RAD and teletherapy

Why You May Need to Know About Reactive Attachment Disorder (RAD)

Attachment Disorders and RAD

Attachment is establishing the deep connection between children and their parents; generally the primary caregivers. The attachment will profoundly affect a child's development, the capacity to express emotions, and perhaps most importantly, the ability to build meaningful relationships later in life.

Insufficient attachment, if not adequately addressed, practically condemns a child to experience severe problems throughout his life. A child with an attachment disorder feels unsafe and alone. This will lead to difficulties in managing emotions, a fear of getting close to anyone, and connecting with others in a meaningful way.

Signs and Symptoms of RAD in Older Children

As kids grow up, the signs and symptoms will probably impact their behavior with both adults and children, and their performance in school. What's more, children suffering from RAD often act younger than their age, appear always to be anxious, and become extremely dependent on others, especially those whom they don't even know!

Signs and Symptoms to Watch for Include:

  1. A noticeable aversion to physical affection and touch
  2. Problems controlling oneself
  3. Easily angered
  4. Difficulty displaying love or genuine care for another
  5. Minimal sense of conscience

RAD children develop inhibited or disinhibited patterns of symptoms.

Inhibited symptoms of RAD. These children are emotionally detached, resist comforting and extremely withdrawn. Despite the child being fully aware of what is happening around him, at times even hypervigilant, nonetheless, the child doesn't respond or also react. The only reaction may be to ignore, or push was, sometimes aggressively, when others try to get too close.

Disinhibited symptoms of RAD. The child seeks attention and comfort from practically anyone without any distinction, with no preference to parents over strangers. The child seems to be perpetually anxious, very dependent and considerably immature for his age.

Causes of RAD

RAD sets in between just less than a year until five years old, when it is normal for children to attach to their parents. Children suffering from RAD, rarely seek or respond to comfort when they are in stressful situations. They become irritable for seemingly no reason at all and seem to be sad or afraid when in the presence of their parents or caregivers.

The chronic experience of feeling isolated, abandoned, uncared for, or powerless, irrespective of the reason, ingrains in the child that others are undependable, and that the world around them is a dangerous place. This is often the unfortunate consequence when these circumstances are repeated again and again:

  1. The child cries are not comforted by the parent
  2. The baby is left hungry or wet for hours
  3. The baby child experiences a significant separation from parents
  4. The baby feels alone because no one is looking or smiling at him
  5. The only way the young child can get attention is by "being bad" \
  6. The infant or child's needs, while met, are done so unpredictably
  7. The child has an emotionally unavailable parent because of illness or depression

Although many of these circumstances may be unavoidable, the child doesn't take that into account. Lacking the ability to discern, all the child knows is that "no one cares." The child learns not to trust others as his world becomes an unsafe place.

RAD is Often Deceptive

Not all kids suffering RAD look the same. These same symptoms- difficulty sleeping, seemingly non-existent social interactions, chronically irritable, and never smiling could easily be explained as depression. But in reality, it could be RAD.  

Similarly, that child who is always losing his temper, questions authority figures regularly, and his bullying the other children most certainly meets the criteria for Oppositional Defiant Disorder, but again, could be a RAD child.  

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Others have mistaken the child’s lack of interest in interacting with peers as Pervasive Developmental Disorder, Autism Spectrum Disorder or PTSD.  In fact, there are some who believe that RAD is a derivative of PTSD altogether.

What it boils down to is this. Without a developmental history conducted with care, access to the relevant medical records, and the benefit of interviewing one or both of the parents, there is no way to be confident of a RAD diagnosis.

How to Successfully Treat RAD

Unfortunately RAD is unique and therefore doesn't lend itself to most of the conventional therapies available to most therapists, who conduct therapy face-to-face or via teletherapy.

Most therapists trained in CBT (Cognitive Behavior Therapy) will implement this therapy, whether face-to-face or via teletherapy on their RAD clients, but with little success. Child therapists who may be proficient with play therapy often won't find their success duplicated with RAD children either.

Effective treatment for RAD usually involves a combination of therapy (face-to-face or teletherapy) and parenting education. Involving the parents is essential to any successful intervention first and foremost to guarantee that the child's environment will be safe and that the interactions will be positive and nourishing.

Often the most effective therapeutic approach with children suffering from RAD both unconventional and confrontational. Often sensory input plays a vital role as well. More innovative trauma therapies such as EMDR has had success with RAD children as well particularly for those children suffering from panic attacks or flashbacks.  

Whatever the specific treatment to be used, it is critical to remember that restoring a sense of safety and security is the core issue that healing must address.  These children are distrustful and detached as a result of their feeling unsafe in their world. The same vigilance that protects them is their impediment from accepting support and love.

It may very well be that the most valuable function that the therapist can serve is to become another trustworthy, consistent authority figure in the RAD child's life; someone whose concern and care are genuine.  

It is crucial to keep in mind that RAD children need help, even though they will do practically anything to resist it.  Working with these children requires a willingness on the part of the therapist to try some unconventional approaches. The rewards are that the efforts can profoundly affect many lives for the better, for years to come.

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