If you’re a parent of a child with reactive attachment disorder (RAD) – a developmental trauma disorder – you, like me, are probably all too familiar with the “resource desert” we face: a lack of professionals who are trained to treat children and families in our circumstances.
What Parents of Kids with Reactive Attachment Disorder Report
“Where I live, there are not any resources specific to RAD,” says Tina Eckert of Hastings, Michigan, who, like the other parents I interviewed, attended last year’s Navigating RAD event. “Currently we drive an hour each way to our therapist, whose specialty is attachment issues.”
Fellow mom A.L. from Hackensack, New Jersey says: “I work with one therapist who gets RAD. In general, they aren’t trained, and I know more than the professionals.”
Cheryl from Melbourne, Florida, adds: “I don’t yet have leads on RAD-specific resources locally. Many facilities seem to list RAD treatment on their sites, but I haven’t seen any tailored treatments.”
The same is true for T.J. Kyri of Westchester, New York. “I haven’t found many people familiar with RAD. My younger daughter is in her fourth placement, and even in the placements, they may have heard of it, but don’t really understand it. I would love to educate therapists, police, lawyers, judges, schools and others,” says Kyri, who is the author of a new book about RAD “Up-Rooted: Climbing Through Family Chaos.”
To find out why we face such a resource desert, I spoke with three professionals.
Why Isn’t Reactive Attachment Disorder Better Covered in Graduate Programs?
Ryan Brunner and his wife adopted two children in 2011. Both showed signs of attachment issues, but while their daughter responded positively to treatment over the years, their son did not. He was diagnosed with severe reactive attachment disorder.
Brunner himself is a professor of psychology and holds a Ph.D. in social psychology. Still, they encountered the same issues other RAD parents face when trying to find qualified treatment for their children.
“We repeatedly dealt with professionals who knew next to nothing about his disorder, and despite my wife and I both having advanced degrees and specialized training, they refused to listen to us when we tried to explain,” he says.
I asked Brunner why the disorder isn’t better taught in graduate programs.
“Reactive attachment disorder is a poorly understood and poorly defined psychological disorder,” he says. “The labeling of the disorder itself has been modified and relabeled in the last two editions of the Diagnostic and Statistical Manual of Mental Disorders (DSM) and now distinguishes between reactive attachment disorder and disinhibited social engagement disorder (DSED). But to put it in perspective, these two disorders take up less than two pages of a manual of disorders that is over 1,000 pages long. Thus, if something has been studied very little and receives relatively little public attention, it typically receives significantly less attention in graduate training programs.”
Graduate programs have a lot to cover, so many professionals only receive cursory exposure to a whole host of disorders that they may or may not encounter in their careers, Brunner explains.
While some professionals like social workers will certainly encounter clients with reactive attachment disorder, they receive very little training beyond the definition of the disorder.
Carrie O’Toole also parented two adopted children who were diagnosed with reactive attachment disorder and chose to attend graduate school to become a counselor as a result. She’s the author of “Relinquished: When Love Means Letting Go” and founded Carrie O’Toole Ministries, which offers coaching, groups and retreats especially for parents struggling with the grief and trauma that comes from parenting a traumatized child. Both the universities she attended for her counseling training barely covered reactive attachment disorder. Trying to gain greater knowledge in attachment issues, she earned an advanced level-two attachment-based intervention specialist certification. However, this training also didn’t cover reactive attachment disorder.
“I think it’s difficult to teach because unless you’ve lived it or worked in the trenches, getting all the nuances of what this disorder does to the child and family as well as the community dynamics is next to impossible,” says Forrest Lien, a clinical social worker and trauma expert who developed specialized treatments for children with reactive attachment disorder and their families. He is the founder of Lifespan Trauma Consulting.
“I think graduate schools set their curriculums on research data, which we need more of,” he adds.
Why Don’t More Professionals Recognize Reactive Attachment Disorder?
In addition to the lack of training, the nature of the disorder itself makes it difficult for practitioners to recognize. Children with reactive attachment disorder are often charming and manipulative to adults outside the home. If they’re seen by a therapist one-on-one, then the distressed parents may come to be seen as the bigger problem.
“If you’re a therapist who believes in working with kids individually, you’re not going to see the dynamics,” Lien says. “Kids with RAD are poor reporters of their symptoms. They blame others for how they feel. Away from their parents, they aren’t conflicted. They aren’t agitated. They aren’t dysregulated. The smarter the child, the better they're able to charm others as well. They figure out quickly how to get people on their side. Parents are on an island with no one listening to them.”
Therapists, like other adults outside the home, have difficulty understanding the disorder.
“Nearly all of us want to be loved by others, trust most people we come in contact with, and try to avoid hurting people who care about us,” Brunner explains. “We generally assume that others will have these same motives. Thus, it is very upsetting and almost unbelievable when people don't follow these social rules. Children with attachment disorders take advantage of these assumptions in order to regain a sense of control and avoid the threat of emotional closeness with others.”
Unless the professional has specialized training or repeated direct experience with children with reactive attachment disorder, it is unlikely they will recognize it or listen to parents about it.
Brunner says: “Although attachment disorders are challenging to live with and treat, they are nearly impossible to communicate or explain to others unless they've directly experienced it themselves. It is one thing to believe that an adult with a severe personality disorder (like psychopathy) can lie and be manipulative for their own gains, it is much harder to believe that a young child can behave the same way, especially when they have loving, caring parents. The same is true among mental health professionals: They have trouble believing because most disorders just don't look like this.”
Parents often find out about reactive attachment disorder on their own or from someone other than our child’s therapist, such as a school counselor, fellow parent or psychiatrist.
Adding to the complication is our medical system’s approach, O’Toole says. Practitioners tend to treat symptoms vs. the underlying cause. Our kids end up with an alphabet soup of other diagnoses.
“Why don’t we figure out why they have a mood disorder and why they need medication?” O’Toole laments. “To me, let’s go back to attachment and trauma that come before that. Instead of just treating the symptoms, let's uncover the cause and heal that.”
Some practitioners may believe myths, such as that the disorder is rare or only occurs in children from depraved orphanages, or that it’s a “hopeless” diagnosis they don’t want to saddle the child with.
Unless the professional has specialized training or repeated direct experience with children with reactive attachment disorder, it is unlikely they will recognize it or listen to parents about it.
Lien echoes Brunner’s comments about the DSM definition of the disorder. “The DSM diagnosis is so limited, it really doesn’t tell you much,” he says. In the future, he hopes the diagnosis can be changed to developmental trauma disorder, which would be a more encompassing diagnosis and hopefully lead to issues being better recognized by professionals.
How Can We Address the Reactive Attachment Disorder Resource Desert?
“Addressing the lack of resources for children with reactive attachment disorder will require a combination of efforts from a variety of sources,” Brunner says. “First of all, we need to do more things to increase public awareness about the plight of families who have children with this challenging disorder. The public needs to hear more stories of good families who have been driven to the breaking point by the lack of resources available to them. Public outcry is needed in order to push academic institutions to increase the attention they give to the disorder in their programs. So why don't more families speak out? Because families who have gone through this disorder often feel shame and guilt from all of the judgment they have already faced. Telling our story is painful and opens us to even more judgment. It feels like a dangerous step to take, but it is terribly important if we want change in how this disorder is perceived.”
Luckily, RAD Advocates is providing just such a venue for families to share their stories and to organize and form networks of providers, another factor Brunner points out as important.
“RAD Advocates is already helping with this in several ways, including through their annual conference, education initiatives and direct advocacy for individual families,” Brunner says.
Lien and O’Toole hope to see more clinicians learning from the few existing counselors who specialize in reactive attachment disorder.
“We need to train folks to carry the baton,” Lien says.
While many professionals may not be trained in reactive attachment disorder, there are specialists in things like EMDR (eye movement desensitization and reprocessing) who can be part of a comprehensive treatment plan.
Practitioners tend to treat symptoms vs. the underlying cause. Our kids end up with an alphabet soup of other diagnoses.
“One strategy won’t fix the whole problem,” Lien says. “You have to have a lot of tools in your toolbox – family therapy, marriage therapy, trauma work, EMDR.”
However, these specialists must be open to learning about reactive attachment disorder and the complicated family dynamics it creates.
While there are specialized attachment providers, even they may not understand the dynamics created by reactive attachment disorder. If they push attachment between a stressed out mother with post-traumatic stress disorder from her experiences and a child with severe reactive attachment disorder who is triggered by closeness, it may only make the situation worse.
Ultimately, we – the families impacted by reactive attachment disorder – are a key part of addressing the resource desert. For example, parents of children with reactive attachment disorder started RAD Advocates, O’Toole started her ministry after raising her traumatized children. I give my services in the form of writing.
Ultimately, we – the families impacted by reactive attachment disorder – are a key part of addressing the resource desert.
Similarly, Lien is helping families work together to provide structured respite. This works as an outpatient treatment model for children not on the severe end of the spectrum. If the child can’t be respectful and responsible in their home, they can go to structured respite to practice. There, they reflect, journal and do other activities they may find boring. It’s a way to “fake it till you make it.” Most kids will decide they’d rather be home trying.
Each of us, after we’ve done our own healing, can help the next generation of families. “We all need to work together and help in our various niches,” O’Toole says. Banding together is the only way to get through it.
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.
Photo by Giorgio Parravicini on Unsplash