RAD vs. Attachment Disorder

Reactive Attachment Disorder is a diagnosis from the DSM IV, the Diagnostic and Statistical Manual, 4th edition. It is used by all mental health professionals for diagnosis and by insurance companies. Attachment Disorder is a broader term describing a person who has had experiences in the first few years of life that have damanged that person's capacity to form authentic affective ties to others. All children with RAD have an attachment disorder, but not all people with an attachment disorder have RAD. Hope this helps.

Hi Dr Art, How do you recognise/diagnose a child with this disorder, what behaviour might they display?

There needs to be a history of maltreatment during the first two or so years of life. The specific symptoms and behaviors can vary and may include difficulty accepting affection on the parent's terms and any of others...you can find a list on my website. You should get a through assessment. but along with the history I described, you might see severl (five or more) of the following: 1. My child teases, hurts, or is cruel to other children. 2. My child can't keep friends for an age-appropriate length of time. 3. My child doesn't do as well in school as my child could do even with a little more effort. 4. My child pushes me away or becomes stiff when I try to hug, unless my child wants something from me, in which case my child can be affectionate and engaging. 5. My child argues for long periods of time, often about meaningless or silly things. 6. My child has a large need to control everything. 7. My child is hyper-vigilant. 8. My child acts amazingly innocent, or pretends that things aren't really bad or a problem when caught doing something wrong. 9. My child does dangerous things such as runs away, jumps out of windows, or other potentially harmful actions. My child seems oblivious to the fact that my child may be hurt. 10. My child deliberately breaks or ruins his things or other's things. 11. My child doesn't seem to feel age-appropriate guilt when my child does something wrong. 12. My child is impulsive. My child seems unable or unwilling to stop doing something my child wants to do. 13. My child teases, hurts, or is cruel to animals. 14. My child steals, or shows up with things that belong to others with unbelievable, unusual, or suspicious reasons for how my child got these things. 15. My child likes to sneak things without permission, even though my child could have had these things if my child had asked. 16. My child doesn't seem to learn from mistakes, consequences, or punishments (my child continues the behavior despite the consequences). 17. My child makes false reports of abuse or neglect. My child tries to get sympathy from others, or tries to get us in trouble, by telling others that I abuse, don't feed, or don't provide the basic necessities. 18. My child seems not to experience pain when hurt, refusing to let anyone provide comfort. 19. My child does not usually ask for things. My child demands things. 20. My child lies, often about obvious or ridiculous things, or when it would have been easier to tell the truth. 21. My child is quite bossy with other children and adults. 22. My child hoards, sneaks food, or has other unusual eating habits (eats paper, raw sugar, non-food items, package mixes, baker's chocolate, etc.) 23. My child often does not make eye contact when adults want to make eye contract with my child. 24. My child has extended temper tantrums. 25. My child chatters non-stop, asks repeated questions about things that make no sense, mutters, or is hard to understand when talking. 26. My child is accident-prone (gets hurt a lot), or complains a lot about every little ache and pain (needs constant attention). 27. My child acts cute or charming to get others to do what my child wants. 28. My child is overly friendly with strangers. 29. My child has set fires, or is preoccupied with fire. 30. My child prefers to watch violent cartoons and/or TV shows or horror movie (regardless of whether or not you allow your child to do this). 31. My child was abused/neglected during the first year of life, or had several changes of primary caretaker during the first several years of life. 32. My child was in an orphanage for more than the first year of life. 33. My child was adopted after the age of twelve months.

Dear Dr. Art I am a foster parent to 3 children, the youngest (4.5) of which was diagnosed last week with RAD. I have scoured the internet since I was given this information and the more I read the more anxious and apprehensive I become. Of your list of 32 potential problems my foster child fits all but 5, including #30 dealing with abuse/neglect at the hands of his bio-parents. Is this an indicator as to the severity of this boys problem? I am comitted to helping him and am trying to educate myself but am beginning to fear that this may be over my head. Thanks Pogie

Don't dispair. There is hope and help...IF YOU GET THE RIGHT treatment. Generally, usual treatment such as family therapy, play therapy, individual therapy are ineffective treatments for children with RAD. The only effective treatment for such children (meaning the only treatment with empirical evidence to support it's efficacy) is Dyadic Developmental Psychotherapy (at my website you can find the results of a follow-up study we completed and also other studies published in professional peer-reviewed journals. You should be able to find a therapist in your region who is trained and experienced in working with adopted and foster children and who is specifically trained in attachment-based treatment at [url]www.attach.org[/url] The Assoc for the Treatment and Training in the Attachment of Children. You might also want to read Attaching in Adoption by Deborah Gray, Facilitating Developmental Attachment by Daniel Hughes, Ph.D., and When Love is not Enough by Nancy Thomas. However, you do need to realize that most children with RAD need BOTH attachment-based treatment by a trained certified therapist and attachment-based parenting. Our study found that over one year after treatment ended over 90% of the children continfued to experience excellent results (meaning all variables measures in the "normal" range). Best regards...

Dr. Art, I have two children with attachment disorders, my daughter with the more severe RAD symptoms of the two. They are 8 and 9 years old. We have been in behavioral therapy for over a year. My daughter shows signs of escalating behaviors. She started lying and stealing. Her impulsiveness is getting worse. She has been on adderall and is now starting strattera. the meds help but nothing is perfect. Just yesterday I asked our therapist when we would begin teaching my son to try to control his emotions. He has emotional regulatory issues impacting my other two children. She immediately got defensive and blurted out that I should seek another counselor. She has been working very hard with my son behind a closed door. She has been working on him to verbalize his feelings instead of jumping off the wall. He has been bringing her 'pearls' every week. These are insights into what happened to him in Russia that she has never made me privy to. He had a melt down yesterday and my husband and I are just as lost about what to do as we were a year ago. What concerns me most is that he has been on medications (risperdol) this year which really has calmed him down. The therapist told me at the beginning that this would make him more suseptable to therapy and eventually he would be able to get off of this. I think we have made little progress. What should I expect in the way of progress? I am beginning to think this is not the right therapy. I have begun making inquiries to try to find 'attachment therapy' in our area. What kind of progress should I expect with the right therapist? Am I being too hopeful? The current therapist has lost all of my trust and confidence because she told me last night that this was as good as it was going to get! She said he may never get off of the meds. She has given up!

A good therapist who can do attachment work will meet the following criteria: 1. Be a licensed Mental Health provider 2. Have SUBSTANTIAL training and experience in evaluating and treating families who have trauma-attachment disorders. The training should be from a nationally recognized training program such as that provided by Danile Hughes, Ph.D. or our program, or the Attachment Center at Evergreen, to name a few. 3. Over 25% ot the practice should be with adopted and foster children. 4. The therapy must be attachment-based...Meaning involving the parents in all sessions or have the parents view the sessions on closed circuite TV...NO sessions with a child alone without the parent in the room or observing!! Children with trauma-attachment problems DO NOT HEAL with family therapy, play therapies, RTC's or other such usual care. The only evidence-based effective treatment is attachment based treatment, such a Dyadic Developmental Psychotherapy. My website has the results of an outcome study clearly demonstrating this. You should look at the other info on my site as well. Fiinally, you may be able to find such a competant therapist on the website [url]www.attach.org[/url] Regards,

"4. The therapy must be attachment-based...Meaning involving the parents in all sessions or have the parents view the sessions on closed circuite TV...NO sessions with a child alone without the parent in the room or observing!!" Never without the parents. An unattached child can really work a therapist. He could be making up a really good story about Russia. He could also make up a really good one about you that could land you in jail. Besides, he can't attach to you if you're not there. Risperidal is an antipsycotic medication. If it is helping your son, I'd question what other diagnosis he has. RAD does not respond to medication as it is a thinking disorder. In case you're questioning yourself, you were right and your therapist was wrong. She blew up at you because you know more about your child's disorder than she does which put her on the defensive. While persuing a qualified attachment therapist(drive where ever you have to to find one), you might look at Nancy Thomas' material to give you some parenting tools to work with as normal parenting won't work with this disorder. It will also help you feel less crazy as you realize this is the child and not you. Love and logic techniques(Foster Cline and Jim Faye) are helpful, also. I woul find it very unlikely that an eight or nine year old is too far gone for help. More challenging, maybe, but not hopeless by any means.

Dr. Art...I came to this website because I needed to reach out to others for support since I am going through grieveing the loss of a relationship with my daughter after she found her birth relations...I look at this list of RAD behaviors and a light turned on...this is her!!!!! she is 24 now and has two kids...what can be done??? Is there snything I can do??? She seems happy and this explains a lot to me as to her weird behavior of abandoning the ones who raised her...thank you...thank you...I am so much more at peace reading the posts on this board....

Dear Lynn, My pleasure...your welcome. I think you'll find lots of help on these boards. Regards,

Reactive attachment disorder was first identified in me at the age of 11 at I am now 28 years old, but we have been dating for a while. Stay strong, everyone; there is someone out there for you.