Educational Blog Series
BY JOPLIN CLINIC
Navigating the Challenges of Reactive Attachment Disorder
A roadmap for parents, carers, guardians, & foster parents
the Unique challenges faced by parents, carers, guardians, and foster parents in Australia when it comes to Reactive Attachment Disorder.
- Post Date: May 21, 2023
Navigating the Challenges of Reactive Attachment Disorder: A Roadmap for Carer
As parents, guardians, and carers, nurturing children can be both deeply gratifying and equally challenging. Yet, when embarking on the path of caring for children with RAD, the journey can appear especially daunting, as it often entails manoeuvring through a system seemingly laden with significant lapses in support.
RAD, or Reactive Attachment Disorder, is a complex condition that impacts a child’s ability to form secure and healthy bonds with their caregivers. Although the exact incidence of RAD in Australia is not definitively known, overseas studies propose it affects roughly 1-2% of the general population, with increased rates in foster children and those who have endured trauma early in life. Regrettably, these children and their carers often find themselves slipping through the cracks in our healthcare and social support systems.
The manifestation of RAD can vary in intensity and appearance, but below we’ve provided a comprehensive list of prevalent symptoms associated with RAD.
- Inhibited, emotionally withdrawn behaviour: Children with RAD might appear emotionally distant or non-responsive to affection or nurturing attempts from caregivers.
- Failure to seek comfort or respond to comforting: They may not actively seek solace or fail to respond positively when comfort is offered.
- Limited social and emotional reciprocity: Children with RAD grapple with engaging in reciprocal interactions and have difficulty expressing emotions or maintaining prolonged relationships.
- Unexplained irritability, sadness, or fearfulness: RAD can materialise as excessive irritability, frequent expressions of sadness, or persistent fearfulness without a clear cause.
- Difficulty showing genuine affection: Children with RAD might struggle to display authentic affection towards their caregivers or others.
- Indiscriminate or excessive familiarity: They may demonstrate a lack of appropriate boundaries by showing undue familiarity with strangers or displaying little or no fear of unfamiliar individuals.
- Hyperactivity or impulsivity: RAD can manifest with hyperactive or impulsive behaviours, often resulting from the difficulty of regulating emotions and impulses.
- Poor peer relationships: Children with RAD may struggle to establish and maintain positive relationships with peers, often displaying disruptive or aggressive behaviours.
- Lack of cause-and-effect thinking: RAD can impair a child’s capacity to comprehend the consequences of their actions and make connections between their behaviours and outcomes.
- Control-seeking behaviours: Children with RAD may engage in manipulative or controlling behaviours as a means of maintaining a sense of control over their environment and relationships.
- Disrupted sleep patterns: RAD can disrupt a child’s sleep, leading to difficulties falling asleep, staying asleep, or experiencing frequent nightmares.
- Impaired cognitive and academic functioning: Children with RAD may experience delays or difficulties in cognitive and academic areas, including learning, problem-solving, and attention.
Superficially engaging and charming: Children with RAD may display a superficial charm and engaging behavior that often serves their own agenda.
Lack of eye contact on parents’ / carers’ terms: They struggle to make and maintain appropriate eye contact with parents or caregivers, often avoiding direct visual engagement.
Indiscriminately affectionate with strangers: Children with RAD may demonstrate overly friendly and affectionate behavior towards unfamiliar individuals, lacking appropriate boundaries in forming attachments.
Not affectionate on parents’ terms (not cuddly): While they may exhibit affection towards strangers, these children have difficulty showing affection or responding to parental or caregiver affection in expected ways.
Destructive to self, others, and material things (includes being accident-prone): RAD-affected children may engage in self-destructive behaviors, exhibit aggression towards others, and display a propensity for damaging objects and belongings.
Cruelty to animals: Some children with RAD demonstrate acts of cruelty or mistreatment towards animals, displaying a lack of empathy and appropriate understanding of appropriate behavior.
Lying about obvious things: Children with RAD may frequently lie about obvious matters as a means of manipulation or control.
Stealing: RAD-affected children may engage in stealing behaviors, attempting to fulfill unmet needs or exert control over their environment.
Poor impulse control (frequently acts hyperactive): Impulse control challenges are common in children with RAD, leading to frequent hyperactive behavior and difficulty adhering to rules or boundaries.
Learning lags: Children with RAD often experience delays in their learning compared to their peers.
Lack of cause and effect thinking: They may struggle with understanding cause and effect relationships, making it challenging for them to comprehend the consequences of their actions.
Lack of conscience: Children with RAD may display a lack of conscience or moral compass, showing little remorse or guilt for their behaviors.
Abnormal eating patterns: Some RAD-affected children may exhibit abnormal eating patterns, such as extreme food avoidance or excessive consumption.
Poor peer relationships: Difficulties in forming and maintaining positive relationships with peers are common among children with RAD, stemming from their attachment difficulties.
Preoccupation with fire: Children with RAD may display a preoccupation or fascination with fire, requiring careful monitoring and intervention to ensure safety.
Preoccupation with blood and gore: RAD-affected children may demonstrate a fixation on blood and gore, potentially as a result of their exposure to trauma or disrupted attachment.
Persistent nonsense questions and chatter: Some children with RAD engage in continuous nonsensical questioning and chatter as a means of seeking attention or control.
Inappropriately demanding and clingy: RAD-affected children may exhibit inappropriate demands for attention and affection, becoming excessively clingy or dependent on caregivers.
Abnormal speech patterns: Speech patterns in children with RAD may deviate from typical development, including abnormalities in rhythm, tone, or language use.
Triangulation of adults: These children often engage in manipulative behaviors by getting between adults, seeking to create divisions or exert control.
False allegations of abuse: In some cases, children with RAD may make false allegations of abuse as a way to manipulate their caregivers or create chaos in relationships.
With an estimated 1-2% of the population affected, including high-risk groups like foster children and those with early life trauma, RAD can leave parents and carers feeling overwhelmed and isolated. Our Educational blog series unpacks the complexities of RAD, the gaps in our healthcare system, and the stigma that surrounds it.
Parenting Strategies for Children with Reactive Attachment Disorder (RAD)
- Use calming phrases to defuse confrontations, for instance, “I’ll be glad to listen when your voice is as quiet as mine.”
- If the child tries to argue, deescalate the situation with phrases like “I understand.”
- Avoid arguments with the child. Maintain a calm manner and consistently state your expectations.
- If the child questions a consequence, respond with a non-confrontational statement such as “The sun is shining in Brisbane” or “The cockatoos are squawking.”
- Interrupting or asking you to repeat something frequently.
- Requesting to use the bathroom or get a drink excessively.
- Ignoring your questions or directives.
- Refusing to complete chores or tasks.
- Engaging in stealing or telling lies.
- Set slightly higher expectations for the child than they demonstrate at home or in therapy. This helps them learn to rise to challenges.
- Reinforce positive behaviours and downplay negative ones.
- Request the child to perform a problematic behaviour – by taking the joy out of challenging authority, oppositional children may be less likely to act out.
- If the child causes damage or steals, ensure they make amends. This is not a punishment but a way for the child to understand the impact of their actions.
- Establish and maintain eye contact. This aids in developing trust and connection.
- Try to maintain a respectful relationship with the child. Encourage them to see you as a source of guidance and support rather than just authority.
Create a Safe and Secure Environment: Children with RAD need to feel safe in their environment. Consistency, predictability, and clear boundaries can help foster a sense of security.
Use Therapeutic Parenting Strategies: Therapeutic parenting combines high levels of empathy and care with high levels of boundary-setting and expectation. It’s about responding to the child’s emotional age, not their physical age, and understanding their unique needs.
Engage in Attachment-based Therapy: This type of therapy is specifically designed to address attachment issues and can be very helpful for children with RAD and their families.
Take Care of Yourself: Parenting a child with RAD can be challenging. Remember to take care of your own mental and physical health as well. Seek support when needed, whether from support groups, friends, or professionals.
Involve the Child in Family Activities: This can help the child feel part of the family unit and develop stronger bonds.
Misdiagnosis of Reactive Attachment Disorder (RAD) and Associated Clinical Issues
RAD is a complex disorder that can sometimes be confused with or overlap with other conditions. One of the most common misdiagnoses is Attention-Deficit Hyperactivity Disorder (ADHD). Both RAD and ADHD can present with issues such as impulsivity, inattention, hyperactivity, and problems with social interactions. However, the root causes and optimal treatments for these two conditions can be quite different.
Potential Clinical Issues
It’s important to get the correct diagnosis because the interventions for RAD and ADHD are quite distinct. ADHD is typically managed with a combination of medication, behavioural therapy, and other interventions aimed at managing symptoms and improving functioning. On the other hand, RAD is often treated with attachment-focused therapies, which aim to build secure attachment relationships, and help the child develop healthy social and emotional behaviours.
A misdiagnosis can lead to ineffective treatment and unneeded medications. Furthermore, the child’s issues may worsen if their attachment difficulties continue to be unaddressed.
1. Initial Consultation: The psychologist will have an initial meeting with you and your child to understand the concerns and symptoms that led you to seek help. They will take a detailed history, including developmental, medical, family, and social histories.
2. Behavioural Observations: The psychologist will observe your child’s behaviour during different situations. This could be during a play session, while interacting with peers, or during interactions with you and other family members.
3. Use of Standardised Assessment Tools: These are questionnaires or checklists designed to assess specific symptoms and behaviours related to RAD. They might include tools such as the Child Behaviour Checklist (CBCL) or the Disturbances of Attachment Interview (DAI).
4. Collateral Information: The psychologist might also gather information from other sources such as teachers, carers, or other professionals involved in your child’s care. This helps them get a more comprehensive understanding of your child’s behaviour across different settings.
5. Differential Diagnosis: The psychologist will consider other conditions that might explain your child’s symptoms, such as ADHD, Autism Spectrum Disorder (ASD), or trauma-related disorders. This is a critical step to ensure that the correct diagnosis is made.
6. Feedback Session: Once all the information is gathered, the psychologist will provide feedback on their findings, including a diagnosis if one is made, and recommendations for treatment and management.
Remember, the process of diagnosing RAD is complex and requires a comprehensive, multi-faceted approach. It’s crucial to find a psychologist or mental health professional who is experienced in assessing and treating RAD to ensure that your child receives the correct diagnosis and most appropriate treatment.
Dr Samantha Joplin
Author
Dr Joplin is the founder of Joplin Clinic and has a special interest in complex paediatric presentations, including the diagnosis and treatment of Reactive Attachment Disorder (RAD). With extensive experience in working with children placed in alternative care and childhood/youth trauma, Dr Joplin is a respected authority in the field. She holds a Ph.D. in Paediatric Neuropsychology and is a member of The Child, Adolescent and Family Psychology APS interest group.