REACTIVE ATTACHMENT DISORDER(DEVELOPMENTAL TRAUMA DISORDER)
What is it?
“Our kids are crying out for a relational connection.” – Josh McDowell, The Disconnected Generation
Many children and teens have a disconnect between them and their parents. Sometimes it seems as though this is just a part of growing up. But often it’s a sign of more serious problems. Children of all ages should be able to communicate freely with their parents without fear of retribution, judgement, condemnation, or abuse. Likewise, parents should be able to communicate with their children to show love, interest, guidance, and appropriate discipline without being shunned or disrespected.
It’s about building relationships that matter-- relationships of acceptance, mutual respect, and love. For families whose children have a history of trauma or separation, this is a difficult goal, since their children are not always psychologically capable of having such relationships.
These children often have difficulties making attachments with people due to Developmental Trauma Disorder, also known as Reactive Attachment Disorder. While not every child or teen with behavioral problems falls into this category, those who do need an extraordinary amount of understanding and help. And so do their parents.
Section 313.89 of The Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5) states: “Reactive attachment disorder of infancy or early childhood is characterized by a pattern of markedly disturbed and developmentally inappropriate attachment behaviors, in which a child rarely or minimally turns preferentially to an attachment figure for comfort, support, protection, and nurturance.” Basically, Reactive Attachment Disorder (RAD) is the inability of a child to form meaningful attachments with people. A RAD child is not capable of bonding with, completely trusting, or truly loving another person. Physically, there are connections in the brain that are responsible for humans being able to bond. In a RAD child, these connections have never formed. However, it has been proven by brain scans that a child who undergoes attachment therapy and whose parents practice therapeutic parenting techniques can eventually heal and his brain can form those connections over time, enabling the child to develop healthy human attachments and live a “normal” life. But in many cases where this disorder is not treated and the child’s brain does not heal, the child will never bond with his parents, he will not be able to form meaningful attachments as an adult, and his family will never truly be at peace.
As with any disorder, there are varying degrees of severity in children diagnosed with Reactive Attachment Disorder. If not treated, the children with milder cases merely have difficulty with relationships as they grow older. But those with more severe cases can develop into sociopaths and psychopaths. They never develop a conscience, and because they are unable to bond with people, they do not find value in human life. And, of course, there are many variances in between. What’s scary about being a parent of a RAD child is that you don’t know which path your child will take if left untreated. So, the answer? Get help and get it now!
Reactive Attachment Disorder begins with a child not ever bonding with his primary care giver – in most cases, his mother.
Reactive Attachment Disorder begins with a child not ever bonding with his primary care giver – in most cases, his mother. There are multiple possible reasons why this bond never occurs. In many cases, it’s because of an adoption or foster care situation where there was inconsistency in the home. Or perhaps the child was separated from his mother for a time because of another reason. It could even be caused by a lingering childhood illness where the mother was not able to comfort the child for an extended period of time by no fault of her own. And, in many unfortunate situations, it is also results from abuse or neglect.
Whatever the cause, RAD children learn from infancy that they can trust no one, that no one can meet their needs, and that they need to look out for themselves because nobody else will. They live in a constant state of survival mode, fearing for their lives. While this may seem ridiculous to think that an infant could develop such thoughts, it happens because this is how his brain is forming (or not forming, as the case may be) in response to his environment. This state of constant fear then manifests itself in anger and results in disruptive and destructive behaviors.
Heather T. Forbes and B. Bryan Post, in their book Beyond Consequences, Logic and Control: A Love-Based Approach to Helping Children with Severe Behaviors, state that “all behavior arises from a state of stress; and between the behavior and the stress is the presence of a primary emotion. There are only two primary emotions: Love and Fear. It is through the expression, processing, and understanding of the primary emotion that you can calm the stress and diminish the behavior…When seeking to understand children of trauma, we must fully comprehend that at their deepest core is an emotional state of fear.”
In healthy child development, there is a process of a child’s needs being met that teach him that he can trust his primary caregiver to meet those needs.
The cycle is as follows:
This needs-response cycle repeats multiple times daily, thousands of times over time as the child is developing, teaching him that he can trust his parents (or primary caregiver) to meet his needs. If an infant or young child is frequently denied his needs and nobody consistently comes to his aid, he learns that he cannot trust anyone to meet his needs and, therefore, can only trust himself. At this point, his brain begins developing without the ability to trust with or bond with people. Gregory C. Keck and Regina M. Kupecky discuss this in their book, Adopting the Hurt Child: Hope for Families with Special-Needs Kids. They state, “Failure to complete and repeat the bonding cycle leads to serious problems in the formation of the child’s personality, which, in most cases, will have lifelong implications.” This is what causes Reactive Attachment Disorder, also referred to as Developmental Trauma Disorder, due to the trauma incurred by the child’s needs not being met appropriately.
To better understand a RAD child's behavior, look more closely at the cause.
The best example we have heard to explain the behavior of a child with Reactive Attachment Disorder comes from Nancy Thomas’s seminar, “When Love is Not Enough: Mastering Steps to Reach Children with RAD, ADD, OD, Bipolar, or PTSD” (www.attachment.org).
Compare such a child to an injured puppy. Imagine, if you will, that you walk outside and see a puppy wandering in the road. Suddenly, the puppy is struck by an oncoming car and is injured terribly. What is your first reaction? You run to the puppy and attempt to move it out of the road so that you can get it some help. Your only desire is to rescue the puppy, take care of it, and help it heal. But what does the puppy do to you when you approach it? It barks, growls, and attempts to bite you. Not because you’re a bad person, but because it is scared and doesn’t trust you. That is how a RAD child treats his mother (or primary caregiver). No matter how much she loves him and tries to meet his needs, he refuses her love and is often angry, defiant, and abusive towards her. What he really wants and needs is love, but the more love his mother shows him, the more afraid he gets and the further he retreats. The thought of bonding with his mother (or to anyone, for that matter) is actually frightening to a RAD child, so he does everything he can to avoid it.
So, is there hope for a child with Reactive Attachment Disorder? Absolutely!
No matter how old the child is, he can be helped and he can be healed. But it won’t be easy. Through attachment therapy and therapeutic parenting, a child can learn to trust others. He can learn to bond. He can learn to love. His brain can heal.
We at Live to Connect Ministries are not professionals in this area of expertise, but we are sharing advice from our experience and training as RAD parents. Please take that into consideration as you continue reading this article. And be encouraged. We have witnessed the healing of a RAD child first-hand, and it was an amazing journey in which we were fortunate enough to take part. You, too, can begin this journey of healing with your child and we would like to walk along with you as you do so.
When beginning the process to help your child heal from Reactive Attachment Disorder (Developmental Trauma Disorder), it is important to initially focus on the bonding process with just one primary caregiver, typically the mother.
Focusing on more than one caregiver at the beginning will be confusing to the child and could make the healing process more difficult. Your child needs to learn that his mother (or primary caregiver) is the ONE person on Earth whom he can trust. His mother will hear his cries. His mother will meet his needs. His mother will take care of him. His mother will protect him. (Obviously, if the father, grandparent, other relative, or foster parent is the primary caregiver, that role goes to that person. But for ease of conversation, we will refer to the mother as the primary caregiver.) Once the child learns to trust and bond with his mother, he has learned to trust and bond. Once he has learned this, he can begin likewise relating to other people in his life.
If you suspect that your child has Reactive Attachment Disorder, we strongly recommend that you find an attachment therapist to analyze your child and help your family through the healing process. But there are also techniques you can and should learn to practice at home that will add to what you will learn in therapy. For that matter, these practices should help build stronger relationships with all of your children, but they will especially help children with RAD.
There is a method of discipline and therapy called Trust-Based Relational Intervention® (TBRI®) which addresses a child’s need for attachments and takes into account a history of developmental trauma. This technique simulates the needs-response cycle that is necessary for a child to learn trust, and it works for any age child. The child has a need, the child makes his needs known, the caregiver meets those needs, and the child is satisfied. This cycle can and should be replicated multiple times daily as a RAD child is healing. TBRI® was developed at the Karyn Purvis Institute for Child Development and is discussed at length in Karyn Purvis’s book, The Connected Child. We highly recommend this book to any family dealing with a RAD child or a child who has experienced any level of trauma. There are also several other books listed on our RESOURCES page that could be of great help to your family. (For more information about TBRI,® please visit https://child.tcu.edu/about-us/tbri/.)
Therapeutic Parenting is an approach to parenting in which the parents' words and actions are therapeutic to the child and aid in the child's healing process.
There is much involved in the process of therapeutic parenting which you can learn from professionals or by studying any number of helpful books, several of which are listed on our RESOURCES page. But there are three things that will make a huge difference in your child from the start: your attitude about your child, eye contact between you and your child, and positive affirmations from you to your child.
First, your attitude probably needs adjusting, which is quite common for frustrated parents of RAD children.
It is so tempting to see your child as a trouble-maker, a bad kid, an impossible person to love. But every time you begin feeling that way, remember the example of the injured puppy. Your child isn’t bad. Your child is hurt. Your child isn’t impossible. Your child is injured. Your child isn’t evil. Your child is a blessing and needs your help.
Second, eye contact is critical in the bonding process.
Most RAD children are not able to make consistent eye contact because that is the beginning of a connection with another person. And connecting with people, bonding with people, is extremely frightening to a RAD child. Try catching glimpses of your child’s eyes whenever you can. Make a game of it. Look at your child and playfully remind him to look at your eyes by saying, “Eye contact! Eye contact!” until he looks at you. Smile and praise him every time he successfully makes eye contact with you. Encourage him to make eye contact with every member of the family anytime he talks to any of them. For that matter, encourage your entire family to improve on making eye contact when communicating. This is a good habit for all of us, but it is extremely important to a RAD child because it initiates the bonding process.
Third, let your child continually know how much he means to you.
Get his attention, look him in the eyes, and tell him how much you love him. Tell him how special he is to you. Better yet, ask him, “Do you know you’re special?” And encourage him to respond with “yes.” Ask him, “Do you know I love you?” Again, encourage him to respond with “yes.” Then affirm him again by saying, “Good! Because you are very special. And I love you very much!” This should become a daily practice in your home – with all of your children, but especially with your RAD child. The repetition of these affirmations as well as his acknowledged responses will train his brain to learn that he is special, that he is loved, and that it’s okay to love and trust someone.
The healing process for Reactive Attachment Disorder (Developmental Trauma Disorder) is different for each child, for each family.
It will not be completed overnight, and could take months or even years to reach “normalcy” within your family. But as with anything worthwhile, this is a journey that is well worth the time, effort, frustration, and tears. We encourage you to seek professional help where you can and read as many books as are helpful to you and your family. But most importantly, remember that God put your family together, God gave you your RAD child, and God will see you through this invaluable journey as you put your complete trust in Him. We at Live to Connect Ministries are grateful for you and your family and pray that your future will be full of laughter and love.
God bless you all!
