Attachment Theory and Reactive Attachment Disorder

By at November 18, 2011 | 10:15 am | Print

Attachment Theory and Reactive Attachment Disorder (RAD) are fairly new concepts, both becoming more widely accepted in the last few decades. Attachment theory was developed in the 1960s by John Bowlby, and in 1980 RAD first appeared in the Diagnostic and Statistical Manual of Mental Disorders (DSM), the handbook used by professionals to diagnose mental disorders.

Attachment theory focuses on the relationships between infant and caregiver. It suggests that the relationship infants’ form with caregivers will impact all future relationships and bonds that children will go on to form. Infants look toward caregivers for their needs, security, and comfort, and the caregiver’s response determines the type of attachment the child forms. Attachment theory outlines two different types of attachment as secure and insecure.

In relationships where secure attachment is formed, the child sees the caregiver as a secure base. These children are able to act independently, knowing that the caregiver will be there in times of suffering and the caregiver responds when the child hints for comfort or security. These children are able to trust the caregiver. This is the most common type of attachment seen in infants.

Insecure attachment is broken down into three subgroups; avoidant, resistant, and disorganized attachments. Avoidant attachment is marked by independent children who avoid making contact with caregivers. Children with resistant attachment feel anxiety when hinting for care or comfort because they are unsure if their needs will be met. These children are often too preoccupied with anxiety surrounding the caregiver to become independent. The final type of insecure attachment is disorganized attachment; here the infant develops disorganized behaviors such as rocking or repeated tapping to seek comfort. Parents of insecurely attached children tend to respond to their child’s needs in ways that are inconstant, neglectful or frightening to the child. Insecurely attached children are at a greater risk of developing RAD.

RAD is a rare, but severe attachment disorder seen in infants and adolescents. It presents as an inability to form appropriate relationships with others. While RAD isn’t typically diagnosed until after a child is 18 months old, in severe cases RAD can present in children as young as 6 months old. There are two types of RAD, children with Inhibited RAD may seek independence and avoid or resist forming bonds or attachments with others. Disinhibited RAD presents as undiscriminating friendliness.

A diagnosis of RAD requires an onset of symptoms before the age of 5 years. Symptoms of RAD include:

• Inappropriate affection to strangers or actively resists affection of caregivers

• Problems making eye contact

• Poor impulse control

• Demanding or inappropriately clingy

• Lacks morals, values, and/or spiritual faith

• Little or no compassion, has no conscience

• Cruelty to animals

• Obsessive lying

• Self-harming or harmful to others

• Stealing

• Fascination with fire, blood and/or weapons

• Abnormal eating patterns; either hoards food or refuses to eat

• Has no significant relationships, having few or no long term friends

• Manipulation of others

• Abnormal sleeping patterns

RAD is a last resort diagnosis, and many other disorders including developmental disorders and mental retardation, must be ruled out before RAD can be diagnosed. RAD can often be mistaken for or occur in combination with other disorders including:

• Mental Retardation

• Autism Spectrum Disorders

• Post-Traumatic Stress Disorder

• Substance Use Disorders

• Conduct Disorder

• Attention Deficit Hyperactivity Disorder (ADHD)

• Obsessive-Compulsive Disorder (OCD)

• Bi-Polar Disorder

RAD is a disorder that affects the entire family. While the child may display the symptoms, the disorder is caused by a lack of attachment to a caregiver in infancy. RAD develops as a result of child abuse or neglect, inconsistent parenting, separation from caregivers, having multiple caregivers or other childhood trauma. A child with RAD could cause tension in the entire household. Caregivers may become exhausted from dealing with the symptoms of RAD and either respond in negative ways or want to give up on the children. Siblings may feel victimized by the RAD child or may start to exhibit similar aggressive behaviors.

There is no known prevention of RAD, but it can be assumed that prevention relies greatly on the parenting children receive as infants. Ensuring that a child’s physical, mental, and emotional needs are met is important. This can be done by maintaining a close, loving relationship with your children, and meeting a child’s needs.

While research is still needed surrounding RAD, there are some suggested treatment paths. Some treatment options such as holding therapy, attachment therapy, and re-birthing require that the child completely surrender to the adult as a way of mentally bringing the child back to infancy, then reattachment or reconnection occurs. Some children are being prescribed medications to manage the symptoms of RAD, but none are widely accepted. The most effective treatment approaches seem to be those that not only focus on the child and managing the emotions and behaviors, but those that also focus on the entire family unit. Caregivers, as well as children, need to learn how to manage the symptoms and deal with the behaviors of RAD.

For questions concerning RAD or other youth and family related concerns, please contact Christopher Montes at New Britain Youth & Family Services in room 301 of City Hall; telephone 860-826-3366 or email at cmontes@newbritainct.gov.

 

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