Reactive Attachment Disorder, or RAD, can develop after a child has experienced inappropriate or pathogenic care from a parent or another caregiver. There are a variety of caregiving scenarios that would be considered “inappropriate or pathogenic.” Some of the caregiving scenarios that increase the risk of a RAD diagnosis include, but are not limited to:
- Exposure to abuse—physical, sexual, or emotional—and neglect during the formative years (birth to 5)
- Exposure to domestic violence during the formative years
- Inconsistency in primary caregivers / multiple primary caregivers and child care providers during the first few years of life
- Multiple foster home placements or living in an orphanage
- Living with a depressed, addicted or mentally ill parent
When a child experiences a caregiving environment like this, he or she is more likely to develop RAD, but it isn’t guaranteed. Some children will develop emotional and behavioral symptoms in response to this environment, but a diagnosis of RAD can only occur if all of the following symptoms are present before age 5:
- Consistent pattern of inhibited, emotionally withdrawn behavior towards adult caregivers (i.e. the child doesn’t seek out comfort from an adult and refuses to accept or respond to comfort from an adult when distressed)
- Persistent social and emotional disturbance characterized by minimal social and emotional responsiveness to others, lack of positive affect (i.e. smiling, joking, laughing, etc.) and episodes of unexplained irritability, sadness or fearfulness during non-threatening events.
In the past, there were two subtypes of this disorder: inhibited type or disinhibited type. The inhibited type represented the symptoms that were mentioned above. But the disinhibited type had opposite features. Mental health professionals recognized that the inappropriate or pathogenic care led many children to develop a distrust of others, but that sometimes that care actually led to an inappropriately high level of trust for others, like complete strangers. This was the disinhibited type.
Recently, Reactive Attachment Disorder, inhibited type, becomes the sole diagnosis for Reactive Attachment Disorder and a completely new diagnosis was created for the disinhibited type.
That diagnosis is called Disinhibited Social Engagement Disorder, and in addition to requiring an inappropriate or pathogenic early caregiving environment, it includes the following symptoms:
- The child actively approaches and interacts with unfamiliar adults
- The child has little to no fear of approaching a stranger
- The child is overly comfortable with physical touch and space with a stranger
- The child does little to no checking-in with the safe caregiver
- The child is willing to go off with a stranger without a familiar caregiver
For both diagnoses—Reactive Attachment Disorder and Disinhibited Social Engagement Disorder—treatment must occur as early as possible and should include a safe, consistent caregiver. Treatment involves parent-child therapy to re-build the bonds that were broken during the early years. This may include the parent who provided the inappropriate care in the early years, or the other parent, or a foster or adoptive parent who has taken on the role of the child’s primary caregiver.
At Encompass Mental Health, treatment of these diagnoses—or any symptoms that represent a concern related to a child’s ability to attach to a primary caregiver—includes family play therapy with the parent(s), guardian(s) or other caregiver(s) who will be a consistent part of the child’s life. I engage the child and his or her caregivers in activities that help to facilitate the bond that grows between a parent and child during those early years to repair the bond that wasn’t created during those early years.
Call (605) 275-0009 to learn more about therapy for Reactive Attachment Disorder at Encompass Mental Health.