I remember our first visit to see our child at a residential treatment center (RTC). We entered through the double set of locked doors into the cinder block building. It had no windows and was cold, sterile, and stark.
My anxiety was high.
But our 10-year-old daughter Cory* was smiling broadly as we walked into the room where she waited for our visit. She showed us all the goodies she bought with her behavior incentive dollars from the center’s “store”. Cory raved about the pancakes she had for breakfast. And she told us all about the professional basketball player that came to visit.
As we played a game with Cory, I prepared myself for the end of our visit. I expected tears. I assumed she’d ask when we’d visit again. Or when she got to come home with us. But after we packed up the game and collected our things, Cory stood up without emotion and walked to the door.
Cory had no need to hug us or to say more than a simple good-bye when we left. She stood noticeably relaxed as she happily waved at us through the window. It was the only time I saw her genuinely smile at us—she couldn’t wait to see us go.
It was an instant and painful reminder of Cory’s unattachment to us. I walked back to our car, stunned. And confused about what to do.
A staff member from the RTC called me that week. Cory was ready for discharge, she reported with enthusiasm. I expressed my concern that Cory seemed to prefer the facility environment over her own home. Although the woman assured me that Cory was stable and better, I had serious doubts.
The RTC staff had no idea that they had nurtured Cory’s reactive attachment disorder—the result of early childhood trauma that changes the brain and inhibits trust and authentic relationships.
Rather than work on the root of Cory’s struggles, her internal trauma, the RTC staff gave her constant rewards for short-term external behavior changes. Since a child with reactive attachment disorder seeks goods and services rather than emotional connection, Cory was motivated in that environment.
Cory also liked the chaos of the RTC as it matched the chaos of her brain. Chaos feels calming to a child with reactive attachment disorder.
Cory also felt “safe” away from me, her primary caregiver trying to get the closest to her emotionally (also known as a “nurturing enemy”). And she didn’t feel vulnerable or threatened by anyone trying to get close to her at the RTC. The staff and other children cycled in and out constantly.
But Cory wasn’t healing or making lasting change at the RTC. Once Cory learned the RTC system, she manipulated the environment, got what she wanted, and avoided genuine relationships—just what her disorder needed to flourish.
Still, the RTC staff and our insurance company decided Cory no longer met medical necessity for care. And so we brought her home (read how to prepare for your child's release from an RTC).
The artificial RTC environment certainly didn’t lend to a smooth transition back into our real-life, nurturing home. We didn’t give Cory toys or other rewards when she made her bed or didn't harm anyone that day. And we continued to try to bond with her.
Our family and our home, as always, triggered Cory. But after her stay at the RTC, her rages were even scarier. She felt scared internally by our nurturing and knew that her scary behaviors would likely get her back to the RTC. It began a cycle.
The way a child reacts to residential treatment depends on his or her severity of the disorder. Some children, like Cory, don’t want to return home at all. Others have the capacity to want connection and wish to return home. Sadly, he or she doesn’t have the ability to accept the family’s love and attachment.
No matter the severity of the child’s disorder, he or she does not simply regulate back into the family upon release from the RTC. He or she didn’t learn the skills necessary to do so. And the trauma brain still remains.
To live in an institution prepares children for life in an institution, not in a home. But I didn’t thoroughly understand that then. We were just trying to survive. The home-facility-home-facility cycle continues because parents don’t have an alternative to keep their families emotionally and physically safe. Sadly, the child’s disorder only gets worse.
Here are some ideas from RAD Advocates to help break the institution cycle:
Place the child in a facility or program that specializes in reactive attachment disorder. Although difficult to find, such programs do exist.
Place the child in a therapeutic boarding school. This setting may allow enough of a barrier from the triggers of the child’s disorder for the brain to calm. Once the brain is calm, the child may have a better chance to participate in therapeutic work within the boarding school or once back at home. Therapy options vary depending on the particular school and the family’s needs.
Place the child in a group home or long-term program in your state that supports a child who needs help with rehabilitation in the home environment.
Depending on how far into the cycle the child is and the severity of his or her disorder, specific parenting and home structures may work. Consider different parenting strategies, set up firm boundaries, establish a thorough safety plan, and build a team of professionals and respite care providers that specialize in reactive attachment disorder.
To parent a child with reactive attachment disorder is never easy. It takes research and support to navigate the best way through for the child and his or her family. Parents often learn the hard way via trial and error. We did. Sadly, many families fall apart through that process. But it doesn’t have to be that way.
Continue to educate yourself and find the support you need. And if you find your child and your family on the wrong path, remember that you can always try a new one.