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Ask the Doctor:

Reactive Attachment Disorder

RAD is a common yet under diagnosed entity in internationally adopted children. Could you explain this condition?

Reactive Attachment Disorder (RAD) is the result of several interruptions that occur during the formative period of a child’s development. Their ability to “attach”, trust others and relate to primary caregivers is negatively affected.

A child’s ability to bond with or "attach to" others is greatly determined by what happens between the infant and caregiver during the first few months, when the brain is rapidly developing.

Relating to an inconsistent caretaker or having the lack of a nurturing and loving relationship can physically change the "wiring" of the brain and lead to difficulty regulating emotions and behavior. This may result in poor impulse control, a sense of separation and mistrust. There may be expressions of anger or controlling and attention-seeking hyperactive behavior. These can be confused with other conduct disorders such as ADHD and OCD, which may sometimes coexist, making management more difficult. These children can have difficulty accepting comfort and may be either overly affectionate or unable to express affection. One of the most difficult situations for parents to deal with is the disbelief of others outside the family who are exposed only to the child's endearing qualities which seem to contradict the behaviors encountered in the home.

Attachment begins when a parent responds to their child’s needs and wants. Over a period of time, the child comes to trust them. They learn to believe that their parents will be their guardians and providers. Later, when they leave their parents temporarily to stay with a babysitter or to go off to school, they carry the idea of their protective parents with them. They make use of this when necessary, during periods of insecurity, frustration or anxiety. This strong foundation empowers young children to face the many challenges throughout their lives. Because a child's initial relationship is with his/her parents, it lays the framework for many of the relationships that will follow. Children with a secure attachment background tend to approach others in a positive manner. Since they feel valued by their own parents, they assume that others should be valued as well.

The notion of attachment reminds us of the child who does not want to be left at day care, throws a tantrum or cries when a parent exits the room. This form of attachment is quite normal and expected at certain times. There are some instances, however, when attachment problems are quite severe and are truly a diagnosable disorder. According to the official diagnostic handbook of the American Psychiatric Association, the diagnosis refers to young children who have severely disturbed relationships with others resulting from the poor parenting they have received.

Children with RAD may avoid forming personal relationships. These are known as the inhibited or unattached type. On the other hand, they may seem overly friendly to everyone, not distinguishing between parents and strangers. These are known as the uninhibited or indiscriminate type. In both cases, there is no real sense of trust. The children treat other people either as threats to be avoided or as targets to be manipulated. Not all children who are adopted internationally, the so called post-institutionalized children, are destined to have RAD. But the more emotionally and physically deprived they were, and the longer they remained in that environment, the greater their risk becomes.

Many people face this situation every year. Children available for domestic or foreign adoption may have faced difficulties early in life that make it very hard for them to attach to a new family. These difficulties may take the form of physical or sexual abuse, neglect or multiple placements. When this occurs to children within the first few years of life, they can develop the lack of trust that characterizes RAD. A child with this disorder may not be able to open themselves up to love regardless of how loving the adoptive family is. They have learned from the previous caregivers that it is not safe to love. This has become their defense mechanism, a mode of survival, a way of coping with their environment and the people in it.

A prospective adoptive parent should find out everything possible about the infant’s background as well as that of the biological parents. Inherited temperament or mental health conditions can also affect the child’s ability to recover from early influences. Insist that social and psychological evaluations be provided and translated, if necessary. Many families are not receive this information until after the adoption is almost finalized. In international adoptions, families have a more difficult task obtaining this information from the agencies. Potential adoptive parents deserve this information before they make the decision to adopt a particular child.

When considering adopting a child, either domestically or internationally, there are many important decisions that need to be made every step of the way. One way to become empowered is through gaining knowledge and learning from the experiences of others in similar situations. Contact support groups for adoptive parents for assistance and guidance. If your child shows signs of an attachment problem, talk to your child's doctor or see a counselor who specializes in child specific therapy. Although RAD can be extremely difficult to treat, the situation is not hopeless. With guidance from experts in the field of RAD and other conduct disorders, as well as a great deal of determination on the part of you and your child, the situation can be improved.

by George Rogu, M.D.


Disclaimer

The information and advice provided is intended to be general information, NOT as advice on how to deal with a particular child's situation and or problem. If your child has a specific problem you need to ask your pediatrician about it - only after a careful history and physical exam can a medical diagnosis and/or treatment plan be made. This Web site does not constitute a physician-patient relationship.

This material has been provided by AdoptionDoctors.com, an innovative adoption medicine private practice and educational service, dedicated to helping parents and adoption agencies with the complex pre-adoption medical issues of internationally adopted children. All medical interactions are performed via, e-mail, express mail, telephone, and fax. There is no need to make a live appointment or travel outside of your hometown. For more information, visit AdoptionDoctors.com or call 631-499-4114.

© George Rogu, M.D.

Related Terms: attachment theory, attachment disorders, Treating Reactive Attachment Disorder and Adult Reactive Attachment Disorder


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