Reactive Attachment Disorder
Teresa Guerard, LMHC

The subject of attachment in children and the diagnosis of attachment disorder is a controversial subject. Not because people don’t acknowledge the importance of attachment in child development, but because therapeutic treatment of these children sometimes appears to be unconventional. There is also the problem that many professionals will claim to be familiar with and able to work with children with Reactive Attachment Disorder, but the children end up getting worse instead of better and the parent ends up being the one blamed for the problem. Traditional therapy does not work with these children because traditional therapy depends on the relationship between the therapist and the client in order for progress to be made. Children with RAD are not able to form such relationships, so traditional therapy will not create change in the child.

So what is Reactive Attachment Disorder? RAD is a condition that generally occurs as the result of abuse and/or neglect of a child from the time of conception to the age of about two or three years. In a healthy child / mother relationship bonding generally begins as soon as the mother finds out she is pregnant. She begins anticipating the child’s birth, making plans and preparing for the child’s arrival. Once the baby is born, the mother’s focus is on caring for her infant child. A newborn baby has five basic needs: food, touch, movement, eye contact and verbal interaction. A newborn baby’s only means of expressing these needs is to cry. When the baby cries, the mother attends to the baby in a timely, appropriate and consistent manner, she identifies the baby’s need and meets that need. This happens time after time, day after day, week after week, month after month. As a result, the infant learns to trust in his/her caregiver. The baby learns that the world is an okay place to be and that there is something pretty special about him/her that keeps mom coming back time after time.

Now imagine that child is born to a mother who does not respond in a consistent, timely, appropriate manner. Perhaps the mother is addicted to drugs or alcohol; perhaps she suffers from severe postpartum depression, or was an abused child herself and never learned to put the needs of another above her own. This child’s reality and experience of life and relationship is completely different. When those hunger pangs come and the cries for nourishment are not acknowledged, or perhaps they are acknowledged with a shout or a slap instead of a bottle, the baby learns a completely different lesson. This infant will develop a belief system that says that the world is a dangerous place, that no one can be trusted, that he can rely on only himself and therefore, his survival is dependent on him controlling his environment. This child will also believe that there is something inherently wrong with him – that he is “bad”.

This child then takes that early experience and uses this belief system to make his decisions on how to exist in the world. So what behaviors do these children engage in? Some of the common symptoms are superficially charming and engaging, manipulative, chronic lying, poor eye contact (except when lying), affectionate with strangers (but not mom), control problems, sneaky, cruel to animals and/or younger children, lacking impulse control, learning lags and disorders, lack of conscience, abnormal eating habits, poor peer relations, preoccupied with blood, gore and fire, persistent chatter, inappropriately demanding or clingy, false allegations of abuse and mom generally appears hostile and angry.

Many of the symptoms just listed are present with other disorders such as Attention Deficit / Hyperactivity Disorder and Oppositional Defiant Disorder. In order to be diagnosed with RAD, there must be evidence of abuse, neglect, separation from the primary caregiver or unrelieved medical pain during the first three to four years of the child’s life. Some famous people who had untreated RAD are Adolph Hitler, Jeffrey Dahmer, Ted Bundy and Sadam Hussein. A person with RAD who was successfully treated was Helen Keller.