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What Is Reactive Attachment Disorder?

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Many of the women we talked to last week who have adopted from Haiti say that their children suffer from RAD (Reactive Attachment Disorder). We wanted to know more about RAD, so we called psychologist Dr. Michelle Golland for insight.

child in haiti

Dr. Michelle Golland: The core feature of RAD is severely inappropriate social relating by affected children. It involves either the indiscriminate and excessive attempts to receive comfort and affection from any available adult, even strangers. If the child is older, they may also use this behavior with peers. Another way RAD manifests is in extreme reluctance to initiate or accept comfort and affection, even from very familiar adults. This behavior is not explained by a developmental delay.

RAD is most likely to occur in relation to neglectful and abusive treatment of a child. It has also been most noted in adoptive children who were institutionalized for long periods of time. Other contributing factors can include prolonged hospitalization, extreme poverty, postpartum depression of the mother, parents who have a mental illness, anger issues, or drug and alcohol abuse within the home.

To diagnose RAD, there must be evidence of persistent pathogenic care, such as:

• The caregiver neglects the child's basic needs for affection, comfort, and stimulation.
• The caregiver neglects the child's basic physical needs.
• Stable attachments cannot form because of repeated changes of caregiver (such as repeated foster care placements).

There is no explanation for why RAD causes two distinct types of reactions. RAD has never been reported in the absence of serious environmental adversity, yet outcomes of children raised in the same environment vary widely. It appears that the child's temperament impacts the disorder greatly. Reactive Attachment Disorder is a rare occurrence, and affects both boys and girls. The disorder usually begins before age 5.

Signs and symptoms in babies:

• Withdrawn, listless, and sad
• Failure to smile
• Failure to reach out when picked up
• No interest in playing with toys

Signs and symptoms in toddlers and older children:

• Withdrawing from others
• Avoiding or dismissing comforting gestures or comments
• Acting aggressively toward peers
• Watching others closely but not engaging in social interaction
• Failing to ask for support or assistance
• Obvious and consistent awkwardness or discomfort

Treatment for RAD

The ultimate goal of RAD therapy is to develop and teach loving bonds and create healthy attachments for the child. The therapy is not designed to simply change the child's behaviors, which are really just symptoms, but to attach the child to the parents and to truly treat the condition.

There are no standard treatments for RAD. However, it often includes:

• Family therapy
• Individual therapy
• Parental education and skills training
• Medications for other conditions such as depression, ADHD, or anxiety
• Special education services.

Managing RAD is a long-term challenge for a family. It can be demanding on the parents and other caregivers as well. It may be important for the family members to receive their own counseling services to cope with the stress of having a child with Reactive Attachment Disorder.

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