Sanctuary for the Abused
Saturday, November 24, 2012
Reactive Attachment Disorder (RAD)
RAD: What Is It?
As a fairly new diagnosis to the DSM-IV manual, Reactive Attachment Disorder (RAD), sometimes known as Attachment Disorder (AD), is frequently misunderstood, and is misdiagnosed as Bipolar Disorder or Attention Deficit Disorder (or even NPD) as often as 70% of the time.
Today, perhaps more so than at any point in history, kids are apt to be separated, ignored, or neglected by their birth parents, shuttled between multiple foster parents and day care workers, or traumatized by physical, sexual, or emotional abuse. Even while physically present, some mothers are yet incapable of providing adequate care and attention for their children.
RAD kids have learned that the world is unsafe, and that the adults around them can’t be trusted to meet their needs. They have developed a protective shell around their emotions, isolating themselves from dependency on adult caregivers. Rather than depending on their parents or other adults to protect them, the protective shell becomes the child’s only means of coping with the world.
Dependent only upon themselves for protection, they come to see anyone who is trying to remove this protective barrier as a threat, not to their emotional well being, but to their very lives. They turn on those who seek to help them the most.
People require attachments with others in order to develop psychologically and emotionally. Attachment is the bond that normally develops between a mother and her child during the first few years of a child’s life. The quality of this bond affects the relationships that a person will have for the rest of his life.
Attachment develops in the early years of life when a mother responds to her baby’s cries by meeting its needs, appropriately feeding, consoling, soothing, and comforting, as well as keeping the infant safe from abuse and harm.
Fundamental to RAD kids is that they haven’t bonded and are unable to trust. They have learned that the adults in their lives are untrustworthy. Trust hasn’t worked for them. Without trust, there cannot be love, and without love they are emotionally underdeveloped. Instead of love, rage has developed within them.
In the first few years of life, at a time even before they have learned to speak, they have learned that the world is a scary place, and that they cannot rely on anyone else to get them through it.
Normal parenting doesn’t work with RAD kids. Neither does traditional therapy, since these therapies are dependent upon the child’s ability to form relationships that require trust, something that is at the root of the problem. Sticker charts and behavioral programs don’t work because the RAD child doesn’t care what you think about his behavior. Natural consequences work better than lectures or charts. Structure is a necessity, but only when combined with nurturing.
While these kids can be healed, they have to want it, and the prognosis is not good. Without healing, these kids grow up unable to form healthy relationships with other human beings. Too often, these kids develop into sociopaths devoid of conscience or concern for anyone other themselves.
Stages of Conscience Development
Indicates stages of normal development. Some children do not move through stages within the time frames described below. Others seem to regress to Shame during adolescence. Attachment disordered children are often stuck in Pleasure/Pain.
The child does what brings him pleasure and avoids what brings him pain. The child has no inner moral code, and no awareness of other’s feelings or needs. This stage is typical of children under the age of three. Children with attachment disorder are often stuck here.
If I misbehave long enough, people will give up and I can do whatever I want.
You’re not my friend if you don’t take my blame.
The child feels bad when criticized or punished. The child feels shame. By apologizing, asking forgiveness, distracting behaviors, or a wide range of other coping skills, the child will focus on eradicating the feeling of shame, but not on changing the behavior that led to the feeling.
Sometimes a child will stick to one strategy for making the shame go away, whether it is effective or not. At this point in development, the child is not likely to be focused on the effects of his behavior on others. This stage is typical of children age 3 to 7.
Before the age of 5, children don’t understand the concept of possession. Normal kids may not understand stealing until the age of 9.
Children in this stage want the parent’s approval, but once they are out of your sight that’s not enough to sustain them.
I did something wrong and I want to make the shame go away.
If I think you’re watching, I’ll behave.
The child wants to live in a way that brings pleasure to himself and others. When the child hurts others, they see the effects of their behavior on on the other party, feel guilt, attempt to make amends, and change their behavior. The child tries to find another way to meet his needs without hurting others. Under good conditions, this stage is typical of children age 7 to 11.
Essentially honest and able to accept blame.
What would happen if everyone took things?
Basic Environmental Conditions for Emotional Health
A relatively stable, predictable environment in which the child knows how to get their needs met.
An environment in which the child can be stopped from hurting themselves and others.
A sense of being loved as a person, even after misbehaving.
An environment in which punishment or reward is based on the child’s behavior rather than the moods of adults.
Discipline Techniques for Each Stage of Conscience Development
With infants and toddlers in pleasure/pain who have little awareness of expectations, consequences, or other’s needs, our discipline approaches need to be based on:
Childproof environments to reduce tension.
Prioritize misbehaviors to be acted upon.
Rely on action and distraction rather than requests or orders.
Immediate use of timeouts after misbehavior.
Not recommended for attachment disordered children.
Continuous use of praise and rewards and other positive reinforcements.
Ignore minor misbehaviors when possible.
ShameWith young children who have some, but not enough, awareness of expectations and other’s needs, our discipline approaches need to be based on:
Communication of expectations and needs of others.
Restitution in order to make amends in addition to apologizing.
Develop a sense of empathy through constant discussion of emotional needs of others.
Use of logical and natural consequences to correct misbehaviors rather than
Continuous praise for proper decisions made by child.
Using invectives, surprise rewards, and tangible rewards to reinforce specific expected behaviors.
Both children and adolescents benefit when the important adults in their lives encourage discussion of:
Usual feelings and typical reactions to other’s behaviors.
The effects of their behaviors on others.
Negotiating problems by looking at options and the consequences that might result.
Parental expectations that the child regulate his own behavior.
Behavioral consequences to actions, yet avoiding the tendency to over-punish.
Praise to continue to reinforce expected behavior.
Rewards are often the inner pleasure the child receives by meeting expectations.
With Older Children and Teens in Pleasure/Pain, Add the Following Recommendations:
An environment with clear, predictable structure in which there are immediate positive and negative consequences for wanted and unwanted behaviors.
A short published list of rules that the child has signed and dated.
The rewards and consequences to behaviors are determined by the adult and the youth.
Caregivers who act rather than react. It may be a waste of time and energy to tell
the child to do something or not to do something if the adult is not prepared to follow up with action.
Adults who will protect themselves by limiting the power the child has over them.
Adults who will find others to support their self-esteem, get away regularly, and not let the child provoke battles in adult relations.
In Addition to Basic Behavior Modification, Effective Approaches for Working With a Child Stuck in Shame Include:
Emphasize restitution to the person harmed by their behavior.
Adults must prepare for the child’s efforts to make them feel guilty for the punishment.
Using descriptive, specific praise frequently.
Deal with the child’s misbehaviors before the adult gets angry.
Disconnect how the adult feels from how the child feels. The child may be unhappy, but the adult doesn’t have to be.
Talk about feelings only when the level of conflict is low; otherwise focus on behavior.