Reactive Attachment Disorder or RAD is one of those terms thrown around rather imprecisely. It is often used as a catch-all term for children who are struggling due to problems in their past. Our first step needs to be to discuss what RAD actually is and to discuss other terms that might be a better choice.
Reactive Attachment Disorder (RAD) – This is the condition which occurs when a child has experienced significant abuse and/or neglect as an infant or very young child. These adverse childhood experiences cause the child never to form an attachment with the caregiver. As a result, it becomes difficult for the child to form a secure attachment to anyone. RAD is at the extreme end of the spectrum of attachment challenges. Parenting a child with RAD can be overwhelming for the parents.
Attachment Disorders – Attachment disorders are a spectrum, and not every child who has experienced trauma falls at the extreme end. A child, for the same reasons stated above or because of other trauma and/or neglect, can develop problems attaching with a caregiver, but these problems are not as pervasive or as severe as a child diagnosed with RAD.
PDD or Pervasive Developmental Trauma – These are both terms to describe how a child reacts to previous trauma. While we normally think of PTSD as related to trauma associated with war, it can also describe what happens to a child in an abusive or neglectful situation. Some therapists and doctors prefer to use the term Pervasive Developmental Trauma to describe the global effects that trauma has on a growing brain, but due to its lack of inclusion in the DSM-IV (Diagnostic and Statistical Manual of Mental Disorders published by the American Psychiatric Association), it is not a term used universally or as an official diagnosis.
There is significant overlap in cause and effect between these three categories, and this can cause confusion. All three come with a hefty dose of fear, anger, and a lack of trust. Children with genuine RAD can be superficially charming to non-family members, but so can children suffering from Pervasive Developmental Trauma. Fear can cause raging or disassociation. And it can be difficult to know if a child is not attaching to a caregiver because her early experience never allowed her to learn to form personal bonds or because she formed a bond and then was hurt by it being severed. While there is nothing clear or simple about any of the effects of trauma, remember that there is a broad spectrum of attachment and related disorders. The term “RAD,” while frequently applied to a wide range of behaviors, actually applies only to the most serious extreme of this spectrum.
There are a few things that parents can do that can often help.
1. Connected Parenting – Children affected by trauma do not respond well to traditional, consequence-based parenting styles, which are far more likely to hurt the child and the parents’ relationship with the child. In contrast, connected parenting looks for the reason behind the behavior and places a high value on the relationship between parent and child. It helps build trust and puts the parent on the same team as the child.
2. Healthy Habits – Children affected by trauma have brain and body systems that need support. This means in practical terms that sleep, hydration (with water), and protein (as often as every two hours) can help the child maintain equilibrium. Exercise, especially large muscle exercise such as running and jumping, are also vitally important.
3. Find Outside Help – The more extreme a child’s behaviors, the more important it is to find a good therapist to help. Often, a child significantly hurt by trauma has more issues than a well-intentioned parent can manage. This is particularly true with a child who has a genuine RAD diagnosis, as the potential for the child growing into an adult with personality disorders is high. Finding a support group made up of other parents dealing with similar things can also be helpful.
4. Find Support – Parenting a child with a trauma history can be difficult and frustrating. It can take a toll on both the parents and the parents’ marriage. Finding outside support is extremely important, whether it is a good friend who is a supportive listener or a therapist who can help with the feelings that such parenting brings up.
In short, all children with a true RAD diagnosis have experienced trauma, but not all children who experienced trauma will manifest RAD. Be on your child’s team, search out the best help for them, and remember to find help for yourself as well.