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The key factor that underlies Reactive Attachment Disorder is severe emotional neglect and/or abuse, occurring at an early age and especially before the age of 2. Emotional and behavioral problems appearing similar to RAD symptoms, but emerging later in childhood or without history of neglect or abuse, are likely better explained by other mood, anxiety, or impulse-control disorders such as Bipolar Disorder, Severe Mood Dysregulation Disorder, Posttraumatic Stress Disorder, Oppositional Defiant Disorder, and Intermittent Explosive Disorder or developmental disorders such as Autism or Apserger’s Disorder.
If you know or suspect that your child may have experienced a sustained period of neglect or abuse early in his development, then consider the following symptoms as potential signs of Reactive Attachment Disorder:
Persistent attempts to be the boss and direct caregiver behavior
Is demeaning or punishing of caregivers
Tries to take care of caregiver’s physical or emotional needs
Is overly familiar with strangers
Displays emotions that are inappropriate to the situation (e.g., laughing when he should be sad)
Lacks fear or wariness in dangerous or unfamiliar situations
Moods shift abruptly and severely
Avoidance of eye contact except when angry
Superficial friendliness
Lack of empathy or moral insight
Allows physical contact and affection only on her terms
Compulsive lying and hoarding
These symptoms are listed not because they are exhaustive, but because they tend to differentiate between RAD and other disorders. You are encouraged to seek professional help from a licensed clinical psychologist with specified training in attachment issues if you suspect that your child may have RAD.
Overcoming the brain adaptations inherent with early severe neglect and abuse is a huge challenge. In overly simplified terms, the key deficit is a lack of proper connectivity between emotional centers of the brain and meaning centers (as in, “What does my experience mean and what do I do about it?”) of the brain. Without a caregiver to consistently label, sooth, and give meaning and direction to distressing emotional experiences (such as hunger, pain, fear, and anger), attachment disordered children are unable to develop healthy and adaptive regulating strategies for emotional distress. And on the flip side, their foundation for positive emotional experience is generally non-social, such as eating, self-stimulation, and exploration. The adaptive response to this kind of early environment is to be highly controlling and manipulating so as to avoid emotional distress (which you have little or no way to handle) and take advantage of whatever meager opportunities arise for emotional satisfaction. Furthermore, when very intense negative emotional experiences do arise, the brain of a child without an adult to take emotional refuge in develops the adaptive capacity to simply dissociate, or “check-out” from the experience causing the distress.
If, then, the basic problem is a lack of connectivity (bridges, if you will) between emotional centers and meaning centers, then the solution lies in building those bridges through your interactions with your child. This is difficult, especially the older your child is, because brain development focuses on different regions by age 4. The following list, however, provides some examples of the kind of activities that are recommended to force your child’s brain to re-organize itself to function adaptively in a nurturing environment (as oppose to a chaotic and neglectful one):
Model and label the emotions your child should be feeling in a given situation. In other words, show and tell them what they should be feeling.
In particular, model and label appropriate fear and wariness to strangers and danger.
Trigger distressful emotions and make your child “stay with you” as you lead them out of the emotional state. This includes both affectionate and confrontive interactions. Make eye contact as it triggers emotional centers of the brain and puts you in the middle of that experience. Your child resists this because it makes him or her uncomfortable and they don’t know what to do with the discomfort. Start with short and relatively minor emotionally triggering situations and work your way up to more intense situations.
If your child becomes emotionally dysregulated (emotions take over and she is unable to “stay with you”), then it is better to provide them safe isolation until they can engage with you again. If they dissociate (“check out” of the emotion state) return them to it so they can experience you returning them to a regulated emotional state. If you are dysregulated (your emotions have taken over), remove yourself from the situation until you yourself are regulated again.
Create situations which are instinctively fear-provoking and overwhelm your child’s ability to control the situation. Camp deep in the woods. Swim out in the ocean. Take a ropes course. Find a situation where your child will be forced to cling to you. While you’re doing it, make eye and physical contact like crazy so that your child experiences your provision of safety in a personal and intimate way.
When your child lies, and you know all of the facts, do not accuse your child. Simply state that you know all the facts, that it is safe for them to tell the truth, and get them to “redo” their response. Make the safe emotional experience of truth telling a primary objective. Make eye-contact and celebrate their ability to share embarrassing or incriminating information.
Spend time each night retelling the events of the day, with special attention to emotionally charged, interpersonal, events and especially those involving the two of you. Label the emotions and emphasize the successful emotional resolution of the event, if it was initially distressing.
Constantly repeat the mantra that you are the adult, that you make the rules, that you keep them safe; Get them to repeat that mantra to you when they become controlling (You: “Who is in charge?” or “Who makes the rules?” Your child: “Mommy is in charge” or “Mommy makes the rules?”)
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© 2008 Apprenticeship Parenting, All rights reserved.
Not to be duplicated without express written consent.
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