Carol was in a complete state of panic when I answered the phone. Her son Ty, a child with reactive attachment disorder (RAD), had been staying at a residential treatment center (RTC). The staff had just called to let Carol know that they’d discharge Ty the following day.
Prior to his stay at the RTC, Ty had stayed at multiple hospitals and RTCs. The last time that the staff released her son from an RTC, he was combative and self-harming within 48 hours of returning home. Once again, Carol didn’t feel like he was ready to come home safely.
As an advocate for families raising a child with RAD, I get many calls like the one from Carol. I understand the panic completely as someone who has parented a child with RAD myself—it can be incredibly scary and traumatizing.
Here are two important things to know if your child with RAD is in an RTC now:
1. While RTCs can offer much-needed respite from a child with RAD, such facilities typically do not help in the long-term.
A child with RAD often appears quickly regulated in an institution like an RTC. This is because he or she is away from the home environment where emotional intimacy and connection happen—the very things that feel scary to the child.
As contrary as it seems, a facility can feel like a safe escape from your love and care. Your child may act out even more than before to get back to that safe feeling. This often creates a cycle of hospital and RTC visits.
2. You need to prepare immediately for your child’s return home.
Parents often get short notice of hospital releases. We at RAD Advocates advise parents to start planning for discharge the day a child is admitted to a facility.
We recommend the following measures:
Implement a personalized safety plan rather than rely on generic strategies from the facility (RAD Advocates can help you with that task if needed). Staff at residential facilities typically recommend traditional coping skills that don’t work for RAD. A child with RAD dysregulates quickly in the home environment. It is important to have a plan of action beforehand.
Install devices to keep your family safe. Door alarms can alert you when your child enters or leaves a room. Code locks for the bedroom doors of other family members (other than for your child with RAD) can provide safety for you and your other children. Cameras always allow you to see your child with RAD. Cabinet locks help keep sharp objects, medications, and poisons away from your child.
Set up professional support. Schedule appointments with your child's therapist and/or someone else who understands RAD. Make psychiatry appointments to continue medication management. Request meetings with your child's to determine supports in an educational setting. Find other available programs in your area such as day treatment or social-emotional schools. Request transportation services from your insurance company if you do not feel safe with your child in the car.
Ask your family and friends for support. Their assistance can provide you time to rest so you have more energy to provide care for your child. Tell them exactly how they can help as they likely don’t grasp the extent of your situation. Meals and help with household chores and errands are a great first step.
Plan for other children in your home to have play dates or other outings outside of the home. They'll need some relief once your child with RAD returns home.
Communicate and set clear boundaries with your family members, friends, and professionals before your child returns home. It’s important for all the adults in your child’s life to be on the same page—for the sake of your child with RAD and for you (you can start by asking them to read Why the mom of a child with reactive attachment disorder needs you to call her).
Bring a support person along to pick up your child. He or she can act as a witness for paperwork and provide a level of protection as you transport your child home. Ask that person to oversee as you ask for clinical notes, incident reports, and general information in your child’s file. If you disagree with the discharge, ensure that the staff notes your disapproval in your child’s chart.
Most people in your life will not understand all the preparation needed for your child’s return home from an RTC. Even the staff at the RTC will likely think it’s odd. After all, most adults in your child’s life don’t see the behaviors you do at home.
But no matter the skepticism or shame you get from others, we urge you to always do what’s right for your family. You’re not parenting a neurotypical child under traditional parenting norms. A child with RAD has unique needs. And that requires unique decisions and plans on your end.