When Karen and Joe adopted Kya, they were thrilled to have a little girl in their lives. They had two sons biologically but couldn’t have any more children. Kya was a miracle to them. At two years old, she wasn’t quite potty-trained, but she seemed a happy, healthy child. That is, until she practically destroyed her bedroom in one, single temper tantrum.
Logan’s parents were in a similar predicament. They adopted Logan at six-months old, but he didn’t seem to show emotions that other babies and toddlers typically showed. He was super affectionate – almost to the point of inappropriate behavior – with strangers, but he would not accept hugs or other physical displays of affection from his parents.
Jesse also acted strangely, though his parents had not adopted him. Jesse had spent the first few months of his life in the Neonatal Intensive Care Unit (NICU) due to his premature birth. As he grew, he was very withdrawn and shied away from people, including family members, not just strangers or other children. At three years old, he couldn’t seem to bond with his parents or other caregivers.
Each of these children show signs and symptoms of Reactive Attachment Disorder. Reactive Attachment Disorder (RAD) is a rare but serious condition where infants or toddlers don’t establish healthy attachments with parents or loved ones. Reactive attachment disorder can develop if the child’s basic human “needs for comfort, affection and nurturing aren’t met and loving, caring, stable attachments with others are not established.”
With treatment, children with reactive attachment disorder can create stable, loving, and healthy relationships over the course of their lifetimes. Here we discuss the risk factors, signs and symptoms, diagnosis, treatment, and how to cope with a diagnosis of reactive attachment disorder.
he risk of developing reactive attachment disorder tends to come from serious social and emotional neglect. Many times, children don’t or lack the opportunity to develop stable attachments. Children with RAD may have spent substantial amounts of time in children’s homes or other state institutions; they may have bounced from foster home to foster home, with very little stability; or a child could have been separated from the natural parents for a long period of time.
Mya spent most of the first two years of her life in various foster care homes – none of which lasted more than a few months. She was constantly moving, getting new caregivers, and having to adjust to new environments. After a while, Mya seemed to sense that getting attached to anything or anyone would just cause pain when the next, inevitable separation occurred.
Logan was born addicted to drugs and was immediately sent to a state children’s hospital for detoxification and withdrawal treatment. In the hospital, there was never just one nurse, doctor, or specialist in charge of his care. He was simply passed from person to person on a daily basis. To make them like him, he started behaving like a happy baby with everyone – just so no one would put him back down.
Jesse had to stay in the NICU for the first three months of his life. He was born premature but also developed myriad complications that prevented his parents from touching him or holding him. Once they were able to hold him, he was already four months old and had experienced very little human contact. Imagine how scary that must have been!
The good news for all of these children is that reactive attachment disorder can be treated, once a physician recognizes the signs and symptoms and can make a diagnosis.
Signs and Symptoms
As you can see in our vignettes, reactive attachment disorder can start in infancy. All the current research suggests that RAD most commonly effects children under 5 years of age. But every parent, even a new parent, can tell when a child isn’t behaving as he or she should. The child could be missing milestones or be emotionally detached.
Emotionally, children and infants with reactive attachment disorder display unexplained withdrawal, fear, sadness, or irritability; they are sad and listless, seeking no comfort or showing no response when comfort is given; and they rarely smile. When Jesse celebrated his first birthday, he didn’t even smile when he ate piece after piece of his super sweet birthday cake.
Children with RAD are also watchful, observing others closely but not engaging socially. They don’t ask for support or help, won’t reach out when picked up, nor do they play peekaboo or other interactive games. Mya was very reserved; it was something her parents hoped she’d outgrow, but the disengagement soon led to a violent level of frustration for Mya. She couldn’t express her feelings without acting out.
All infants and young children need a stable, caring environment. Their basic human physical and emotional needs must be met consistently. “For instance, when a baby cries, the need for a meal or a diaper change must be met with a shared emotional exchange that may include eye contact, smiling and caressing.”
But for the child whose needs are ignored or met with blank expressions, that child does not expect care or comfort in their time of need, nor do they form a stable attachments to caregivers. For Logan, no one in the state hospital had time to “ooh” and “aah” over him or spend time doing anything but meeting his most very, basic needs of food, clothing, cleanliness, and shelter. Logan’s super exuberant greetings and physical connection with strangers was his attempt to get more than just basic attention.
Researchers and doctors don’t know why some infants and children develop reactive attachment disorder while others don’t. Numerous theories about reactive attachment disorder and its roots exist, but more research is needed to develop a better understanding of RAD dynamics and improve diagnosis and treatment options.
If you suspect your child may be displaying signs and symptoms of reactive attachment disorder, seek out a pediatric psychiatrist or psychologist to conduct a thorough, in-depth examination before reaching a diagnosis of reactive attachment disorder.
Most diagnoses are based on direct observation of the family by the physician or psychologist and reported behaviors the parents have taken note of. There is no blood test or x-ray that can show doctors what is happening in the heart and mind of a child. Doctors need to ask questions about the home and living situation since birth
Doctors will directly observe interaction of the child with parents, loved ones, and other caregivers, which allow the doctors to evaluate parenting and caregiving styles and abilities. After observation, the doctors will seek additional information about interactions between the child and parents or others.
The observations reported by parents and caregivers give the doctors details about the child’s patterns of behavior over time or provide examples of behavior in a variety of situations. For instance, is there a certain kind of music that provokes a specific behavior in the child, or is there a food that can set off a temper tantrum.
Doctors will also need to rule out other psychiatric disorders or other mental health conditions that can co-exist with RAD, such as intellectual disability, other adjustment disorders, Autism spectrum disorder, or depressive disorders.
But primarily, for a diagnosis of reactive attachment disorder, the child must exhibit the following behaviors:
- A consistent pattern of emotionally withdrawn behavior toward caregivers; rarely seeking or not responding to comfort when distressed
- Persistent social and emotional problems that include minimal responsiveness to others, no positive response to interactions, or unexplained irritability, sadness, or fearfulness during interactions with caregivers
- Persistent lack of having emotional needs for comfort, stimulation and affection met by caregivers, or repeated changes of primary caregivers that limit opportunities to form stable attachments, or care in a setting that severely limits opportunities to form attachments (such as an institution)
Mya, Logan, and Jesse’s families were all given diagnoses of Reactive Attachment Disorder based on their behaviors and the situations they lived in from birth. Each child was then given a treatment plan.
Children with reactive attachment disorder have been determined to have the capacity to form attachments, but their experiences have hindered their growth. While most children are naturally resilient – even those who’ve been less than optimal situations – there is no way to predict which child will develop RAD.
There’s no standard treatment for reactive attachment disorder, but everyone who interacts with the child on a regular basis must be involved. Goals of treatment are to help ensure a safe and stable living situation and to develop positive interactions and strengthen attachments with parents and caregivers.
For Mya, her RAD stemmed from an extreme lack of stability. She was often sick with minor infections that were never treated, was injured by other children in the foster homes, and never had the chance to call someplace home. Since being adopted, Mya was given a complete physical and all medical issues had been addressed, she had been provided with her own room that no one else invaded, and her parents referred to their house as home as often as possible, encouraging Mya to call it home as well.
Logan needed consistent caregivers to develop stable attachments. His early life was dull, sterile, and lonely. Working with a therapist, his adoptive parents provided a positive, interactive, and stimulating environment for Logan. They made every effort to never leave him alone – except at bedtime – and engaged with him through playtime and learning activities.
Jesse’s lack of physical touch left him bereft of the basic human need for relationships with other humans. Jesse’s parents were encouraged to increase the chances of bonding by being nurturing, responsive, and caring at all times. They held him as often as possible, being generous with hugs and kisses, while at the same time being patient enough to not overwhelm Jesse with sensory overload.
All families who care for a child with reactive attachment disorder should participate in both individual and family counseling. This can begin by educating parents and caregivers about the child’s condition and offering parenting skills classes that address children with special needs.
As difficult as life is for the child with reactive attachment disorder, it is also very exhausting and challenging for the caregivers and families.
Coping with RAD
Parents and caregivers of children with reactive attachment disorder can find it hard to cope. They may feel like the child doesn’t love them — or that it’s hard to like the child sometimes. These are perfectly normal reactions that no parent or caregiver should feel ashamed of or try to hide. These are just the types of feelings you want to deal with in family counseling or individual therapy.
You can begin by educating yourself and your family about reactive attachment disorder and ask your pediatrician about resources. “If your child has a background that includes institutions or foster care, consider checking with relevant social service agencies for educational materials and resources.” There are dozens if not hundreds of resources out there for parents in this situation.
It is also important to find someone to give you a break from time to time. You do not want to burn out because you ignored self-care. But keep it in the family. Don’t bring a stranger in to watch the child while you take some me time. And practice stress management. Practicing yoga or meditation can help you relax and if you’re into sports or weight-training, those are great stress relievers as well.
Mya’s parents dove headfirst into her treatment. For weeks on end they took her to therapy, gave her special attention, and doted on her. It was exhausting. Finally, one weekend, Mya’s mother hit her breaking point and began sobbing uncontrollably. She and her husband agreed that every Saturday, they would take turns having me time away from the home; it may seem strange to schedule me time, but sometimes it’s the best option.
Logan’s parents ran into a similar situation. Logan was not only struggling with RAD, but he still had lingering affects from being born addicted to drugs. So not only did they deal with RAD, but Logan needed special medications and countless doctor visits to maintain a healthy life. Logan’s mom and dad knew there were other parents like them, so once a month, they went to a support group for parents of children born addicted to drugs.
Jesse’s family was the luckiest. Even though Jesse spent months with very little human contact, once he was home and his parents knew his diagnosis, the whole family (including extended relatives who helped care for him) joined in family counseling, learned about RAD and how to treat it, and created a whole program and routine for the house that took Jesse’s condition into consideration. That way, no one burned out.
Reactive Attachment Disorder is an incredibly tough diagnosis for a family. But knowing the roots of the disorder and how best to treat it can help the child lead a normal life with exceptionally healthy relationships.