Horses and Zebras…and RAD

The importance of understanding Reactive Attachment Disorder

Sonia Billadeau March 19, 2014
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I first expressed my desire to be an adoptive parent at the age of 14; that goal was preceded by my declaration (at age 5) that I intended to be a veterinarian. Happily, I have achieved both goals, although I never would have guessed how unexpectedly those aspirations intertwined. I have learned much about life and people, and developed a variety of skills as a result of the education I have received from both arenas. As a student of veterinary medicine, I was expected to absorb voluminous amounts of information and apply it differently to a multitude of different species. The problem solving skills I developed have served me well as I continue my unexpected journey with attachment-disordered children.

I am often reminded of two sayings I learned while still a veterinary student. The first was, “If you hear hoofbeats in the woods, think horses, not zebras!” This was a favorite saying of several professors who grew weary of eager veterinary students diagnosing newly studied but rare and exotic diseases while missing the obvious! We were also admonished not to be a practitioner who used the “Aunt Minnie” approach to diagnostics:  “My Aunt Minnie had these symptoms and she died of this disease; you have the same symptoms, so you must have the same disease…..!” I still believe in these principles, although I apply them much differently these days.  My husband and I had added 3 children with special needs through adoption to our family before we really understood the ramifications of attachment disorder.  The agency we used did little to ensure that we were prepared for our undertaking, I had friends who tried to explain the possibilities that lay ahead. In this case, I really needed to be looking at zebras, but all I could see were horses! Children with Reactive Attachment Disorder (RAD) usually don’t have visible stripes or markings that clearly distinguish them from kids who are more capable of forming attachments. In fact, children with RAD can appear to be incredibly charming, calm, well-adjusted, tame little horses compared to their more normal and exuberant counterparts. Don’t get me wrong, I am not actually comparing kids to horses. I am only saying that my propensity to look for the obvious did not serve me well when it came to seeing what was more hidden and evasive.

As a result of my family’s experience with our troubled children, I have devoted a great deal of time and energy into the dissemination of information about RAD.  According to the Mayo Clinic, RAD typically begins before age 5.  Signs and symptoms may occur when the child is still an infant and may include:

  • Withdrawn, sad and listless appearance
  • Failure to smile
  • Lack of the normal tendency to follow others in the room with the eyes
  • Failure to reach out when picked up
  • No interest in playing peekaboo or other interactive games
  • No interest in playing with toys
  • Engage in self-soothing behavior, such as rocking or self-stroking
  • Calm when left alone

Signs and symptoms in toddlers, older children and adolescents may include:

  • Withdrawing from others
  • Avoiding or dismissing comforting comments or gestures
  • Acting aggressively toward peers
  • Watching others closely but not engaging in social interaction
  • Failing to ask for support or assistance
  • Obvious and consistent awkwardness or discomfort
  • Masking feelings of anger or distress
  • Alcohol or drug abuse in adolescents

I have found that some parents are adopting zebras when they think they are getting horses, and many mental health professionals seem to be diagnosing RAD kids using the “Aunt Minnie” theory. Sadly, the DSM-IV (Diagnostic & Statistical Manual of Mental Disorders) gives a very poor description of Reactive Attachment Disorder. Children with RAD often present to therapists and counselors as having symptoms of Attention Deficit Disorder, Attention Deficit Hyperactivity Disorder, or perhaps merely “depression”. Older children may be labeled “Oppositional Defiant Disorder” (more a description of certain behaviors than an explanation of their origin), “has Borderline tendencies”, or “Bipolar” (often exists concomitantly with RAD). Children with attachment disorder may become adults labeled as Sociopathic, Narcissistic, Antisocial or Borderline. Therapists have expressed the opinion that the description in the DSM-IV mandates that the diagnosis of RAD be made before the child is 5 years old. That is not the case. The DSM-IV states, “The onset of Reactive Attachment Disorder is usually in the first several years of life and, by definition, begins before age 5 years.”

Attachment therapists are not insisting that all troubled children are attachment disordered. If one would only learn the basic principles of attachment and formation of trust, it would be easier to understand how a troubled infancy and early childhood irrevocably impacts the future of an individual.  Parents, before you adopt, please learn the more subtle differences between a horse and a zebra. Both horses and zebras need the presence of other members of their species; however, the management of each is quite different. Their medical needs are rarely met by the same individual. Equine vets tend the more domesticated form, whereas zoo vets meet the needs of the horse’s unique cousin. Certainly, the presence of a zebra in the paddock amidst a herd of horses has the potential to be a disaster. Quite possibly, the zebra can be tamed, but it will undoubtedly cause some damage to the rest of the herd. If you are pursuing those hoofbeats in the woods, think horses and zebras!

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Sonia Billadeau


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