We get calls everyday from parents like *Sharon. Sharon called yesterday and told us how desperate she feels—that she and her husband had sought help for years for their daughter with reactive attachment disorder (RAD). Despite a handful of therapists and different medications, however, their daughter’s behaviors had only gotten more extreme with time.
It’s heartbreaking to hear from parents who’ve spent so many resources on ineffective help for their children with RAD. They not only run out of money and patience, but also time. The earlier children with RAD get the right help, the better their chances to heal. A lack of information on behalf of the therapeutic community ultimately hinders the healing of children with RAD everywhere.
We’ve seen many changes and advances in our field while treating children with RAD since our organization began in 1972. Yet, we find that many clinicians still struggle to diagnose and work with clients with early trauma backgrounds. Based on our experiences, we have ideas as to why the field isn’t progressing in that regard.
Here are some reasons that many clinicians don’t know how to effectively help children with RAD:
- Graduate professors skim over the topic of reactive attachment disorder. Many graduate students studying to become clinicians don’t receive sufficient information about RAD while in school. Therefore, many clinicians don’t know how to effectively diagnose RAD after graduation.
- Many clinicians believe that RAD is rare and therefore don’t look for it. In some ways, it is correct to say that RAD is a rare disorder. Reactive attachment disorder is rare in terms of the general population. In our experience, however, RAD is common within the population of children who have been abused, neglected, and transferred to and from various homes before the age of 5. Unfortunately, these situations put foster children and children from orphanages at high-risk for having reactive attachment disorder. (Disclaimer: By no means do we want to discourage people from fostering children or adopting foster children. On the contrary, part of our mission is to advocate for, educate, and support foster and adoptive parents. In order to do so, we provide honest information to help prepare and support them along their journey).
- The definition of RAD in the DSM-5 is too vague. Through our experience in the field since 1972, we’ve seen consistent patterns of symptoms in children with RAD. They are some of the symptoms we look for as we assess for RAD here at the Institute for Attachment and Child Development. However, these common symptoms of RAD are not specifically included in The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) published by the American Psychiatric Association (to read a summary of that definition, you may consider referring to Trauma and Stress-Related Disorders in DSM-5 published by the National Center of PTSD). As a result, we feel many clinicians who rely solely upon the DSM-5 overlook common symptoms of RAD.
Symptoms of RAD for ages children 6-18 unaddressed in the DSM-5:
- Superficially engaging, charming (phoniness)
- Trouble making eye contact (low self-esteem)
- Indiscriminately affectionate with strangers
- Lacking ability to give and receive affection (not cuddly when initiated by parents)
- Argue for long periods of time over ridiculous things
- Extreme control problems that often manifest in covert or “sneaky” ways
- Act amazingly innocent when caught doing something wrong
- Engage in self-soothing behaviors (i.e. rocking and other rhythmical movements)
- Controlling with animals and younger children
- Display temper tantrums over the smallest corrections or when told no to their requests
- Chronically lie and steal
- Possess poor impulse control
- Have learning lags and disorders (learned helplessness)
- Have poor cause and effect thinking
- Lack empathy
- Reactive attachment disorder can co-exist or look like other more commonly known mental health disorders. Some therapists misdiagnose RAD as attention-deficit/hyperactivity disorder (ADHD) or bipolar disorder. On the other hand, clinicians may correctly diagnose other co-existing disorders (like ADHD and bipolar disorder) but miss the children’s symptoms of reactive attachment disorder.
- Children with RAD are difficult to get to know authentically. Children with RAD lie to, manipulate, and superficially charm those around them—it is the very nature of their disorder. Even when clinicians understand the concept of RAD, they often lack the ability to see past the children’s manipulative behaviors.
Here at the Institute for Attachment and Child Development, we find that the best clinicians for children with RAD are those who have dedicated their entire careers to the field of reactive attachment disorder. Given that it’s so difficult to find the education and resources necessary to work with clients with RAD, it takes true dedication to succeed in the specialty. The best attachment therapists have taken it upon themselves to find answers in regard to trauma, never stop their quest to learn more, and possess a specific passion to help children with RAD and their forever families heal.
*We’ve used a pseudonym to protect the mother’s identity