R.A.D Reactive Attachment Disorder Nicole Kramer & Kathleen Miller

Handout  What is RAD?  RAD is a complex psychiatric disorder that begins in infancy or very early childhood.  A markedly disturbed and developmentally inappropriate social relatedness in most contexts, beginning before age 5 years (Hardy, 2007).

Hand Out  Description of RAD:  A child’s attachment to primary caregivers is normally created during infancy and throughout the first few years of life. When child fails to find those attachments it can result in attachment problems and trust issues, which can cause in most severe cases RAD (Shaw, & Paez, 2007).  Older children and adolescents characteristics:  Poor cause and effect thinking  Little to no remorse for their actions  Self-esteem is generally low- feeling worthless, unlovable, and masked by anger  Controlling and manipulative

Handout(continued)  Many of the children have been physically, emotionally, or sexually abused, or may been received inadequate or even neglectful care (Lake, 2005).  Two distinct types:  Inhibited- tend to no initiate or respond to social interactions at all or in an appropriate ways.  Symptoms: physical and emotional delays, poor hygiene, poor motor development and coordination, and/or an unfocused, blank or bewildered expression  Disinhibited - socially indiscriminate (may be excessively friendly with strangers)  Symptoms: excessive familiarity or ‘Psychological promiscuousness’ with unknown people

Handout  Strategies/Interventions for RAD: * Most effective therapies and treatments will differ from child to child.  Child-focused therapies:  Psychotropic medications  Counseling  Holding Therapy:  Trying to recreate bonding cycle in infancy.  Therapist holds the child’s head in his or her lap and maintains eye contact with the child, while the other restrains the child’s arms and legs.  This goes on for 10 days with a total of 30 hours.

Handout (Continued)  Rebirthing Therapy:  More extreme form of restraint where the child is wrapped in a blanket to simulate the womb. Pillows are pushed against the child to simulate the contractions and the child must push their way out through the end of the twisted blanket.  Dyadic Developmental Psychotherapy (DDP):  Emphasizes a positive relationship with the child  Therapist would listen and reflect back the child’s experiences

Additional Information to share  Children who are hard to calm, irritable or unresponsive, because of temperament, illness, or a disability like autism or attention deficit/hyperactivity disorder (ADHD), can have harder time forming strong relationships  Domestic violence, poverty, and/or war can all play into effect of attachments being formed  As much as 3 to 6% of the general population may be affected by RAD.  RAD symptoms tend to worsen over the years without treatment

Information to share  Symptoms of both types of RAD often persist into adulthood.  Diagnoses are usually based on reports of symptoms, observable behaviors, family history and the clinical course of the disorder. This can be VERY tricky.  Many symptoms of RAD mirror and overlap multiple other childhood psychiatric disorders.

Information to share  Key elements of effective interventions are to target the underlying issues, not just the symptoms that accompany RAD.  Treatments should be designed to:  Raise self-esteem levels could help improve functioning  Social support  Involve the parents as well as child  Consistent and reflective in nature to provide structure  Earlier the interventions happen the better; might help prevent lifelong consequences.

Information to share  By the time children with RAD reach adolescences, many have accumulated comorbid disorders:  ADHD  Oppositional defiant disorder (ODD)  Posttraumatic stress disorder (PTSD)  Learning disabilities  Anxiety disorders  Depressive disorders  Mood disorders

Information to share  In school settings students are usually easy to pick out based on their antisocial or violent behaviors.  Many don’t believe they can succeed in school, which leads to acting out  Trouble learning from their mistakes and a poor sense of reality  Students with RAD need to feel as though they BELONG in a classroom or school setting.

Any Questions?