I talk to parents everyday who say no one seems to understand their children with reactive attachment disorder (RAD). Many children visit countless therapists and residential treatment centers. Yet, the children remain the same. That’s because many mental health professionals don’t thoroughly understand the disorder yet.
Reactive attachment disorder is still a relatively new term in the mental health field. The Diagnostic and Statistical Manual — the standard classification of mental disorders used by mental health professionals in the United States — didn’t recognize the disorder until the 1980s. Even so, that definition was, and still is, flawed.
As a social worker in the early 1980s, I felt as though I was missing something in my work with foster and adopted children. When I initially learned about the term RAD, something clicked. As a result, I dedicated the rest of my career to researching reactive attachment disorder. For the last 32 years, I’ve focused on and worked solely with kids with RAD and their families.
A Narrow Definition of RAD Affects Appropriate Assessment
Even though we now have a definition of RAD, the Diagnostic and Statistical Manual is too vague and broad to help professionals understand the disorder. The definition has been updated over the years. Yet, it’s still lacking.
The current definition of RAD doesn’t help professionals understand:
- A child’s parental figure may have emotional triggers and character issues of his/her own that can also affect the behavior of a child with RAD.
- When a child has a genetic mental illness, that illness also affects attachment relationships. This can be confused with mood disorders.
Professionals Lack RAD Assessment Tools
The RAD assessment tools, like the definition itself, also limit professionals’ abilities to diagnose RAD. Most professionals only have a symptom checklist and the Randolph attachment disorder checklist, a Likert scale that measures symptoms.
Mary Ainsworth created the strange situation tool to determine anxiety in young children. Her tool is useful to assess attachment issues with infants. However, her tool doesn’t help to evaluate children over the age of two.
IACD Assesses RAD with Varied and Expansive Tools
So, mental health professionals lack sufficient tools to assess RAD. Furthermore, RAD is more complicated than the Diagnostic and Statistical Manual defines it. Possible genetic mental illnesses and parental emotional triggers and characters complicate the dynamics of RAD even further. As a result, professionals can’t sufficiently assess or treat kids with RAD with the limited resources available to the general mental health field population.
I’ve been in the field of foster care and adoption for 36 years and focused specifically on RAD for 32 years. During that time, I’ve recognized patterns of behavior in families that live with kids with RAD. I developed a checklist to assess attachment disorder/reactive attachment disorder during that time. So, in addition to standard RAD assessment tools, we combine years of experience and extensive research to further assess clients for RAD here at IACD.
We include the dynamics of family into assessment as well as treatment. As a result, we assess three areas in reference to the therapy protocol: child, parent (or primary caregivers), and family system. Before parents can participate in therapy, we require them to complete an initial information and assessment packet in regard to these three areas.
The IACD RAD assessment includes the following:
- Early History
– Record of out-of-home placements i.e. prenatal care, birth-trauma, foster or adoptive homes, shelters, detention, hospitalizations, deaths of caretakers, chronic pain
– Emotional and physical condition of birth mother
– Developmental history
– Medical history
- Current Signs and Symptoms
– RADQ (Randolph Attachment Disorder Questionnaire)
– CBCL (Child Behavior Checklist)
– Behavioral disturbances (parents fill out a “Day in the life of their child”)
– Cognitive functioning i.e. cause and effect thinking, negative working model, victim/aggressor, learning and language problems, neurological damage
– Affect i.e. disheartened, depressed, tantrums, rage reactions, moods
– Interpersonal behavior i.e. chronic non-compliance, manipulative, controlling, defiant
– Previous testing and diagnosis
– What therapy has been tried and what has worked and what hasn’t
– Diagnosis & medication
– Cognitive scored, projective, neurological
– Recommendations to parents (blaming of parents and splitting by professionals)
– Parent assessment (MCMI assessment)
– Legal arrangement/permanency
– Family of origin (losses or parenting issues that hooks parents)
– Family systems
– Family functioning (roles, boundaries, coalitions, alignments, sibling patters, pressures, commitment, motivation)
– Supports system (extended family, friends, school, respite)
Learn How to Accurately Assess for RAD
If you’re a clinician who would like further training in RAD assessment, we’re working on future webinars for professionals. My training will include how to determine severity of attachment problems, the psychological health of attachment figures, and family dynamics that affect RAD. I will also cover how to rule in or rule out mood disorders and how to recommend treatment for clients with RAD.
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Image courtesy of Stuart Miles at FreeDigitalPhotos.net