Content note: This post contains mention of childhood abuse and trauma. Please exercise discretion if this is something that may be triggering or upsetting.

Reactive Attachment Disorder (often called RAD) is a childhood disorder characterized by:

• A consistent pattern of emotionally withdrawn behavior toward caregivers, shown by rarely seeking or not responding to comfort when distressed
• Persistent social and emotional problems that include minimal responsiveness to others, no positive response to interactions, or unexplained irritability, sadness or fearfulness during interactions with caregivers
• Persistent lack of having emotional needs for comfort, stimulation and affection met by caregivers, or repeated changes of primary caregivers that limit opportunities to form stable attachments, or care in a setting that severely limits opportunities to form attachments (such as an institution)
• No diagnosis of autism spectrum disorder

In the general population, RAD is believed to occur in 1.4% of children under the age of 5. However, this may be an under-estimate, as many families do not seek help for the symptoms, or know that help is available. Often when a child has a RAD diagnosis, they have experienced extreme neglect and/or abuse during their early childhood. The first child I saw with RAD was during my graduate training. (I will call her Sarah in this story, though both the name and any identifying details have been changed.) Both of her parents were multi-substance abusers, and were unable to attend to her needs when they were impaired. Additionally, they allowed their fellow drug abusers to cycle through their home, exposing their daughter to not only more witnessing of drug abuse, but also sexual and physical violence at the hands of her parents’ “friends.” Sarah was removed from her home at age 8, and was placed with her grandparents, where she had a stable, healthy home environment for the first time in her life.

Problem solved, right?

Unfortunately, no.

I look at RAD as a series of behavioral habits that have been learned over a period of time.

Like many children who have experienced neglect, Sarah stole and hoarded food. On the surface, this may just look like “bad” behavior, especially if viewing the behavior without the trauma lens. However, knowing Sarah’s background and understanding that, through many periods of her childhood, there was no food in her house. She had learned to save food from school and from the times when her parents were in a mental space to remember (and could afford) to buy food. Though she wasn’t in the same situation any more, the instinct to save herself from hunger was still there.

Similarly, like many kids raised in environments of abuse and neglect, Sarah had no self-regulation skills. (I’ve talked before about how important self-regulation skills are!) When parents cannot or do not attend to their children’s emotional needs, children cannot develop the skills to regulate their own emotions. So then why, in a stable situation, would Sarah have suddenly been able to connect to her caregivers emotionally? For kids with RAD, we see extremes in behavior—standoffishness that can’t be dismissed as being shy (a true unwillingness to allow people to get close to them), or immediate hyper-connectiveness that often puts the child at risk of future sexual or emotional abuse.

Not being able to self-regulate can look like age-inappropriate tantrums too. I’ve seen kids with RAD diagnoses scream like infants when they’re suffering. Those needs weren’t met when they were at the developmental stage of infancy, so when they feel those same needs aren’t being met, they return to the behavior that they engaged in at the time.

So what’s to be done?

People with RAD aren’t hopeless. (One of my personal biases is that people have an immense capacity for change, and are remarkably resilient.) However, change has to be precipitated by safety in the home environment and community. I can’t teach you that you’re safe if you’re not in fact safe. (In fact, that’s incredibly unethical and dangerous.) Studies have been done recently that show that therapy, even with “temporary” parents (i.e., foster parents), can be healing and bring about lasting change and progress. The key to making lasting, positive behavioral change is “providing a stable environment and taking a calm, sensitive, non-intrusive, nonthreatening, patient, predictable, and nurturing approach toward children” (Haugaard; Nichols, Lacher, & May). Fortunately, that’s something that specially-trained therapists can help you with! Contact True North Counseling for your first appointment.