Reactive Attachment Disorder
The development process in children and adolescents is exceedingly complex. As a parent, you care deeply about your child and spend extensive effort fostering a healthy upbringing, but things don't always go according to plan. Despite best efforts, some children have a harder time navigating the world than others.
As the adolescent years progress, you may begin to notice signs that your teen isn't like his peers. He may be withdrawn, detached, or unable to behave normally in social settings. On the other hand, he may seek out as many social situations as possible, injecting himself into social groups and violating many understood boundaries of social interaction. Displays of affection may be treated with suspicion or, in contrast, extreme enthusiasm.
If any of these signs sound familiar, you're not alone. Your teen may be among those suffering from Reactive Attachment Disorder, or RAD, a severe yet relatively uncommon condition related to improper bonding with caregivers early in life.
What is Reactive Attachment Disorder (RAD)?
Reactive Attachment Disorder is a behavioral condition categorized by negligent care in childhood and insufficient bonding relationships with caregivers, most commonly mothers. Included in the 5th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-V) due to its predictable presentation and currently understood treatment practices, RAD presents in a small but critical percentage of the population.
The development of attachment begins in infancy when children are soothed, comforted, and cared for by their primary caregivers, including the consistent fulfillment of a child's base needs. This process teaches children to love and trust others, creating a basis for future relationships with family, friends, and even romantic partners. Additionally, healthy attachment as a child can positively affect self-image and self-esteem, leading to appropriate adjustment later in life.
The presence of RAD is directly linked to the development of emotional bonds before age 5. For children in abusive or neglectful situations without a comfortable, loving family environment, brain development may be permanently altered in a way that challenges an individual's ability to create healthy relationships. Many children who suffer from RAD were abused by their parents, entered foster care at a young age, or were placed in an orphanage or group home facility in infancy.
Attachment is vital in early development, and the absence of proper attachment can create problems that will last throughout adolescence and into adulthood. Unfortunately, missed stages in infancy are often very hard to overcome, and can create many complications, including delinquent behavior, trouble relating to peers, and a general distrust of others. However, through therapy, it can be possible to overcome the devastating effects of RAD.
How Common Is RAD?
Reactive Attachment Disorder is not a common condition, although the true incidence is largely unknown. The circumstances that can trigger RAD are comparatively rare in the United States, and only an estimated 10% of children who do not develop healthy attachments prior to the age of 5 will show symptoms of RAD in older childhood and adolescence. However, as many individuals suffering with RAD never seek treatment, few legitimate estimates of frequency are available.
RAD has been found to be far more common in populations predisposed to contributing environmental factors. For example, a study of 279 foster children found that nearly 20% displayed diagnostic indicators of RAD.
The Causes of RAD
The primary cause of Reactive Attachment Disorder is directly related to attachment and care of a primary caregiver prior to the age of 5. When care is irregular and undependable or nonexistent altogether, children do not learn the love and trust necessary to build strong relationships. This lack of attachment can occur in several different ways, including:
- Persistent disregard of a child's physical needs, including food, water, and physical comfort
- Consistent disregard of a child's emotional needs, like love, attachment, soothing, and comforting
- Regular changes in primary caregivers, such as changes in foster homes
- Physical abuse
Children born into a normal, nuclear family and raised by loving parents or caretakers are generally at no risk of developing RAD. Risk factors, however, include:
- Inexperienced or disinterested parents
- Life in an orphanage or institution
- Regular changes in foster homes or caregivers
- Physically or mentally abusive situations
- Extreme neglect
- Prolonged hospitalization or care outside of a home environment
- Significant poverty
- Parents with drug abuse or alcohol problems
- Mentally ill parents
Signs of RAD
Reactive Attachment Disorder can affect all areas of a child's development, but signs become clearer as children begin to build independent relationships with their peers. In most cases, symptoms displayed fall into one of two main subtypes: inhibited and disinhibited. Some children may show signs from both categories, while others will limit behavior to just one.
Inhibited RAD involves reclusive and antisocial traits. Children may be detached from their peers and often avoid comforting efforts. They are withdrawn and avoidant, resisting relationships with both family members and friends.
Symptoms of disinhibited RAD are largely opposite of inhibited RAD, with children attempting to force themselves into relationships with virtually anyone in a socially indiscriminate manner. They may try to develop attachment relationships with inappropriate individuals, and often ask for help from anyone who will listen.
In relationships, those with RAD may be manipulative, controlling, or untrusting. They may blame themselves for mistakes or lash out when emotional responses don't fit with expectations. RAD sufferers can also be moody, angry, or depressed, and most have a negative self-image that may be extremely difficult to overcome. Some children will also show a lack of remorse for their actions, and a lack of empathy for others' feelings.
Dangers in Not Treating RAD
Left untreated, RAD can prove to be crippling. Individuals with RAD will be largely unable to develop healthy relationships with anyone, including family members, peers, coworkers, and bosses. This can bleed over into everything from romantic partners to career growth, impeding every activity that involves social interaction. The long-term ramifications are extensive, including:
- Anger problems
- An underdeveloped conscience
- Strong aversion to physical touch
- Inability to feel compassion toward others
- Control issues
- Problems with authority
Those with untreated RAD usually do not date well, have problems finding a partner to marry, are unlikely to have children, and may not be able to hold jobs for more than several months. Living a normal life is generally very challenging.
Substance Abuse and RAD
For children with diagnosed or undiagnosed RAD, coping is an uphill battle. Those suffering with RAD often realize that they are different, but may not understand how or why, or what can be done to remedy the problem.
Teens unable to make friends or maintain social groups for any reason often turn to drugs and alcohol, and RAD is no different. Using drugs to loosen up, fit in with others, or mask feelings of dwindling self-worth or self-hatred is unfortunately common for those with RAD. Unfortunately, this can further negative feelings, deepening many of the underlying issues at hand rather than providing relief.
Drug use often accelerates rapidly for those with RAD, especially as continued dosages do little to treat feelings of inadequacy and anger. For this reason, teens with RAD are often highly susceptible to drug abuse or addiction.
Treatments for RAD
For most patients, RAD is treated proactively through therapy. This process is most effective when coupled with two necessary qualities:
- A safe, comfortable place to call home
- Positive interactions with caregivers and parents
There's no standard approach to therapy and counseling strategies will depend greatly on the personal factors that led to RAD, including events in early childhood. The goal of therapy is to help children learn how to trust, to behave appropriately with peers, and an overall sense of security, both with others and with oneself.
Most treatment strategies for RAD include a focus on relationships; treating RAD doesn't necessarily attempt to address anger and behavior to create a bond, but rather creates bonds to facilitate independent behavioral shifts. Therapy can take years of effort, but many affected children are able to show great progress with adequate time and attention.
How We Can Help
While Teen Treatment Center is not focused specifically on addressing behavioral issues, we are able to treat many co-occurring disorders that contribute to substance abuse and addiction. If your child has been using drugs or alcohol to cope with the effects of RAD, our highly trained therapists are prepared to assist. We have extensive experience working with those with behavioral problems, including RAD, helping to treat the underlying causes of drug abuse rather than simply working to temporarily ameliorate surface issues.
The road to recovery for RAD isn't easy, but we are prepared to help your child take positive steps forward. In our safe, supportive environment, we can lay the foundation for a healthier approach to relationships and attachment. Through a combination of coping strategies, proven therapeutic techniques, and a loving, caring place to call home throughout recovery, our patients can learn to build self-esteem and self-confidence in a way that negates the need for drugs.
Recreational drug use can be hard to control even with a positive mental state. If your child is experiencing symptoms of RAD and shows signs of drug use, Teen Treatment Center is here to help. Please contact us today at (844) 611-2175 to learn more about how we can help your teen move beyond his addiction while working through the complex effects of Reactive Attachment Disorder.
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