Is it Reactive Attachment Disorder? Three of the Most Important Questions for Parents to Answer
Updated: 5 days ago
Like so many other people raising kids with reactive attachment disorder, I can’t remember the first time I heard of the diagnosis. All I know is that, by the time I did, it was far too late in our family journey. And we couldn’t get the time back.
I know reactive attachment disorder was never mentioned in our foster care training. I know I didn’t learn about the term until years after I realized something was seriously wrong. I know it wasn’t until after we’d sought help from multiple professionals only to be told my son Joe* was too young for a diagnosis. Or that we needed to be better parents. I know it wasn’t until after Joe’s first 5-day in-patient psychiatric hospitalization when he was just 7 years old.
But I cannot remember the exact moment I learned of reactive attachment disorder.
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When I finally heard the term, I remember relentlessly devouring everything I could learn about reactive attachment disorder online. I remember the heart-clench I felt the first time I read the phrase “nurturing enemy” and how it finally made my life make sense.
I remember the sinking feeling I had as I read the list of reactive attachment disorder symptoms in some long-forgotten article. I remember loading my Amazon cart with every book I could find about attachment and parenting kids with attachment issues.
I know reactive attachment disorder was never mentioned in our foster care training. I know I didn’t learn about the term until years after I realized something was seriously wrong.
I feel as though I should remember the exact moment I heard about reactive attachment disorder because the diagnosis played such a pervasive role in my family’s life. I’m guessing when I heard it for the first time, it didn’t register as significant because I had never heard it before. I had absolutely no idea what it was or the toll it would take on myself, Joe, and the rest of my family.
Out of curiosity, I posed the question to a group of parents who have a child with reactive attachment disorder. Most, like me, did not learn of the disorder until well after they were in the thick of behaviors, overwhelm, and desperation. Most, like me, eventually became more knowledgeable about the diagnosis than the professionals they were working with to help their children.
The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, or DSM-5, states that the symptoms and conditions of reactive attachment disorder must be present before the age of 5.
According to clinician Forrest Lien, an expert in the diagnosis and treatment of reactive attachment disorder as well as the keynote speaker at the Navigating Reactive Attachment Disorder 2023 (NavRAD23) event, the average age of children newly diagnosed while he was in active practice was between ages 8 to 9. The delay in diagnosis, and subsequent treatment, is due to the lack of both parental and professional education.
Unfortunately, most parents and professionals lack the necessary information to truly understand reactive attachment disorder. With young children, they often miss significant behaviors as they believe the child is merely a traumatized toddler who simply needs time, love, and consistency to calm down. Many also tend to believe that reactive attachment disorder is rare or only affects specific populations, like adoptees from Eastern Europe. Neither is true.
Need help navigating the system while raising a child with reactive attachment disorder? Become a RAD Advocates member.
Part of RAD Advocates’ mission is to educate parents as early as possible to ensure proper interventions before families reach a crisis point.
One of the keys to successful treatment of reactive attachment disorder is early diagnosis and treatment. “The earlier, the better,” says Lien. “Early diagnosis gives the child and the parents a chance to avert some of the more serious consequences of untreated RAD that tend to pop up once puberty hits and into the teen years.”
Unfortunately, most parents and professionals lack the necessary information to truly understand reactive attachment disorder. With young children, they often miss significant behaviors as they believe the child is merely a traumatized toddler who simply needs time, love, and consistency to calm down.
I wrote about the 14 signs of reactive attachment disorder I missed early on from a parent’s perspective in a past post. But I recently had the pleasure to interview Lien about his clinical experience after working with RAD families for over 40 years. From that discussion, I learned the three most important things parents should look for when trying to determine whether or not their child has reactive attachment disorder.
3 of the most important questions you can ask yourself if you're wondering whether your child has reactive attachment disorder:
1. How often was the child disrupted from caregivers early on?
The diagnosis of reactive attachment disorder must include one or more primary caregiver disruptions within the first three years of life. These disruptions may look like adoption at birth, multiple foster care placements, long-term hospitalizations of a parent or child, death of a parent or other circumstances that require separation. With each disruption, the child feels grief, loss, and a fear of abandonment, gradually determining that caregivers are unreliable and inconsistent and therefore cannot be trusted.
The more disruptions a child has, the greater the likelihood the child will fit the diagnostic criteria for reactive attachment disorder. “If the child has had multiple disruptions or has been in foster care for years, I’m always suspicious that RAD is part of the picture,” says Lien. “That’s why full assessments are so important for these kiddos and their family success.”
Given that my husband and I adopted a sibling group of three, one question professionals always asked us was why only one of our children had reactive attachment disorder. Our oldest and youngest sons only had one caregiver disruption prior to the age of three. Joe, who ultimately was diagnosed with severe reactive attachment disorder, had three disruptions before the age of 2. Also, unlike his older brother who didn’t attend daycare until he was 18 months old, Joe attended daycare from the age of 3 months old until he came to live with us at 23 months old.
2. Can the child allow themselves to be vulnerable?
The degree to which a child will allow themselves to feel vulnerable is a key indicator of their level of trauma impact. A child who is experiencing the effects of trauma will react differently from a child on the far end of that spectrum who has the more serious implications of reactive attachment disorder.
When a child learns early on that they are not safe, their brains develop differently in a survival mode resulting in reactive attachment disorder. They rely on maladaptive behaviors to self-protect and avoid vulnerability.
When my children were young, I had to train them to find an adult if someone got hurt while they were playing together. My oldest and youngest quickly picked up that behavior. However, my son with reactive attachment disorder never did. When he was about 8 years old, he pulled a portable basketball hoop down on himself. He walked in the house with a gaping head wound, covered in blood, and calmly said, “I think I need to lay down.” As he was going in and out of consciousness, he proceeded to argue with me that he wasn’t going to the emergency room. He insisted that he was fine and didn’t need help from anyone else.
Other signs of invulnerability may be a lack of crying, both in infants and older children. They may stiffen when touched or refuse to be held or hugged. Increasing attempts to maintain control of situations is a sign that develops as the child ages.
Left untreated, a child with reactive attachment disorder grows more skilled at maladaptive behaviors designed to protect themselves and to maintain emotional distance from others.
3. What is home life like when the child isn’t there?
Because the child cannot or will not allow themselves to be vulnerable, they will attempt to control the physical and/or emotional climate of the home in order to feel safe. This usually brings chaos to everyone else in the family. But when the child is gone, the home feels calmer and safer.
When my husband and I began fostering our sons, our oldest had just turned 3 years old. We attributed the ensuing chaos to going from zero children to three overnight. Their troubling behaviors, we assumed, were only a symptom of their early trauma that would settle down with time. However, the chaos never relented. We never found our groove. I remember sitting in a therapist’s office years later telling her that we still hadn’t developed our “sea legs” and felt as though that wasn’t normal.
It wasn’t until Joe’s first in-patient hospitalization when he was 7 years old that we realized the level of chaos our home and family had been operating in. His absence loomed large because the quiet and peace that filled the void were such a contrast to what we had become accustomed to in our home. During his first hospitalization, Joe was gone for five days. No one had a meltdown. No one got hurt. No doors were slammed. No one wet the bed. No one had nightmares. Friends came over to play in our house for the first time ever. We had conversations at dinner. No one complained about the food. We had family game nights and no one threw the game pieces or tried to cheat.
Because the child cannot or will not allow themselves to be vulnerable, they will attempt to control the physical and/or emotional climate of the home in order to feel safe. This usually brings chaos to everyone else in the family.
At the time, we all felt guilty for enjoying ourselves. However, within an hour of Joe returning home, the chaos resumed with screaming, door slamming, name-calling, and threats. As the years went by, we began to realize that time away from Joe was a necessity for our family’s well-being.
What to do if you suspect your child may have reactive attachment disorder?
If you suspect that your child has reactive attachment disorder, realistically assess your family’s situation.
The degree to which your family is struggling is an indication of how severe your child’s disorder is. To make excuses, wait for love to cure all, or rely on the wrong diagnosis will only delay treatment and make the child’s condition worse.
Find the right help.
RAD-specific treatment is just that – specific. Most conventional therapies enable the disorder rather than treat it. One of the worst possible things a family of a child with reactive attachment disorder can experience is an uneducated professional who allows the child to control therapy sessions and triangulate the adults in their lives via lies and manipulation. These are all symptoms of the child’s disorder and a way for them to self-protect through control. When professionals don’t understand this, they have a tendency to inadvertently make matters worse rather than better.
Find your people.
You are not alone. Given that those raising children with reactive attachment disorder get blamed and misunderstood, you probably feel like an island. It wasn’t until I found RAD Advocates that I felt like a part of a community rather than an outcast.
Not only does RAD Advocates offer advocacy services for families in all stages of navigating this disorder but they also host the annual NavRAD experience. The event helps parents assess how severe their child’s RAD is while also helping them discover resources their family can use to successfully and safely navigate the disorder. While the event is sold out this year, you may plan ahead to attend NavRAD24.
There are people out there walking in your shoes. Whether you find them through RAD Advocates or elsewhere, make it your mission to find them.
Reactive attachment disorder is a serious affliction that impacts the child’s brain. Just like any other serious disorder, you can’t “fix” it with good parenting. Love is not enough. And you can’t do it without professional support. Take a moment to step outside of the chaos and assess the gravity of your family situation, get the right help, and find the right people. It’s far from easy, but it can be done.
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*name changed to protect identity