Reactive Attachment Disorder

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I. What is Reactive Attachment Disorder?

The love and dependency that is displayed by children toward their parents is one of the most touching relationships in our society. This attachment has been discussed in literature and depicted in our art. But sometimes a piece of this picture is missing. Sometimes the love, devotion and affection a child feels for his or her family seems to be non-existent. This syndrome is labeled Reactive Attachment Disorder. It is devastating and difficult to diagnose and treat. If diagnosed and treated correctly, however, the rewards are immeasurable.

Among the basic needs of a human being are safety, security, and trust (see Abraham Maslow, Motivation and Personality, 2nd ed. 1954, 1970: Harper and Row, Publishers, New York). An attachment disorder is formed when these needs are, not only not met, but also ignored. Children who lack proper care and attention during infancy and the first few years of life have a high level of stress hormones. This affects the way important elements that affect the way the nervous system and the brain system react.

There are a number of factors as to why this impairment occurs. Among them are premature birth, in utero drug or alcohol trauma, unwanted pregnancy, separation from the birth mother, postpartum depression in mother, abuse or neglect the first few years of life, adoption trauma and hospitalization.

II. What are the Symptoms of Reactive
Attachment Disorder

Some of the symptoms of Reactive Attachment Disorder are: lack of impulse control, self destructive behaviors, intense rage, destruction of property, preoccupation with fire or evil, aggression towards others, inappropriate sexual conduct, cruelty to animals, manipulating, bed-wetting, whiny, demanding, lack of remorse or conscience, and controlling.

III. How is Reactive Attachment Disorder (RAD) diagnosed?

RAD indications are similar to those of conduct disorders and bi-polar disorder; important distinctions have to be made. Doctors and clinicians have developed checklists for parents and caregivers, and interview parents and caregivers, in order to make a detailed and accurate diagnosis. These checklists were developed by observing the behavior and the symptoms of children who exhibited most or many of the above symptoms.

IV. How is Reactive Attachment Disorder treated?

RAD is treated with a behavioral modification regimen for both parents and child. In some cases, biofeedback has also had some degree of success. Coping techniques for both parents and children are taught by trained coaches, therapists and counselors. Various residential treatment programs have shown some degree of success in treatment of RAD.

Find out more about Behavior Modification

Co-occurring disorders
Co-occurring disorders or comorbidities are distinctly different disorders that can be found to exist alongside RAD. The most common co-occurrences are substance abuse, conduct disorder, and Obsessive-Compulsive Disorder. Once frequently misdiagnosed as bi-polar, in truth the two disorders don't necessarily co-exist. These co-occurring disorders may be treated with medication and with therapy. In the case of these co-occurring disorders, when the primary disorder is treated successfully, in many cases the co-occurrences are lessened. However, some behavior is indeed, by that time, learned behavior, and behavior modification and therapy is usually indicated for a longer time frame.

To find out which medications are used to treat Substance Abuse, Conduct Disorder, and Obsessive-Compulsive Disorder, click here.

Medication section

Treatment Results: A number of research studies indicate that after intensive treatment, positive results are indicated after a period of approximately one year. Intensive treatment could mean training on a daily level for a period of no less than two weeks to months and occasionally years.

There appears to be a higher success rate (see Liz Randolf, 1997) when patients are placed in residential treatment and parents are nearby to participate on a daily basis. Studies have shown that after two weeks of intensive therapy, patients still have shown improvements up to a year after the training period had concluded.

Outpatient Facilities
A. Outpatient facilities have therapeutic staff on-hand to offer therapy and support to patients on a part-time basis. This can be helpful in the treatment of RAD but it is not as optimum a treatment as a residential type treatment facility.

Professionals to Seek Out

1. See your physician or pediatrician
   
2. Consult with your clergy to assist in spiritual
   and practical guidance
   
3. Consult with an educational consultant to help you
   find the right program for your child.
   
4. Consult with a therapist or counselor.
   
5. Consult with an Educational Advocate to help you
   with your current school situation
   
6. Consult with an Educational Consultant to find
   the right program for your child.

Programs

1. Inpatient: hospitalization
   
2. Outpatient Facilities
   Outpatient facilities have therapeutic staff on-hand to offer therapy and support to patients on a part-time basis.
   
3. Day Treatment
   
4. Residential Programs
   

a. Emotional Growth School
Emotional Growth schools are highly structured environments that stress academics and teach coping skills through the use of conflict resolution. Children learn they can make choices and learn to accept responsibility through the use of modeling behavior and outdoor therapy. The length of stay is between 9 and 18 months, at which time they either return to the mainstream or attend a boarding school, if possible. Parents are involved with the school staff and the children throughout the child's attendance at the school.
Find out more about Outdoor Therapy

b. Therapeutic Residential Boarding School
These schools are usually fully accredited schools with emotional growth programs. They stress holistic education: growth of the person through holding children responsible for their actions. There is no rehabilitation or physicians on staff.

c. Therapeutic Wilderness Program
A Therapeutic Wilderness program does not necessarily have academics; their goal can be to introduce the children to a different role. These programs use Outdoor Therapy to help build low self-esteem. They make obtainable goals for them to reach. The programs vary but they are about 6 to 8 weeks long. It is a very structured program with a goal of teaching the children coping skills and raising their self-esteem. Children go from this program to mainstream back into their public school or attend a small structured boarding school.
Find out more about Therapeutic Wilderness Programs

d. Residential Treatment School
A Residential Treatment Program or School provides a full professional staff that includes therapists, psychologists, and psychiatrists. They also have a small academic program. Many of the children in the program have been recommended there by mental health agencies that make the placements. It is a highly structured environment whose emphasis is on treatment and learning coping skills and independent living. Chemical dependence education and rehabilitation is also provided. Outdoor therapy is sometimes used to facilitate building social skills and self-esteem. Recovery programs are also available. Residential Treatment schools are secure schools.
Find out more about Residential Treatment Schools

Which program is right for my child?