The Pros and Cons of 14 Alternative Reactive Attachment Disorder Treatments, for and by Parents
Reactive attachment disorder – a developmental trauma disorder – is not easily treatable, and finding professionals with experience successfully treating it is even more difficult. Because of this, many parents are left doing their own research and grasping at straws to find something that works. Maybe that something is an alternative treatment?
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RAD Advocates surveyed and spoke with parents about some of the alternative treatments they’ve tried and the outcomes. We also spoke with clinicians who are RAD parents themselves and/or highly specialized in RAD.
While RAD Advocates doesn’t promote any specific treatments, the organization fosters a community of support for families of kids with reactive attachment disorder to learn from one another. "Our philosophy at RAD Advocates is to support and guide RAD parents to safely care for their whole families," says RAD Advocates Chief Executive Officer Amy VanTine. "We don't have all the answers, but we do know that parents can't do it alone. That's why we're here."
What is an alternative treatment for reactive attachment disorder?
Christine Dalton is a licensed clinical social worker with a private practice. She’s also a mom to two children, one with severe reactive attachment disorder. When asked to categorize what makes a treatment alternative, she tends to include anything that basic health insurance does not cover.
“The thing with reactive attachment disorder is that the brain gets rewired in an atypical way, so to think that typical treatment would work is rather silly,” she comments. Dalton recommends asking yourself these questions as you consider an alternative treatment: Is it harmful to anyone? Can you afford it? Does it work for your child? How would it look to a third party evaluating your home or parenting?
Katie Egbert is a family advocate at RAD Advocates, and she also provides family advocacy consulting through her business, Foundational Connections LLC. Egbert has nine children, including three with attachment issues (who are now adults). Until there’s science to back the results of an alternative treatment, she recommends proceeding with caution and doing research beforehand.
What alternative treatments have parents tried?
Parents who responded to the RAD Advocates survey had tried alternative treatments including Revolutionize DMDD (a.k.a. "Dr. Matthews"), somatic experiencing, Brain Balance, essential oils, supplements, massage, acupuncture, alpha-stim, stellate ganglion block, expressive trauma integration, homeopathic medicine, diet changes and more – often with mixed results.
"Our philosophy at RAD Advocates is to support and guide RAD parents to safely care for their whole families," says RAD Advocates Chief Executive Officer Amy VanTine. "We don't have all the answers, but we do know that parents can't do it alone. That's why we're here."
While some of the treatments below do have research backing their effectiveness, we included them under “alternative” treatments because they are not well known or are not often covered by insurance. Depending on who you are, some treatments may be considered more alternative than others.
The list below is not comprehensive or exhaustive. It is a RAD parent community resource compiled for and by RAD parents who have first-hand experiences or perspectives to lend.
1. Applied behavioral analysis (ABA)
ABA is one method Egbert does not recommend for kids with reactive attachment disorder. “It’s conditioning and repetition to help teach new skills, generally life skills. For kids with reactive attachment disorder or significant developmental delays that make understanding cues difficult and bonding challenging, it can open a host of difficulties.”
Egbert says biofeedback can be a useful tool, especially for children who have experienced trauma before they had solid communication skills or if they struggle with sensory processing or being able to focus enough to explain how their feelings and emotions are interconnected.
3. Brain Balance
Brain Balance is a personalized, non-medical program to strengthen and build brain connectivity. Dalton has had a few patients without reactive attachment disorder use this with success. If used for reactive attachment disorder, a specific approach and questions would be needed versus an approach for attention deficit hyperactivity disorder (ADHD), she says. “Brains of kids with reactive attachment disorder are unbalanced in a different way than kids with other diagnoses. You can look at functional MRI or PET scans and see differences in front to back not just left to right.”
4. Brain integration
Brain integration uses applied physiology and acupressure to help re-pattern brain activity. While one survey respondent is personally a fan, the technique did not work for her child with reactive attachment disorder. “He has too much to gain being dysregulated. It keeps him in control," they said. "He wouldn’t do the exercises or use any of the tools taught/offered to him. You have to want to change.”
5. Eye Movement Desensitization and Reprocessing (EMDR)
“EMDR works for a lot of our families because it allows trauma to be processed in a way that doesn’t rely as heavily on talk therapy, which can be challenging for kids with RAD,” Egbert says.
6. Myofascial release/massage
Myofascial release is a type of physical therapy performed on the myofascial (multi-layered connective tissue in your body). It may be performed during a massage therapy session. While no survey respondents reported trying it, at least one parent reported massage as beneficial. Dalton says: “I have not had particular experience with myofascial release and RAD, but I have had a few clients use this as an adjunctive service while working through trauma. ‘The Body Keeps Score’ is a great book accounting for what our bodies store as far as trauma, so I am in support of this type of service; however, it can be pricey for families.”
Neurofeedback (NFB), also called neurotherapy, is a type of biofeedback that presents real-time feedback from brain activity in order to reinforce healthy brain function through operant conditioning, according to licensed clinical social worker and trauma specialist Forrest Lien. Typically, electrical activity from the brain is collected via sensors placed on the scalp using electroencephalography (EEG), with feedback presented using video displays or sound.
Many parents we surveyed said they tried neurofeedback. While some found the treatment very helpful for their children, others didn't see a positive difference. For further insight, we asked Lien about his experiences successfully utilizing the treatment for his clients.
"Neurofeedback is an effective intervention to calm the brain of trauma victims. Trauma in infancy can create an anxious state in the developing brain which causes a developmental delay in healthy attachment," Lien says. "Just like any profession in mental health, experience in treating trauma victims is necessary for NFB to be effective. Effective treatment protocols can be created by reading quantitative electroencephalography (qEEG)." Lien says he has had success working with treatment protocols created by trauma specialists such as Dr. Robert Coben or Sebern Fisher.
Even with the proper neurofeedback protocol, Lien advises parents to combine the treatment with other interventions. "Neurofeedback alone usually isn’t the answer for kids with RAD that have complex developmental trauma. An effective treatment plan usually combines NFB along with specialized attachment therapy and parent coaching."
8. Play therapy
“If children are younger and have never learned how to engage in reciprocal or parallel play, those are skills that will come in handy in interacting with other kids,” Egbert says. However, play therapy won’t be helpful to children with moderate to severe reactive attachment disorder.
No matter the form, any therapy type can cause more harm if the clinician doesn’t truly understand the dynamics of reactive attachment disorder. Read here for more insight from a RAD mom/therapist herself.
9. Revolutionize DMDD
Pediatric neuropsychiatrist Dr. Daniel Matthews developed a treatment for disruptive mood dysregulation disorder (DMDD) that combines anti-epileptic medications in conjunction with amantadine instead of antipsychotics.
"I do think the Dr. Matthew’s protocol is helping,” one survey respondent wrote. “We are definitely having fewer outbursts. However, it is hard to find practitioners comfortable prescribing it.”
Dalton says: “The Matthews protocol has worked for some families that I'm aware of. It makes a lot of sense about calming the brain in order to receive other treatment.”
10. Somatic experiencing
Somatic experiencing is a body-oriented therapeutic model for healing trauma and other stress disorders. It aims to release the stored energy from the freeze response and turn off the threat alarm that causes dysregulation and dissociation in a “body first” approach to healing. Dalton appreciates approaches that use a mind-body connection, and somatic experiencing falls into this category.
11. Stellate ganglion block
The stellate ganglion are sympathetic nerves in your neck. An injection called a stellate ganglion block (sympathetic nerve block) is used to ease certain types of pain but can also help with post-traumatic stress disorder, anxiety and depression. "I saw a mother on a RAD parenting group page mention it,” writes one survey respondent. “It has been completely life-changing. It calms and resets the overactive nerves from the amygdala and allows for other treatment to help. Some people only need one treatment and some need to be retreated.”
If you’re considering a supplement or special diet, consult with your pediatrician or whoever is prescribing medications, Egbert advises. More importantly, weigh the pros and cons for your individual child. While we can encourage a healthy diet and hydration, this can be one of those pick-your-battle moments. If insisting that your child eats their broccoli at dinner leads to escalated behavior, it doesn’t make sense to push it.
If you do decide to pursue supplements, and perhaps even medication, Egbert suggests looking into testing beforehand. Bloodwork can show if there are any deficiencies, such as low iron, and a multivitamin is usually a good idea. “GeneSight is a useful test that can see what medications your child is more likely to respond to,” Egbert says. "We have had good results with a natural practitioner that uses Standard Process supplements and periodic retesting to review and modify as needed," a survey respondent commented.
13. Trust-Based Relational Interventions (TBRI)
“TBRI is a great resource for younger children who have had healthy attachments modeled in their formative years,” Egbert says. “It gives parents a lot of new tools if they haven’t already parented from an attachment-focused, strength-focused perspective. But for youth
with advanced reactive attachment disorder, TBRI isn’t going to cut it because they don’t have the capacity to build that foundation.”
14. Wilderness therapy
There are wilderness programs of varying lengths and focuses. Parents report mixed results from wilderness programs. Dalton says: “Our child participated for 22 months in a highly effective outdoor therapeutic wilderness program, and within two weeks of returning home, regressed to worse than before that placement.”
If you’re considering a wilderness program, Egbert advises: “Do your research. Make sure all the adults there have had trauma training, background checks, that there’s a level of supervision to meet the child’s needs, and that you know the treatment goals.”
Read more about what approaches parents have tried as well as guidelines for finding a therapist for reactive attachment disorder here.
Dalton grew up around several adoptees, and she felt a calling to adopt herself. “As a professional, I felt fairly equipped to handle the issues that I thought my adopted child would have and hit the ground running with various interventions even before our adoption was finalized,” she says. “We started with a general, but highly trained play therapist upon placement in an attempt to be proactive. Then we attended a family-attachment camp. During this time when attachment was really focused on, many of our issues showed up. As we focused on attaching more, our son’s issues got more intense.”
They tried neurofeedback. While their child's brain showed great improvement with neurofeedback, the behaviors in their home were not at all improved.
“I was often frustrated because I was seeking the ‘best of the best’ and setting up services with no notable success,” Dalton shares. “Our home got to the point where it was not safe, so we utilized many residential treatment facilities where we used Theraplay.”
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Like many of us, she read book after book. They also tried dialectical behavior therapy, EMDR and Trust-Based Relational Interventions through highly trained clinicians.
“We worked with nutritional programs, supplements, essential oils, exercise programs and so much more. If anyone suggested it, we tried it. One night in the midst of a psychiatric hospitalization evaluation, my child screamed into my tired ears, ‘It doesn't matter what you do, I'm just like this.’”
Their son is now in an out-of-home placement that doesn’t try and force attachment.
“Any treatment can really only truly be effective if the kid is on board to want the change,” Dalton says. “As much time, money, energy, blood, sweat, and tears that I poured into my son, nothing really changed until I understood that I couldn't want the attachment more than he did.”
However, she is hopeful about the increased focus on trauma over the past decade. With further research and organizations like RAD Advocates offering education and outreach, families dealing with these issues have more resources than in the past.
“What works for us isn’t going to work for other families because needs are different, and every family dynamic can be unique and complex,” Egbert advises. When her children were younger, what worked included parenting them toward their developmental age using a strengths-focused attachment-heavy method – really focusing on connection, communication, enhancing what they were doing well and coaching through their difficulties.
“When they became teenagers, we applied a lot more functional family skills and therapy, where it was around what is the need, meeting the need and providing a sense of consistency for them so they knew what was expected,” Egbert says. “Whether or not they chose to follow the household rules and expectations was a different matter. When you add in trauma and that quest for wanting to be autonomous, I think a lot of families raising kids with reactive attachment disorder struggle more from about ages 14-18.”
Whatever approaches you try, keep your own thorough documentation. Egbert also recommends reaching out to RAD Advocates for guidance specific to your unique situation.
Find Your Own Way
RAD Advocates CEO Amy VanTine says there's no one-size-fits-all answer because reactive attachment disorder is often co-morbid with other afflictions, falls on a spectrum, and lives amongst various family dynamics.
"Just to decipher the diagnosis is confusing," VanTine says. "When you then add in all the advice parents get, it's even more exhausting. Some ways tend to work for most families, but not everyone. Others work for some, but not most. Success looks different and comes in different forms for everyone."
VanTine advises parents to take care of themselves, to not lose hope, and to open their hearts to various possibilities. There are different paths out there for everyone. The answers and journeys are as alternative as the families themselves.
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About the Author:
Micaela Myers and her husband adopted a pair of siblings from foster care in 2015, when the children were 9 and 13. Since then, she has become an advocate for foster care reform and the support and education of adoptive parents. She was a member and is a supporter of RAD Advocates. Micaela earned her MFA in writing from Vermont College of Fine Arts and works as a professional writer and editor in Colorado.
About the Contributing Professionals:
Christine Dalton is a licensed clinical social worker and owner of Integrity Counseling & Personal Development, LLC in Jefferson, Georgia. She has been a foster and adoptive parent and brings a unique perspective to her clinical work with her experience raising kids from hard places. She is highly involved in her community and works to help people heal from the traumas of their lives.
Over the last three decades of his career, licensed clinical social worker and developmental trauma specialist Forrest Lien has avidly shared his expertise to advance the field of trauma. He has consulted with 20/20, HBO, and The Today Show and has presented at over 300 workshops internationally on the effects of early trauma including at the Mayo Clinic. As founder and owner of Lifespan Trauma Consulting, Forrest continues his legacy of therapeutic guidance and assessment and advocacy for families of children with reactive attachment disorder.
Founder of Foundational Connections, LLC, Katie Egbert, is a child welfare expert and professional parent advocate with over a decade of professional and lived experience. She serves the greater Pacific Northwest and graciously volunteers her time as a parent advocate for RAD Advocates. Katie has a bachelor's degree in anthropology, a master's degree in human services, and a post-graduate certificate in contemporary family theory.
Photo by Ryan Gagnon on Unsplash