Reactive Attachment Disorder: The Extreme Consequence Of Extreme Adversity

"I have completely emotionally detached, given up all hope of a loving parent-child relationship with him. I look at myself as disaster control rather than a parent now. No respite care is available and no therapists that can help us. I am so, very, tired," were the words of one mother, the words nobody who becomes a parent ever hopes to speak, much less feel.

She described her son as manipulative, someone who can "fool" people into believing he's capable of forming real connections for a while, but also as one utterly devoid of empathy and remorse, and ultimately incapable of forming any true bonds with parents, siblings, grandparents, teachers, or anyone else. She described the run-away incidents, the outbursts of violence, the tendency to physically destroy anything within reach. This mom honestly, she shared, believed that this child hates her. Unfortunately, there were times when she came rather close to reciprocating the feeling.

Enter RAD, or Reactive Attachment Disorder. RAD has recently began entering the public consciousness as a psychiatric disorder affecting a percentage of adopted children, but the reality behind the term is so much more complex than anyone who has never encountered it first-hand could grasp. There are no magical solutions to RAD, but the above mom's story didn't quite end with her description of absolute despair, either.

What Causes RAD?

In order to thrive, babies and young children require consistent love and care provided by specific individuals — usually their biological parents. Over the course of normal and automatic human development, infants will begin bonding with those caregivers who meet those needs, resulting in an almost unbreakable bond of trust and love. Where a baby's needs are unmet, abuse occurs, they are bounced around from one foster home to the next — coming to see that natural primal relationship between care-giver and child as merely temporary, or cared for (or not, as the case may be) in orphanages, the normal attachment process is disrupted. Reactive Attachment Disorder may develop in such circumstances.

READ Abuse and Neglect Warning Signs: Prevent Child Abuse and Neglect

RAD does not only develop in adopted children but also in those with negligent or abusive parents. Most children in these situations do not go on to develop RAD, however, and exact data on its prevalence doesn't exist at this point in time. It is currently unknown why some children who faced extreme neglect, abuse, or disruptions in care-giving develop Reactive Attachment Disorder while others do not. What we do know is that RAD makes for one hell of a journey, both for those affected and their care-givers or parents.

How Is Reactive Attachment Disorder Diagnosed?

RAD Symptoms Diagnostic Criteria

RAD used to formally come in two types: inhibited and disinhibited. Since the advent of the DSM-5, they have now been separated into two distinct disorders, the other being disinhibited social engagement disorder (DSED).

Children with RAD may come across as withdrawn and apathetic, refusing to reciprocate or acknowledge acts of care. They may actively avoid a parent's or care-giver's attempts to comfort, hug, or care for them, turning to self-soothing actions rather than human interaction for comfort, and acting out aggressively in response to attempts to connect.

Disinhibited RAD, or DSED, children, on the other hand, do interact with care-givers on a social level, accepting hugs, attempts at comforting, and encouraging words. However, they do not discriminate between primary care-givers and others, frequently acting as if they are as familiar with strangers as they are with those who care for them.

Diagnostic criteria for Reactive Attachment Disorder as laid out in the DSM-5, the latest version of the diagnostic and statistical manual of mental disorders, include:

• Consistently displaying inhibited, withdrawn reactions to care-givers
• A pattern of both social and emotional disturbances
• A history of inadequate care in the child's past, a history that must be thought the direct cause of the above
• Symptoms are identified before the child reaches age five, and have been present for a minimum of nine months

How Is Reactive Attachment Disorder Treated?

Successful treatment depends on the child being in the care of stable primary care-givers, such as adoptive parents, and focuses on helping the child forge strong bonds with those care-givers. Therapy may be aimed at both parent(s) and children, in the latter case often through play therapy depending on the child's age. Though there isn't a single medication specifically designed to help children with RAD, medications may be used to treat certain behavioral patterns or sleeping difficulties.

It all sounds so neat, so simple, on paper. Reality is much more complicated. The mother from the beginning of this piece eventually did find therapy for herself, her husband, and their son. Recounting how very little was available in their area in the way of qualified therapists with knowledge about and experience with Reactive Attachment Disorder, she noted that even those therapists who claimed to be familiar with RAD often hadn't encountered it before.

READ Conflict And Neglect Changes Kids' Brains And Affects Health Through Adulthood

Recently, after years of making their family a "celebration-free zone" because their son would act out after any event at which it was made clear that he did now have a "forever home" and people to count on, they celebrated Christmas together, with family out of state. Our anonymous mom's son, previously having "threatened" to sabotage such events, made it clear that he was ready this time. Those days, she says, were some of the best they spent together, and there were no run-away attempts nor outbursts of physical violence afterwards. He is now 15. His journey isn't over, but now features more light than before.

RAD isn't for the faint-hearted. No magical solution exists. It's rare, yet all-encompassing to those who live under its shadow. There is hope, but not without reservation.