Reactive Attachment Disorder:
Etiology, Symptoms, Affected Brain Areas and Treatment
Reactive Attachment Disorder (RAD) is characterized by considerably disturbed and inappropriate social interaction, across situations, that is manifested before the age of five (DSM-IV-R). Evidence for the disorder is usually seen in continuous failure to respond appropriately in social situations (being hypervigilant, inhibited, or ambivalent) and/or inability to develop and exhibit selective attachment to primary caregiver(s) (DSM-IV-R). The causes for the disturbed behavior in Reactive Attachment are associated with the developmental stages of Infancy and Early childhood, when pathogenic care can have profound and lasting effects. DSM-IV outlines three aspects of pathogenic care that explain the disturbance in normal development and behavior: persistent disregard for the child’s physical and emotional needs, as well as repeated changes of primary caregiver and/or surroundings. The connection between pathogenic care and disrupted behavior is compelling and reminds of the critical importance of nurture and effective parenting. Many psychologists have studied in depth child development during the first years of life and reveal that this is an extremely sensitive period for both physical and emotional development and maturation. It is a critical time for cultivating attachment, social skills, developing empathy and understanding basic values.
Maltreatment, no matter whether it is abuse, neglect, abandonment, or witnessing violence, can lead to enduring negative changes in the still developing brain of a child. Each time there is some sort of traumatic experience, the brain suffers a particular change. Many of the brain abnormalities that have been studied in abused and neglected children are located in the left hemisphere. Very often, in children, victims of abuse, there were fewer dendritic connections between different areas in the left hemisphere (Gunnar & Vazquez, 2001). Children that had showed such abnormal results demonstrated self-destructive or aggressive behavior, as well as certain disturbances in behavior, thinking and physiology (higher blood pressure, heart rates temperature, hyper vigilance) (Gunnar & Vazquez, 2001). Studies of neglected children found that their cortex was about 20 percent smaller than that of a control group of subjects (children) who have not suffered neglect (Gunnar & Vazquez, 2001). The data is compelling and reveals that providing stable environment of nurture is of utmost importance. About 1% of children who have developed insecure-ambivalent attachment develop RAD (Lehman and Jegtvig, 2004) and without intervention, support and help, many of these children might grow up to develop Antisocial Personality Disorder and live a disruptive life. Eventually, many of these individuals end up in correctional facilities. This compels helping professionals to promote and teach effective parenting and explain the implications of early childhood stress. In addition, the issue has to be considered within the context of adoption and foster care where, very often, children would be moved often and are being exposed to very different/inconsistent treatment and living conditions.
The non-pharmaceutical treatment of RAD appears to be more successful and beneficial than the behavioral medical model (Lehman and Jegtvig, 2004). It utilizes the attachment model as described by Dr. Daniel Hughes in his book “Building the Bonds of Attachment: Awakening Love in Deeply Troubled Children.” The emphasis is on effective parenting - nurturing holding, eye-contact, providing opportunities for enjoyment, encouragement, unconditional love and being a model for self-regulation abilities (Daniel Hughes). Parents and caregivers are to love, nurture, accept and respect the child, so that he/she can grow healthy and happy. Also, professionals in the helping field need to unite their efforts in attempt to educate people and advocate affective parenting and children’s well-being.
This is a very interesting article. It quite nicely summaries some important information about an important subject quite well. You might want to take a look at an article on my blog:
http://artweidman.wordpress.com/2009/04/23/effects-of-child-abuse-on-child-development-brain-and-behavior/
or on my website’s blog:
http://center4familydevelop.blogspot.com/2009/04/child-maltreatment-effects-on-brain.html
regards
Hughes? That’s Attachment Therapy! Look what Hughes says about treating children. He has no respect for them. Geez, you are legally allowed to do this to kids today? Isn’t this child abuse?
http://www.childrenintherapy.org/proponents/hughes.html
Becker-Weidman and Hughes seem to be two peas in the same pod.
Hello there!
First of all, I’d like to thank you for your comment. I appreciate your opinion on the subject.
I believe I understand why you might have that impression about Daniel Hughes’ methods. However, I disagree he has no respect for children. Unfortunately, good and effective parenting (the very thing these children have not experienced) involves a lot of discipline – positive and negative reinforcers, and even punishment (which should never be physical). These are critical components to any learning process and is especially important with little children, who are yet to form their habits.
The important thing to consider here is that children with Reactive Attachment Disorder are not the average happy and healthy kids one might imagine. (I don’t know if you have had any experience with kids suffering RAD?) Generally, they are very aggressive, disobedient and, often, tend to lie and try to manipulate. Most importantly, however, they are not in the habit of trusting and loving an adult, so any attempt to hold the child is usually followed by an outburst of anger, kicking, screaming, etc. That is why Hughes explains, in the therapy, you have to even struggle with the child, “until she/he complies”. If you think about it, this is the only way to show the child ‘I’m not giving up on you and no matter how hard you kick and scream, I will be here.’ However, Hughes reminds, the adult should always maintain a friendly tone and never, ever humiliate the child. Most of his principles are listed on the following website: http://www.radkid.org/dhughes.html
I would love to continue the dialogue, so feel free to let me know what you think.
Respectfully,
Dima
Dr. Becker-Weidman,thank you for reading and for the kind comment. I enjoyed reading the articles on your website.
Best regards,
Dima
RAD related behaviors often present as challenges for children in care. Do you think following the suggested approach has a possible connection to the outcome of multiple placement breakdowns as foster parents engage in the approach only to find out their family sytem can not maintain such an intensive long term process.
This is an excellent point! Thank you for sharing.
RAD related behavior can be very burdensome on foster parents and their families. The approach requires an enormous amount of dedication and patience and can often be more than a family system can endure.
In order to be able to help the child and administer this approach effectively, the parents have to be familiar with RAD (symptoms and etiology). The first step to approaching the child has to be understanding the condition. It is critical that the parents realize this is a disorder (often, the result of maltreatment). The child is not being intentionally ‘mean’. On the contrary, I believe that the child is the real victim in these cases.
An important component to effective intervention is getting professional help. Parents, including foster parents, often need to work alongside counselors and/or psychologists/psychiatrists. Unfortunately, many families do not have the means to meet such expenses. This raises additional questions; e.g. are foster families provided with adequate support and information?
RAD related behavior is more demanding than many people imagine and it affects everyone in the child’s life, including siblings and extended family. Often, foster parents realize they cannot deal with such burdensome family dynamic and give up on the child. More often than not, this can only aggravate the situation and reinforce the child’s belief that they cannot and should not trust an adult.
I am certainly not judging foster parents, but I am convinced that with more professional help and public support we can increase the chances of successful intercession.
A fine discussion here.
Parenting a child who has experienced chronic early maltreatment is very challenging and difficult. For those who may be interested, I’ve co-edited a book for such families. The basic approach is Dyadic Developmental Psychotherapy, which is an evidence-based, effective, and empirically validated treatment. The approach is grounded in attachment theory and is fully compliant with the ATTACh White Paper Against Coercion and their professional Practice Manual and Therapeutic Parenting Manual (see http://www.ATTACh.org)
The book is Attachment Parenting: Developing Connections and Healing Children. See
http://www.amazon.com/Attachment-Parenting-Developing-Connections-Children/dp/0765707551/ref=sr_1_2?ie=UTF8&s=books&qid=1272842596&sr=1-2
regards