Reactive attachment disorder is a serious attachment disorder that affects infants and makes it increasingly difficult for them to develop emotional attachments with their primary caregiver and others. RAD has been listed in the DSM-IV (Diagnostic and Statistical Manual of Mental disorders). The symptoms of this psychiatric illness manifest before the age of five, however, observant caregivers may notice behavioral warning signs in the child at a much earlier age as well.
An Overview of RAD
When a baby/child is ignored and not given adequate care and attention, he/she may develop a dislike towards the primary caregiver. He/she is likely to find it difficult to establish relationships and trust others wholeheartedly. There are plenty of causes that can lead to this attachment disorder in a child; and if steps are not taken to prevent it, it can lead to more pronounced behavioral problems as the child grows older.
In reactive attachment disorder, the child fails to develop a bond with the caregiver. There are no sure-shot causes that lead to this disorder. However, in most cases, the hostile behavior or sheer neglect by the primary caregiver is believed to have triggered the disorder in the child. Many children with RAD have either been physically or emotionally abused and neglected. Such neglect and maltreatment may have occurred within the home setting or out-of-home setup, such as an orphanage, foster care, hospital, institutional or residential program. Such hostile and resentful behavior adversely affects the psyche of such children, thereby making them feel unsafe in the company of their caregiver.
Symptoms in Babies
- The baby cries inconsolably
- Avoids any cajoling from the caregiver.
- The baby never smiles and is often sullen.
- Babies normally react when you leave them alone, but babies with reactive attachment disorder do not show any such signs.
- The baby avoids eye contact and doesn't react or make any noise when the parent is around.
Symptoms in Children and Adults
Children above 3 years of age and adults may show the following symptoms.
- Depression and anxiety.
- Inappropriate familiarity with strangers.
- Do not display any affection or inclination to talk to family members or peers.
- Passive aggressive behavior.
- Delayed learning and stunted physical growth.
- Learning difficulties at school.
- Lack empathy.
- Not eating enough or gorging.
- Hiding emotions and acting detached.
- Low self-esteem.
- Aggressive or defiant behavior. (Kay Hall & Geher, 2003; Millward, 2006)
These signs can sometimes be contradictory. According to the Diagnostic and Statistical Manual of Mental Disorders (4th ed.; DSM-IV), RAD can be classified into inhibited and dis-inhibited behavioral subtypes. In the inhibited type, children isolate themselves from any social setting and stay away from strangers. Whereas, in dis-inhibited type, children tend to seek attention and affection from any familiar adult as well as strangers, while avoiding their primary caregiver.
The symptoms of this disorder can easily be confused with other disorders, thus, only a certified psychologist can effectively diagnose it properly. The diagnosis includes a thorough evaluation of the child's behavior, past experiences, and his/her family members. The therapy begins once the disorder is confirmed, however, a second opinion is recommended to reconfirm the presence of this disorder in the child.
The first aim of therapy, is to ensure that child is gradually provided with a sense of security and stability. The environment where the child lives is evaluated and steps are taken to ensure that he/she is provided with a safe and pleasant environment. This step is relevant for children who have experienced neglect and emotional/physical abuse at the hands of a parent, foster parent, or at an orphanage. The treatment for this illness involves increasing positive interaction between the child and caregiver.
The treatment procedure combines the efforts of the therapist, caregiver, and the child. The therapy makes use of Behavior Management Techniques (BMT), individual psychological counseling, imparting parenting skills and commands, and therapy exercises that must be done as a team with the help of the caregiver. Medications are prescribed only after assessing the severity of the child's condition and only if therapy fails to yield positive results.
The caregiver is educated about the disorder and is taught appropriate parental techniques to show positive behavior towards the child.
If your child has been diagnosed with RAD, you may consider seeking counseling for yourself as well. Your psychologist will be able to guide you and your child towards building a healthy and balanced relationship. You must aim to give your child all the attention necessary to help him/her feel safe with you. Suppress your anger when the child is behaving inappropriately. Talk and play with your child, and make him/her understand emotions like love and care.
Apart from the behavior of the caregiver, other techniques such as making the child join a social and personality development group, can help improve his/her self-esteem and anxiety issues. The significance of a balanced diet and adequate exercise cannot be ignored. Ensure that your child gets enough sleep and is given a stress-free environment to live in.
It is completely understandable if you as the primary caregiver, feel frustrated and annoyed by your child's behavior. The key here, is to remain calm and engage the child and yourself in some calming techniques under the supervised guidance of your therapist.