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Reactive Attachment Disorder (RAD): Warning Signs, Symptoms, Treatment

Attachment is the deep and lasting connection established between a youngster and caretaker in the first few years of life. It profoundly affects your youngster’s development and his or her ability to express emotions and develop relationships. If you are the parent of a youngster with Reactive Attachment Disorder (RAD), you may be physically and emotionally exhausted from trying to connect with your youngster, only to be met with opposition, defiance, or, maybe hardest of all, indifference.

A youngster with insecure attachment or RAD doesn’t have the skills necessary to build meaningful relationships. However, with the right tools, and a healthy dose of time, effort, patience, and love, it is possible to treat and repair attachment difficulties.

Understanding attachment problems and disorders—

Kids with RAD or other attachment problems have difficulty connecting to others and managing their own emotions. This results in a lack of trust and self-worth, a fear of getting close to anyone, anger, and a need to be in control. A youngster with RAD feels unsafe and alone.

So why do some kids develop RAD while others don’t? The answer has to do with the attachment process, which relies on the interaction of both parent and youngster.

RAD is the result of negative experiences in this early relationship. If young kids feel repeatedly abandoned, isolated, powerless, or uncared for—for whatever reason—they will learn that they can’t depend on others and the world is a dangerous and frightening place.

What causes RAD and other attachment problems?

RAD and other attachment problems occur when kids have been unable to consistently connect with a parent or primary caretaker. This can happen for many reasons:

• The parent is emotionally unavailable because of depression, an illness, or a substance abuse problem.
• The infant or youngster is hospitalized or separated from his or her moms and dads.
• Sometimes the youngster’s needs are met and sometimes they aren’t. The youngster never knows what to expect.
• No one looks at, talks to, or smiles at the baby, so the baby feels alone.
• A youngster or baby is mistreated or abused.
• A youngster gets attention only by acting out or displaying other extreme behaviors.
• A baby or youngster is moved from one caretaker to another (can be the result of adoption, foster care, or the loss of a parent).
• A baby is hungry or wet, and they aren’t attended to for hours.
• A baby cries and no one responds or offers comfort.

As the examples show, sometimes the circumstances that cause the attachment problems are unavoidable. But the youngster is too young to understand what has happened and why. To a youngster, it just feels like no one cares and they lose trust in others and the world becomes an unsafe place.

Early warning signs and symptoms of insecure attachment—

Attachment problems fall on a spectrum, from mild problems that are easily addressed to the most serious form, known as RAD.

Although it is never too late to treat and repair attachment difficulties, the earlier you spot the symptoms of insecure attachment and take steps to repair them, the better. With early detection, you can avoid a more serious problem. Caught in infancy, attachment problems are often easy to correct with the right help and support.

Signs and symptoms of insecure attachment in infants:

• Spend a lot of time rocking or comforting themselves
• Rejects your efforts to calm, soothe, and connect
• Isn’t interested in playing interactive games or playing with toys
• Doesn’t smile
• Doesn’t seem to notice or care when you leave them alone
• Doesn’t reach out to be picked up
• Doesn’t follow you with his or her eyes
• Doesn’t coo or make sounds
• Cries inconsolably
• Avoids eye contact

It’s important to note that the early symptoms of insecure attachment are similar to the early symptoms of other issues such as ADHD and autism. If you spot any of these warning signs, make an appointment with your pediatrician for a professional diagnosis of the problem.

Signs and symptoms of RAD—

Kids with RAD have been so disrupted in early life that their future relationships are also impaired. They have difficulty relating to others and are often developmentally delayed. RAD is common in kids who have been abused, bounced around in foster care, lived in orphanages, or taken away from their primary caretaker after establishing a bond.

Common signs and symptoms of RAD:

• Difficulty showing genuine care and affection. For example, kids with RAD may act inappropriately affectionate with strangers while displaying little or no affection towards their moms and dads.

• Control issues. Most kids with RAD go to great lengths to prevent feeling helpless and remain in control. They are often disobedient, defiant, and argumentative.

• Anger problems. Anger may be expressed directly, in tantrums or acting out, or through manipulative, passive-aggressive behavior. Kids with RAD may hide their anger in socially acceptable actions, like giving a high five that hurts or hugging someone too hard.

• An underdeveloped conscience. Kids with RAD may act like they don’t have a conscience and fail to show guilt, regret, or remorse after behaving badly.

• An aversion to touch and physical affection. Kids with RAD often flinch, laugh, or even say “Ouch” when touched. Rather than producing positive feelings, touch and affection are perceived as a threat.

Inhibited RAD vs. Disinhibited RAD--

As kids with RAD grow older, they often develop either an inhibited or a disinhibited pattern of symptoms:

• Disinhibited symptoms of RAD. The youngster doesn’t seem to prefer his or her moms and dads over other people, even strangers. The youngster seeks comfort and attention from virtually anyone, without distinction. He or she is extremely dependent, acts much younger than his or her age, and may appear chronically anxious.

• Inhibited symptoms of RAD. The youngster is extremely withdrawn, emotionally detached, and resistant to comforting. The youngster is aware of what’s going on around him or her—hypervigilant even—but doesn’t react or respond. He or she may push others away, ignore them, or even act out in aggression when others try to get close.

Parenting a youngster with RAD: What you need to know—

Parenting a youngster with insecure attachment or RAD can be exhausting, frustrating, and emotionally trying. It is hard to put your best parenting foot forward without the reassurance of a loving connection with your youngster. Sometimes you may wonder if your efforts are worth it, but be assured that they are. With time, patience, and concerted effort, RAD can be repaired. The key is to remain calm, yet firm as you interact with your youngster. This will teach your youngster that he or she is safe and can trust you.

• Take care of yourself and manage stress. Reduce other demands on your time and make time for yourself. Rest, good nutrition, and parenting breaks help you relax and recharge your batteries so you can give your attention to your youngster.

• Stay positive and hopeful. Be sensitive to the fact that kids pick up on feelings. If they sense you’re discouraged, it will be discouraging to them. When you are feeling down, turn to others for reassurance.

• Patience is essential. The process may not be as rapid as you like, and you can expect bumps along the way. But by remaining patient and focusing on small improvements, you create an atmosphere of safety for your youngster.

• Have realistic expectations. Helping your youngster with RAD may be a long road. Focus on making small steps forward and celebrate every sign of success.

• Foster a sense of humor and joy. Joy and humor go a long way toward repairing attachment problems and energizing you even in the midst of hard work. Find at least a couple of people or activities that help you laugh and feel good.

• Find support and ask for help. Rely on friends, family, community resources, and respite care (if available). Try to ask for help before you really need it to avoid getting stressed to a breaking point. You may also want to consider joining a support group for moms and dads.

A note to moms and dads of adopted or foster care kids with RAD:

If you have adopted a youngster, you may not have been aware of RAD. Anger or unresponsiveness from your new youngster can be heartbreaking and difficult to understand. Try to remember that your adopted youngster isn’t acting out because of lack of love for you. Their experience hasn’t prepared them to bond with you, and they can’t yet recognize you as a source of love and comfort. Your efforts to love them will have an impact—it just may take some time.

Repairing RAD: Tips for making your youngster feel safe and secure—

Safety is the core issue for kids with RAD and other attachment problems. They are distant and distrustful because they feel unsafe in the world. They keep their guard up to protect themselves, but it also prevents them from accepting love and support. So before anything else, it is essential to build up your youngster’s sense of security. You can accomplish this by establishing clear expectations and rules of behavior, and by responding consistently so your youngster knows what to expect when he or she acts a certain way and—even more importantly—knows that no matter what happens, you can be counted on.

• Be immediately available to reconnect following a conflict. Conflict can be especially disturbing for kids with insecure attachment or RAD. After a conflict or tantrum where you’ve had to discipline your youngster, be ready to reconnect as soon as he or she is ready. This reinforces your consistency and love, and will help your youngster develop a trust that you’ll be there through thick and thin.

• Own up to mistakes and initiate repair. When you let frustration or anger get the best of you or you do something you realize is insensitive, quickly address the mistake. Your willingness to take responsibility and make amends can strengthen the attachment bond. Kids with RAD or other attachment problems need to learn that although you may not be perfect, they will be loved, no matter what.

• Set limits and boundaries. Consistent, loving boundaries make the world seem more predictable and less scary to kids with attachment problems such as RAD. It’s important that they understand what behavior is expected of them, what is and isn’t acceptable, and what the consequences will be if they disregard the rules. This also teaches them that they have more control over what happens to them than they think.

• Take charge, yet remain calm when your youngster is upset or misbehaving. Remember that “bad” behavior means that your youngster doesn’t know how to handle what he or she is feeling and needs your help. By staying calm, you show your youngster that the feeling is manageable. If he or she is being purposefully defiant, follow through with the pre-established consequences in a cool, matter-of-fact manner. But never discipline a youngster with RAD when you’re in an emotionally-charged state. This makes the youngster feel more unsafe and may even reinforce the bad behavior, since it’s clear it pushes your buttons.

• Try to maintain predictable routines and schedules. A youngster with RAD won’t instinctively rely on loved ones, and may feel threatened by transition and inconsistency—for example when traveling or during school vacations. A familiar routine or schedule can provide comfort during times of change.

Repairing RAD: Tips for helping your youngster feel loved—

A youngster who has not bonded early in life will have a hard time accepting love, especially physical expressions of love. But you can help them learn to accept your love with time, consistency, and repetition. Trust and security come from seeing loving actions, hearing reassuring words, and feeling comforted over and over again.

• Find things that feel good to your youngster. If possible, show your youngster love through rocking, cuddling, and holding—attachment experiences he or she missed out on earlier. But always be respectful of what feels comfortable and good to your youngster. In cases of previous abuse and trauma, you may have to go very slowly because your youngster may be very resistant to physical touch.

• Help your youngster identify emotions and express his or her needs. Kids with RAD may not know what they are feeling or how to ask for what they need. Reinforce the idea that all feelings are okay and show them healthy ways to express their emotions.

• Listen, talk, and play with your youngster. Carve out times when you’re able to give your youngster your full, focused attention in ways that feel comfortable to him or her. It may seem hard to drop everything, eliminate distractions, and just be in the moment, but quality time together provides a great opportunity for your youngster to open up to you and feel your focused attention and care.

• Respond to your youngster’s emotional age. Kids with RAD often act like younger kids, both socially and emotionally. You may need to treat them as though they were much younger, using more non-verbal methods of soothing and comforting.

Repairing RAD: Tips for supporting your youngster’s health—

A youngster’s eating, sleep, and exercise habits are always important, but they’re even more so in children with attachment problems. Healthy lifestyle habits can go a long way in reducing your youngster’s stress levels and leveling out mood swings. When kids with RAD are relaxed, well-rested, and feeling good, it will be much easier for them to handle life’s challenges.
  • Sleep –If your youngster is tired during the day, it will be that much harder for them to focus on learning new things. Make their sleep schedule (bedtime and wake time) consistent.
  • Exercise – Exercise or any type of physical activity can be a great antidote to stress, frustration, and pent-up emotion, triggering endorphins to make your youngster feel good. Physical activity is especially important for the angry youngster. If your youngster isn’t naturally active, try some different classes or sports to find something that is appealing.
  • Diet – Make sure your youngster eats a diet full of whole grains, fruits, vegetables, and lean protein. Be sure to skip the sugar and add plenty of good fats – like fish, flax seed, avocados, and olive oil—for optimal brain health.

Any one of these things—food, rest and exercise—can make the difference between a good and a bad day with a youngster who has RAD. These basics will help ensure your youngster’s brain is healthy and ready to connect.

Professional treatment for RAD—

If your youngster is suffering from a severe attachment problem, especially RAD, seek professional help. Extra support can make a dramatic and positive change in your youngster’s life, and the earlier you seek help, the better.

Types of treatment for RAD:

Treatment for RAD usually involves a combination of therapy, counseling, and parenting education, designed to ensure the youngster has a safe living environment, develops positive interactions with caretakers, and improves peer relationships.

While medication may be used to treat associated conditions, such as depression, anxiety, or hyperactivity, there is no quick fix for treating RAD. Your pediatrician may recommend a treatment plan that includes:

• Special education services. Specifically designed programs within your youngster’s school can help him or her learn skills required for academic and social success, while addressing behavioral and emotional difficulties.

• Play therapy. Helps your youngster learn appropriate skills for interacting with peers and handling other social situations.

• Parenting skills classes. Education for moms and dads and caretakers centers on learning about RAD as well as other necessary parenting skills.

• Individual psychological counseling. Therapists may also meet with the youngster individually or while the moms and dads observe. This is designed to help your youngster directly with monitoring emotions and behavior.

• Family therapy. Typical therapy for attachment problems includes both the youngster and his or her moms and dads or caretakers. Therapy often involves fun and rewarding activities that enhance the attachment bond as well as helping moms and dads and other kids in the family understand the symptoms of the disorder and effective interventions.

Parenting Defiant RAD Teens

2 comments:

  1. Reactive attachment disorder, term is used to describe a condition that generally appears in the children before age 5, and is thought to result from a lack of consistent care and the nurturing in early years. The disorder is characterized by the inability of a child or infant to establish age appropriate social contact and relationships with the others.

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  2. Thank you for sharing this wonderful article regarding attachment disorder and other types of disorders.

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