What is Reactive Attachment Disorder?

As a fairly new diagnosis to the DSM-IV manual, Reactive Attachment Disorder (RAD), sometimes known as Attachment Disorder (AD), is frequently misunderstood, and is misdiagnosed as Bipolar Disorder or Attention Deficit Disorder as often as 70% of the time.

Today, perhaps more so than at any point in history, kids are apt to be separated, ignored, or neglected by their birth parents, shuttled between multiple foster parents and day care workers, or traumatized by physical, sexual, or emotional abuse. Even while physically present, some mothers are yet incapable of providing adequate care and attention for their children.

RAD kids have learned that the world is unsafe, and that the adults around them can’t be trusted to meet their needs. They have developed a protective shell around their emotions, isolating themselves from dependency on adult caregivers. Rather than depending on their parents or other adults to protect them, the protective shell becomes the child’s only means of coping with the world.

Dependent only upon themselves for protection, they come to see anyone who is trying to remove this protective barrier as a threat, not to their emotional well being, but to their very lives. They turn on those who seek to help them the most.

People require attachments with others in order to develop psychologically and emotionally. Attachment is the bond that normally develops between a mother and her child during the first few years of a child’s life. The quality of this bond affects the relationships that a person will have for the rest of his life.

Attachment develops in the early years of life when a mother responds to her baby’s cries by meeting its needs, appropriately feeding, consoling, soothing, and comforting, as well as keeping the infant safe from abuse and harm.

Fundamental to RAD kids is that they haven’t bonded and are unable to trust. They have learned that the adults in their lives are untrustworthy. Trust hasn’t worked for them. Without trust, there cannot be love, and without love they are emotionally underdeveloped.  Instead of love, rage has developed within them.

In the first few years of life, at a time even before they have learned to speak, they have learned that the world is a scary place, and that they cannot rely on anyone else to get them through it.

Normal parenting doesn’t work with RAD kids. Neither does traditional therapy, since these therapies are dependent upon the child’s ability to form relationships that require trust, something that is at the root of the problem. Sticker charts and behavioral programs don’t work because the RAD child doesn’t care what you think about his behavior. Natural consequences work better than lectures or charts. Structure is a necessity, but only when combined with nurturing.

While these kids can be healed, they have to want it, and the prognosis is not good. Without healing, these kids grow up unable to form healthy relationships with other human beings. Too often, these kids develop into sociopaths devoid of conscience or concern for anyone other themselves.

Reactive attachment disorder is a very real illness.  Children with reactive attachment disorder are reacting to events in their early life that may include neglect, abuse, or something subtler like ongoing, undiagnosed painful medical issues (see Potential Causes below).  Due to these events, many children are unable to attach to a primary caregiver and go through the normal development that is required in order to function in relationships.  My explanation is somewhat simplified but may be helpful to you.  It does not replace a diagnosis from a qualified attachment therapist.

In the first two years of life, children go through healthy attachment cycles – the first year and second year attachment cycles.  A healthy first year attachment cycle looks like this:

As the baby has a need and signals that need by crying, the mother (primary caregiver) comes and soothes her baby and meets his needs.  If this cycle is repeated over and over again and the baby’s needs are consistently met in the proper way by the same caregiver, the baby often learns to trust.  He will then be able to continue on in his development.  Now, take a look at the disturbed attachment cycle:

As you compare the Healthy Attachment Cycle to the Disturbed Attachment Cycle, you can see how the baby has a need, cries, but this time, the need is not met by his mother (primary caregiver).  Sometimes the need is met but it is inconsistent or there are different caregivers who are not attuned to this particular baby.  Sometimes the baby’s cries go unanswered as in the case of neglect or the baby’s cries are met with a slap as in the case of physical abuse.  Whatever the cause, the baby’s needs are not met in a consistent appropriate way.  (See “Potential Causes” below)

Instead of learning to trust as the baby who experiences the Healthy Attachment Cycle this baby learns that the world is an unsafe place, that he must take care of himself, that he can trust no one to meet his needs.  He learns that he cannot depend on adults.  Instead of trust developing, rage develops and is internalized.   He learns that he must be in charge of his life for his very survival.  Is it any wonder that a child with reactive attachment disorder feels the need to be in control?  He thinks his very life depends on it.

If the child has been able to successfully go through the Healthy Attachment Cycle during his first year of life then he most likely will be able to go through the next which is the Second Year Secure Attachment Cycle:

It is only by going through this Second Year Secure Attachment Cycle that the child will ever be able to learn to accept limits on his behavior.  It is by going through these two attachment cycles – the Healthy Attachment Cycle in the first year and then the Second Year Secure Attachment Cycle – that the child learns to trust, engage in reciprocity, to regulate his emotions.  It is back there that he starts to develop a conscience, self- esteem, empathy, and the foundations for logical thinking are laid down, etc.

The breakdown of these two attachment cycles will damage all of the relationships he has for the rest of his life unless interventions are made. When the first cycle breaks down, the child cannot do the second year.  To expect the child to function as a typical child when his normal development was completely stunted back in infant/toddlerhood is not rational.  We must take them back and help them redo these steps.

*    Some information based on Attachment, Trauma, and Healing by Terry Levy and Michael Orlans

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Dr. Gnap

Dr. Gnap is a family practice physician and behavioral medicine specialist in suburban Chicago.  Dr. Gnap developed the Inner Control™ Program in 1970 and has worked with thousands of people to improve and correct medical, emotional, behavioral and learning problems including performance.  He started the Inner Control program because so many patients asked, “what more can be done along with traditional treatment methods?”

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