What Is Reactive Attachment Disorder (RAD)?

If you don’t move in foster or adoptive circles, you likely haven’t heard of Reactive Attachment Disorder (RAD).  Rare in the general population but more common among children who have spent time in orphanages or foster care, it’s a disorder that brings with it a flock of destructive behaviors and is difficult – some say impossible – to treat.

If you have a child or loved one with RAD, chances are, you have felt bewildered, exhausted, and isolated. Because it’s a rare disorder – a much more serious variant of attachment disorder (AD) – support groups are few and far between. For many of us, online communities are the only contact we will have with another RAD caregiver.

Many RAD children lack a diagnosis, so the source of their big behavior is not understood. When we don’t understand why our children behave the way they do, we don’t know where to begin to change those behaviors. These misunderstood children often end up in institutional care, back in foster care, or the juvenile justice system.

Understanding your child’s disorder is the first step to keeping your child safe, in your home, and moving toward healthy development.

If you found your way here because you’re at your wits end with your own RAD loved one, understand first that I’m not a psychologist or social worker. I’m simply an adoptive mom in the RAD trenches, trying to heal her kiddo while keeping her sanity. Perhaps I can offer you information you didn’t have before, point you in a helpful direction, and share what has worked (and not worked) in my home.

Sometimes all we RAD parents need is to feel validated and know we aren’t alone.

What does normal attachment look like?

Usually, we learn attachment – the ability to trust and bond with other humans – as infants. We cry, and a caregiver comforts us. We are fed when hungry, cleaned when dirty, and played with when lonely. Through this process of having our needs consistently met, we learn that people – especially our caregivers – are trustworthy people who have our best interests at heart.

We’ve all seen a baby who cries if she’s held by anyone but Mom. This is a child working through healthy attachment. She’s attached successfully to Mom, but doesn’t have enough experience with a neighbor, for example, to know that the neighbor will meet her needs like Mom does. Once she learns the neighbor will provide for her needs, she will attach, though typically not as strongly as she attaches to her primary caregiver.

This normal attachment process not only helps us learn to love and trust, but also teaches us how to regulate our emotions, to recognize others’ needs and desires (develop empathy), and build the positive belief that we are worthy of love and security.

When attachment is disrupted

Several things can disrupt the normal attachment process. Sometimes children with major health challenges will spend large periods of critical childhood development isolated from family in a hospital or intensive care unit, where they lack normal interaction for a variety of reasons. Their poor health may cause pain or discomfort that can’t be resolved by a parent holding and comforting them. Babies in orphanages who go without consistent human attention and affection often have difficulty attaching, learning to self-soothe, and recognize others’ needs. Children who are neglected learn that they can’t rely on others to meet their needs. When children move from caregiver to caregiver (as in foster care), this attachment process is cut short. The more disruptions in attachment (the more foster placements, for example), the less likely it is that the child will ever successfully attach.

The good news is that these children often become extremely independent. Remember that this is a strength. A child with an attachment disorder often believes that the only person he can rely on is himself, and he will become very resourceful to fulfill his needs. However, this independence comes at a price later in life, when he has not learned the healthy give-and-take of human interaction. He will find himself without a support network, and sometimes uses unhealthy or destructive methods to get what he needs or wants.

Attachment Disorder (AD)

Attachment Disorder (AD) is an umbrella term that simply means a child has not learned the value of human attachment and struggles to form attachments of all kinds. Left untreated, AD children tend to create only superficial, fleeting relationships. With treatment, however, AD children can come to trust and attach in healthy ways.

Reactive Attachment Disorder (RAD)

At the more extreme end of disordered attachment are cases where a child is actively hurt, physically or psychologically, by a caregiver. Abuse, abandonment, traumatic events like war or witnessed violence, and death teach children that not only can caregivers not be trusted to provide for their needs, but that trust equals pain. These children actively resist attachment out of fear – often subconscious – of pain. If you try to attach to a parent who hits you and then abandons you, for example, you’ll learn to defend yourself by not attaching to the next parent figure who comes along. Somehow, your mind will tell you, it won’t hurt as much when this mom leaves if you don’t love her or need her. Multiple foster placements can also create this dynamic.

This is Reactive Attachment Disorder (RAD). Children – and later, adults – don’t just struggle to attach but become reactive in order to avoid attachment. They will instinctively sabotage relationships, because they have learned – often from events they can no longer remember but have literally hardwired their brains in negative ways – that relationships hurt.

RAD children show “big” behavior and explosive, unregulated emotions. They lie, they steal, they manipulate people, they set fires, run away, and are often violent or seem cruel. Parents often describe their RAD children as lacking empathy, which is understandable, because empathy means you can be hurt by the feelings of others. Also, the work of learning empathy happens during normal attachment, and RAD children simply have not developed that part of their brain in normal ways.

RAD children are, simply put, done with being hurt by people, and they will do whatever it takes to prevent it.

These children will fulfill their own needs and desires (which often remain very basic and underdeveloped, although they look complex on the surface) in whatever way they can, because they have learned they can’t rely on others to do this. RAD children can be charming one minute and abusive the next. They are almost always most abusive to their primary caregiver, because the fear of attachment is strongest in this relationship. Outside of the home, they are usually at their most charming.

Further complicating the RAD dynamic is the fact that many RAD children also come with a variety of other diagnoses, most commonly depression and anxiety.

My RAD child

When my husband and I adopted my son at the age of three, we were his tenth placement. He left his mother as an infant and cycled through a variety of family and non-family foster placements, several of them abusive, until he reached our home. His older half-brother, who remembered the violence of his biological family and his abandonment at the age of three, was diagnosed with RAD.

But this little one, my boy with the cheeks out to here, seemed fine considering his rocky start to life. He was smart and funny. He was compliant and, except for what I considered normal toddler behavior, was generally good-natured. He didn’t hug often, but asked to be held. I had abdominal surgery shortly after his adoption and couldn’t lift him for six weeks. He stopped asking to be held after that, but I chalked it up to a developmental stage.

He was unusually stubborn and independent. He refused to allow my husband or me to teach him how to ride a bicycle, for example. He taught himself when he was five. Even though I felt like I missed out on a significant piece of parenthood, I was impressed at his independence and tenacity, and praised him for it. (Remember, your child’s deficits can often be reframed as strengths. I encourage you to do exactly that. Your child will appreciate it and you’ll preserve more of your sanity.)

Every night when I tucked him in for that first year, he asked, “Is it tomorrow that I go to a new home?” But his question seemed reasonable to me, given his history. I would just remind him that the judge – the man in the big black robe – told us we could stay together always. We were a family. I wasn’t particularly worried that he didn’t seem to understand my explanation and eventually just stopped asking. I thought he would get it with time.

It wasn’t until we started seeing the characteristic “big behaviors” at around the age of eight or nine that we started hearing the words “attachment disorder” from the professionals around us. And the older he got and the more I watched him, the more I saw the telltale signs of RAD.

The road ahead

My RAD child is now thirteen, and I have to admit that the odds aren’t in his favor. Last month, a child therapist told my husband, “He’s a RAD kid, isn’t he? You know you can’t fix RAD, right?”

As RAD parents, we already feel isolated, exhausted, discouraged and fearful. We try to hide our child’s behaviors because we hope we can protect them (and ourselves) from people who don’t understand. Then professionals sometimes send messages of doom, and Google searches only confirm the dismal rates of success for RAD treatment, especially when RAD symptoms still exist by the time the child reaches his teen years, like mine.

Sometimes it’s all RAD parents can do to not pack their child up and move him to institutional care. Sometimes – and I have to tell you this – it’s the only option left if your child is a danger to himself or others.

If you’re in this boat, please know you’re not alone. Please don’t blame yourself. Please know that there is hope for your family, for your child.

I’m in the thick of it. I’ve felt the anger, the overwhelming sadness, the periods of hopelessness, the grief over what I thought parenting would be, and the judgement of people who don’t understand the disorder, the behavior, or the unorthodox parenting techniques it requires. But I choose – over and over again – to hope. I have to hope that my family will get through this, that my son will find a way to work through his trauma and find happiness and peace. I see all the amazing things he could become, lurking behind the fear and trauma of his first few years.  I choose to keep facing each new day, regrouping when needed and scrounging for help wherever I can find it.

You aren’t alone. Many of us chose to bring traumatized children into our homes and lives because we thought we could do an important work. Remember that great works require great sacrifice. Remember that, no matter how reactive your child is, no matter how difficult to love, what he or she needs more than anything is to know you will stick it out. That you are safe. That you will do the hard things that no one else has done to provide for his or her needs.

The road is long and uncertain, but I still believe it’s worth the heartache.

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