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Reactive Attachment Disorder (RAD) aka Attachment Disorder (AD) It’s Time To Understand . . . What Is Attachment Disorder?.

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reactive attachment disorder rad aka attachment disorder ad it s time to understand

Reactive Attachment Disorder (RAD)akaAttachment Disorder(AD)It’s Time To Understand . . .

what is attachment disorder
What Is Attachment Disorder?
  • Attachment Disorder is a condition in which individuals have difficulty forming loving, lasting, intimate relationships. The words “attachment” and “bonding” are generally used interchangeably. Attachment Disorders vary in severity, but the term is usually reserved for individuals who show a nearly complete lack of ability to be genuinely affectionate with others.
  • They typically fail to develop a conscience and do not learn how to trust.
what causes ad
What Causes AD?
  • Any of the following conditions put a child at high risk of developing an attachment disorder. The critical period is from conception to about twenty-six months of age.
  • maternal ambivalence toward pregnancy
  • sudden separation from primary caretaker (i.e.., illness or death of mother or sudden illness or hospitalization of child)
  • abuse (physical, emotional, sexual)
  • frequent moves and or placements (foster care, failed adoptions)
  • There are more . . .
what causes ad4
What Causes AD?
  • (Continued . . .)
  • traumatic prenatal experience, in-utero exposure to alcohol/drugs
  • neglect
  • genetic disposition
  • birth trauma
  • undiagnosed and/or painful illness, such as colic or ear infections
  • inconsistent or inadequate day care
  • unprepared mothers with poor parenting skills
why is attachment so important
Why Is Attachment So Important?
  • Attachment is essential for the foundation of a healthy personality and is necessary for:
  • the attainment of full intellectual potential
  • the ability to think logically
  • the development of a conscience
  • the ability to cope with stress & frustration
  • becoming self-reliant
  • the development of relationships
  • the ability to handle fear & worry
  • the ability to handle any perceived threat to self
early development is critical
Early Development Is Critical!
  • Most (50%) of what we need to know for life is learned in the first year of life!
  • Another 25% is learned in the second year of life!
  • From the age of three on, only 25% of life’s survival skills are added.
conscience development

6 yo

Self Control

5 yo

With Verbal Instruction

4 yo

Parent Present and Able to Act

3 yo

Parent Present and Initiates

0 - 2 yo

Parent Present and Controlling

Conscience Development
  • Interruption in the conscience development of the AD child will evidence itself in the cessation of maturing in conscience and responsibility at that stage of development.
how does attachment develop

1. Need

4. Trust

2. Rage Reaction

Necessary Input:

(a) Eye Contact

(b) Touch

(c) Movement

(d) Smiles

3. Gratificationor Relief


How Does Attachment Develop?

First Year

of Life Cycle

Freud: Oral

Erikson: Trust Vs. Mistrust

how does attachment develop9

1. Child Wants

4. Parents Allow:

Increasing Independence

2. Parents GiveAppropriate Limits

3. Child Gives:Acceptance of Parental


How Does Attachment Develop?

Second Year

of Life Cycle

Freud: Anal

Erikson: Anatomy Vs. Shame & Doubt


Two Year OldNegativism

what happens when a child is placed in protective custody
What Happens When a Child is Placed in Protective Custody?

Table from the book, “Adopting The Hurt Child” by Gregory C. Keck PhD. and Regina M. Kupecky, LSW

high risk signs in infants
High Risk Signs In Infants
  • Weak crying response or rageful and/or constant whining
  • Tactile defensiveness
  • Poor clinging and extreme resistance to cuddling: seems “stiff as a board”
  • poor sucking response
  • poor eye contact, lack of tracking
  • no reciprocal smile response
  • indifference to others
  • Failure to respond with recognition to Mother or Father.
  • Delayed physical motor skill development milestones (creeping, crawling, sitting, etc.,)
  • Flaccid
symptoms of attachment disorder
Superficially engaging, and charming child

Indiscriminately affectionate with strangers

Destruction of self, others, things

Experiences developmental lags

Will not make eye contact (on parent terms)

Not cuddly with parents

Cruel to animals, siblings

Lacks cause and effect thinking

Has poor peer relationships

Inappropriately demanding or clinging

Engages in stealing or lying

Lacks a conscience

Engages in persistent nonsense questions or incessant chatter

Has poor impulse control

Has abnormal speech patterns

Fights for control over everything

Engages in hoarding or gorging on food

Has a preoccupation with fire, blood or gore

Symptoms of Attachment Disorder

Ref. Reber, Keith. “Children at risk for reactive attachment disorder: assessment diagnosis and treatment.” Phillips Graduate Institute.

what are the effects upon the family
Parental dreams of love and understanding solving all problems are quickly dashed

Frustration of the parents to receive reciprocal loving and bonding

Venting of hatred towards the Mother - suffering through:

Emotional breakdowns

Post Traumatic Stress Disorder

Apparent close bond to the Father

Schools, churches, friends and relatives become critical of parents

The family becomes controlled by the antics of the child, withdrawing the family from normal social functions

Siblings are targeted, and threatened

Family pets are targeted, and endangered

Normal times of closeness such as Christmas become outbursts of reactive anger

Automatic parenting does not work, there is no logical point of reference

Parents appear to be hostile and/or angry

What Are The Effects Upon The Family?
the randolph attachment disorder questionnaire radq
The Randolph Attachment Disorder Questionnaire (RADQ)
  • Unlike the DSM IV which labels symptoms rather than the causes
  • The RADQ attempted to determine the causes and the levels of severity between the two types of AD;
    • Anxious - The "in your face" child with very destructive behavior
    • Differential-The child who has hidden their anger deep inside, easier to live with, but harder to treat
  • The RADQ is considered the most effective tool in the diagnosis of AD
    • Available through the Attachment Center at Evergreen, CO
    • RADQ and AD resource book order site
keys to bonding
Eye Contact: warm, loving, soft

Touch: unrehearsed caresses

Movement:: rocking, bouncing

Smiles: the smile in the eyes is the child’s focus

Basic carbohydrates: lactose, sugar

Parenting interactions to encourage reciprocity on parents terms:

Singing a favorite song together

reciting nursery rhymes together

imitation games that require child to respond to parent

Child and parent working together in a reciprocal way

doing chores together in a fun way

activities that child completes on parent’s terms that enable a child to feel he or she is able to give back

Re-do early developmental stages child may have missed

Demonstrate affection regardless of response

Avoid control battles!!!

Control battles are lose-lose

Try win-win approaches like:

“When you do this, then I’ll do that”

Keys To Bonding
keys to bonding16
Be a tough parent

Build confliction - ask questions like, “Are you happy with your life now?”


Listening actively to child’s behavior

encourage verbal expression of feelings

acceptance of child’s feelings

exploring choices for handling feelings

understanding consequences of choices

Keys To Bonding
  • Promote continuity with child’s past
  • How do you keep ahead of an AD child? Remove their control:
    • Ask the child to do 20 chores and leave all of them undone
    • Alter normal schedule patterns
    • Keep them busy, or have them do quiet sitting
    • For discipline - physical exercise
  • Compliance is the beginning of reciprocity
effective treatment
Effective Treatment
  • Successful therapy with these children will depend upon the therapist’s willingness to use unconventional strategies, to find and to face the depth of the feelings that these children keep hidden, to revisit the trauma with the child and to communicate that by doing this together, the trauma is not bigger than the child, and the child can overcome it.(Continued . . . )
effective treatment18
Effective Treatment
  • Therapists need to be prepared to face the horror’s that these children have experienced if we ever hope to help them heal. Goals of treatment include: resolution of early losses, development of trust, modulation of affect, development of internal control, development of reciprocal relationships, learning appropriate responses to external structure and societal rules, correcting distorted thinking patterns, developing self respect.
effective parenting
Effective Parenting
  • Successful parenting involves high structure, effective environmental control, helping child develop appropriate responses to authority as well as developing internal controls, use of logical and natural consequences, reinforcement of reciprocity and nurturing/reparenting. Goals of parenting are: to prepare child for real world and to help child learn to be:
the need for ad respite care
The Need for AD Respite Care
  • Although many empathize with the need for respite care for the families of AD kids, few understand the requirements
    • AD respite care providers must provide a structured, secure, no fun care
      • It cannot be a reward for driving their parent(s) to the brink of a nervous breakdown
      • Providing plenty of high energy chores
      • Must provide the child with time to reflect
    • The parents must be confident that when they receive the child back, they don’t have to cope with a child that has “won.”
effective parenting can lead to the child being
Effective Parenting Can Lead To the Child Being:



(In a good way)


Fun To Be Around!

new research on rad holds hope
New Research on RAD Holds Hope
  • Brain Development, Attachment and Impact on Psychic Vulnerability
    • Infant caregiver interactions, seminal events in brain development and their possible relationship to later psychic vulnerability - by Deborah A. Lott
    • MHi Psychic Times
  • Affect Regulation and the Origin of the Self - The Neurobiology of Emotional Development
    • This book brings together the latest findings of socioemotional studies emerging from the developmental branches of various disciplines - by Allan N. Schore Ph. D.
  • The Biology of Soul Murder - Fear can harm a child’s brain. Is it reversible?
    • A U.S. News article on the recent research on the development of the mind and the connection between; parental care, the neurobiology of touch, and the chemistry of stress. - Shannon Brownlee