AbstractReactive Attachment Disorder (RAD) is a relatively rare attachment disorder that affects children.
Children with RAD fail to establish strong bonds to both their parents and caregivers. They cannot return the affection of other people because their early needs of stimulation, comfort, and affection weren’t met. Some of the symptoms include avoidance of eye contact, and refusal to associate with others. There are many factors that contribute to the development of RAD, including placement in orphanages.
RAD may manifest differently in two different age groups: early childhood and adolescence.Reactive Attachment Disorder (RAD) is a relatively rare attachment disorder that affects children. Children with RAD fail to establish strong bonds to both their parents and caregivers. They cannot return the affection of other people because their early needs of stimulation, comfort, and affection weren’t met. Some of the symptoms include avoidance of eye contact, and refusal to associate with others. There are many factors that contribute to the development of RAD, including placement in orphanages. RAD may manifest differently in two different age groups: early childhood and adolescence.
RAD is a relatively rare developmental disorder in children, so not enough research has been done on its nature. Its cause is not yet known, but current attachment theories may explain why RAD may develop in some children. Attachment is a child’s emotional bond to his parents or caregivers. According to the theories on attachment, if a caregiver consistently responds to a baby or child’s needs, when he cries for example, a feeling of attachment grows in him, leading to his overall well-being. The first one or two years of a child’s life is crucial in the development of his emotional health, which is determined by whether he creates healthy emotional relationships through attachment with the people around him or not. The term “bonding” has been used to describe this process of attachment (Moe, 2007, p.16).
Problems regarding a baby’s emotional development arise when their physical and emotional needs are not met. A child may not learn how to trust other people when their environment is too unstable and no one nurtures them consistently. Babies especially need positive and caring interactions with their caregivers. Harsh interactions, like roughly feeding a baby without eye contact, smiles, caresses, or kind words teach a baby to not trust his caregivers.
Over time, the baby becomes distrustful of all people, stunting the growth of his emotions, especially affection. Different attachment disorders may result from this process, one of which is RAD (Martin, et al., 2007, p.712). Current attachment theories also propose that interactions between infants and caregivers on the emotional level could shape the brain’s neurological development (Martin, et al., 2007, p.
712). Accordingly, the creation of the brain’s neural networks, which influence the future personality of a baby, depends on these interactions. Babies who don’t receive enough love and care fail to develop the proper neural networks, which then result in attachment disorders such as RAD. There are two types of RAD: inhibited and disinhibited. If a baby isn’t given a chance to participate in emotional interactions with his caregivers, he may develop symptoms of the inhibited type of RAD.
One of the first symptoms of the inhibited type of RAD is the child’s avoidance of eye contact. He may not like looking directly at the eyes of his caregivers or simply not understand the importance of establishing eye contact with people. The child generally resists affection from his caregivers and other people around him. He may sometimes appear to seek affection or contact from people but he’ll soon turn away. Thus, he doesn’t want physical contact of any kind and wouldn’t try to form any bond with others. He is alone most of the time and prefers to play by himself.
If he ever displeasured, he has a way to comfort or soothe himself because he doesn’t want the comfort of his caregivers. Finally, he also always appears to be wary or on guard (Berlin, 2005, p.314-315). The disinhibited type of RAD is developed when caregivers of a baby are frequently changed or if he has too many caregivers.
Unlike babies with the inhibited type, babies with the disinhibited type of RAD form attachments to the people around him, though these are very shallow and inappropriate. Thus, he always seeks comfort from strangers and exaggerates needs to get some help in doing his tasks. He readily goes to them without showing the normal stranger anxiety of children.
Because of his constant need to seek the comfort of other people, he may display childish behavior. Finally, he also appears anxious most of the time (Berlin, 2005, p.314). Signs and symptoms of RAD may appear differently in two age groups: infancy or early childhood and adolescence. Experts in developmental disabilities believe RAD starts before the child reaches 5 years of age, although factors that lead to its development begin at infancy.
An infant who is harshly treated by its parents may feel insecure and rejected, thus becoming unattached and distrustful of his parents and other people around him. They may want to seek affection and comfort from other people but constant rejection may result in developmental disorders like RAD (Sadock & Kaplan, 2008, p.644).Infants who live in orphanages or institutions have an increased chance of developing the disorder. Children in such institutions may end up competing with each other for the attention of professional caregivers, which leads to the failure in establishing emotional bonds with them. If the caregivers tasked to take care of the children in these institutions are frequently changed, the children may find it hard to develop any lasting emotional connection with any one of them, thus also increasing the likelihood of RAD.
According to experts, children who are hospitalized for a very long period of time also have an increased chance of developing RAD (Sadock, et al., 2009, p.125). Infants and children who live with unstable families are also more likely to develop attachment disorders such as RAD. General instability in a family may result in the children not getting enough love and care from their parents or caregivers.
Abusive or neglectful parents unconsciously instill in their children’s minds that they can’t expect any comfort or affection from adults. Children who receive emotional, physical, and sexual abuse from their parents or caregivers may also learn to extremely distrust people, thus developing RAD. Curiously, children who are forcedly remove from abusive homes have an increased vulnerability to the disorder, perhaps due to the abrupt change in the environment. Early childhood is a crucial stage in the formation of a child’s personality, and significant trauma in family life, such as divorce or death could lead to the beginnings of attachment disorders. Parents can significantly influence the child’s personality, so if they have personality disorders of their own such as anger management problems, mental illnesses, or drug/alcohol addictions, then those problems could negatively affect their emotional relationship with their children. Parents who are inexperienced in performing their duties may also unconsciously create the conditions favorable to the development of RAD. Many of such conditions are also present in impoverished homes where parents and children don’t have enough time to create meaningful bonds with each other (Sadock, et al.
, 2009, p.123). Adolescents with RAD are more likely to have conflicts with other people as they grow up. Eating problems could develop, which in turn could lead to malnutrition and delay in growth. At school, an adolescent afflicted with RAD may find it hard to establish any connection with his classmates because of his lack of care for them. He may become a bully or be vulnerable to bullying (Dwivedi et al.
, 2004, p.57). His grades might also suffer because he doesn’t feel compelled in any way to achieve good grades for himself or for the pleasure of his parents. Adolescence is characterized by the development of children’s sexuality.
Adolescents with RAD may have trouble dealing with their sexuality, leading to improper sexual behavior. Since he can’t manage his own sexuality, it may be difficult for him to create any romantic relationships with the people around him. This could persist through adulthood, where it manifests in relationship problems with the opposite sex. An adolescent with RAD lacks empathy and is therefore more likely to have anger or temper problems that translate into the physical or emotional abuse of others. He is very aggressive and doesn’t care about other people’s feelings or pain. He’s also more likely to have an alcohol or drug addiction, over time leading to anxiety and depression.
Parents of adolescents with severe depression due to RAD need to pay close attention to their children because they may hurt themselves or even commit suicide. Some adolescents with RAD may sustain its symptoms into adulthood, where it could result in difficulty landing a job or the frequent changing of jobs. It is the responsibility of parents and caregivers to take their children to medical experts if they suspect that they are afflicted with RAD or any other kind of developmental disorder. RAD has similar symptoms with other psychological problems such as social phobia, autism, and ADHD. An infant or an adolescent with RAD may also have some of these other disorders, so it is very important for treatment to begin immediately. Typical evaluation of RAD includes assessment of the child’s behavioral patterns over time. The doctor may ask the caregiver to provide him with examples of the child’s unusual behavior in different situations.
Relationships of the child with family members and other people around him will be explored to evaluate what kind of attachment disorder the child has. Parents may have to describe their styles in taking care of their children and the overall situation in their homes. The doctor then consults the Diagnostic and Statistical Manual of Mental Disorders or DSM to evaluate whether the child is in fact suffering from RAD or not. Once a child is diagnosed with RAD, treatment with medications or therapies can begin.
It’s advisable to get a second opinion if the parent is unsure of the findings (Seligman & Reichenberg., 2007, p.133). In most cases, RAD is not only the problem of the child but of the whole family or household. Treatment therefore not only focuses on the child with RAD but also on other family members who may be breeding the conditions for developmental disorders like RAD to occur. Goals of treating RAD include ensuring the child has a stable and safe living environment, so that he could develop emotional interactions with his parents or caregivers. Such an environment could boost the self-esteem of the child over time, resulting in more positive relationships and less symptoms.
There’s no standard treatment for RAD because it is rare and not yet clearly understood by medical experts. Treatment usually involves a mixture of medications and therapies, including psychotherapy and occupational therapy. The family who takes care of the child may have to go through sessions of family therapy to improve their child-rearing abilities. To reduce the more disruptive symptoms of the illness, the doctor may prescribe medications for anxiety, hyperactivity, or depression. Children and adolescents who have severe disruptive symptoms may be offered inpatient or residential treatment to protect the people around him. Parents may also choose to put their children in schools offering special education if the doctor advises them to do so (Seligman & Reichenberg., 2007, p.
134). Symptoms of RAD can last for years, especially if the illness is not diagnosed and treated early, so treatment may take a very long time. Some parents resort to unconventional treatments like re-parenting and “compression treatment” in an attempt to cure their children of RAD. These practices, which may involve forcedly establishing eye contact with a child or tightly wrapping him, ignoring his pleas about difficulty in breathing have been denounced by various groups such as the American Psychiatric Association (Berlin, 2005, p.316-319). Parents who take care of children suffering from RAD may get frustrated because they may not feel like their children love them. Tolerance is extremely significant in this situation.
Parents must continue to show that they love them despite the potentially frustrating behavior that they display. It’s also a good strategy to join support groups that could provide parents with more resources to treat and cope with RAD. While the nature of RAD is yet to be completely understood by the medical community, parents and caregivers can reduce the chances of their children developing the illness by fostering stable and loving homes.
Children who receive enough affection from the people around them are less likely to develop RAD because they are able to form secure attachments essential for positive emotional development.ReferencesBerlin, L. J. (2005). Enhancing early attachments: theory, research, intervention, and policy. New York: Guilford Press.
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