properly,
you can have ____,” (lunch, playtime,
etc.) –whatever fits the daily schedule.

Never believe your child, “Honest,
Mom, I’m telling the truth! Why won’t you
believe me, you never believe me!” Don’t
let that sway you; your child is one of the
best liars around. Should a miracle
happen and you later find out your child
was telling the truth; look them in the
eye, apologize sincerely and reward –
perhaps with a favorite dessert, comic,
or hug. If you find that more and more
your child has told the truth, then you
can start to let your guard down.

When giving compliments give them
in ‘now’ time. “You showed great
sportsmanship today!” or “You did a
really good job on the dishes. Thank
you.” Do not be surprised when your
child sabotages these good moments.
This is their only way of regaining control
of their environment. Until they learn to
trust you, this is their safety net.

Disciplines and punishments should
also be in the ‘now’ time. Groundings
for the week(s) may sound good to you
but your RAD child lives in the ‘now’
mode. Cause and effect are not easily
understood, if at all; especially if the
effect lasts more than a day or two. You
will find that if the grounding is too long
or heavy your child will act out even more
as they think, “Why not, I’m already
grounded from everything”.

“Ain’t Misbehaving” Money Jar --
Each week have a roll of $2/nickels or
$5/dimes and place in a jar; then for
each negative behavior take a nickel or
dime out of the jar. At the end of the
week your child gets to keep the money
in the jar. Be sure to point out how much
money was in the jar at the beginning of
the week.

Do not leave RAD children in the care
of adults that will allow the child to
manipulate them. No child will trust and
respect others who are weaker than
them; this includes grandparents,
childcare, teachers, etc. Weak care-
givers will just reinforce your child’s
belief that adults cannot be trusted and
they can only depend on themselves for
survival.

Good luck (you’ll need it!),

Mark
The RAD child's beliefs:

·   I am unlovable.

·   I must control at all costs if I am to
survive.

·   My parents are my enemy and if they
get too close to me, I will not survive the
pain.

·   My parents are unloving.

·   The world is unsafe.


What in a child's behavior or life
experience tells us that we must look
at problems with attachment as a key
focus of treatment?

·        This child did not get her basic
need for protection, belonging or
consistent care met during her first three
years because of abuse, neglect, her
parent's illness or chemical abuse,
separation from her parent, having too
many caregivers or sever chronic pain
that no caregiver could ease.

·        This child is hypervigilent, always
on guard as to what bad thing will
happen next to him. He believes that
whatever he does in school or at home
doesn't count or won't last, which leaves
him feeling angry, powerless and
anxious.

·        This child is out of sync with his
own body and has shut off his ability to
use his five senses to relax or explore
his world. He doesn't know when he is
in pain or feel full after eating. He can
lose bowel control, hoard food, or ignore
his basic hygiene. He has trouble
playing or just "being in the moment"
while having fun.

·        This child lacks the ability to "put
herself in another's shoes" and show
compassion or remorse. She can seek
out doing harm to those she sees as
weaker or to the adult doing the most to
try to care for her. She can tease, hit, set
fires, and break objects in ways that
seem deliberate and at times, cruel.

·        This child relates to people in
either an "inhibited" or "disinhibited" way,
meaning he avoids contact with anyone
who tries to get close or gets
immediately friendly with anyone then
pulls away when that person is no
longer useful to him.

·        This child seems surrounded by
adults who are unreasonably hostile to
her because she is so skilled in
bringing this feeling out in anyone who
tries to guide or care for her. She can
also appear superficially charming to
adults new to her and can rally sympathy
for "how badly she's been treated" by
those hostile others.

·        This child seems to need to be in
control of everyone around her, even as
she seems so unable to be in control of
herself. She does this by demanding,
arguing, needing to win, having the last
word, taking other's things, taking on the
"boss" role or blaming other kids and
"crazy" lying, that is unable to say, "I did
it, I am sorry" no matter what evidence to
the contrary.

·        This child's self worth has become
tied to playing whatever role she learned
to use to get attention from her first
adults. She became an entertainer, a
mini-caregiver, a demanding bully, a
manipulator or an overly compliant
pleaser, but she never felt secure that
the adults could stick around and keep
her safe.
PDF Files--

Right click on the links below, then select
"
Save Target As" or "Save Link As"...

CHILDREN DIAGNOSED WITH ATTACHMENT
DISORDER: A QUALITATIVE STUDY

Report: APSAC Task Force on Attachment
Therapy, Reactive Attachment Disorder

Practice Parameter for the Assessment and
Treatment of Children with RAD