Thursday, April 01, 2010

RAD 101

This is my contribution to Brenda's (Living With RAD) cry for more basic information. I humbly hope that it helps...

What is RAD?

RAD is an acronym for Reactive Attachment Disorder, or Attachment Disorder. It is caused by the lack of attachment or unhealthy attachment in a child.

What are the symptoms of R/AD?

According to the DSM-IV-TR the diagnostic criteria for 313.89 Reactive Attachment Disorder of Infancy or Early Childhood, is;

A. Markedly disturbed and developmentally inappropriate social relatedness
in most contexts, beginning before age 5 years, as evidenced by either (1)
(1) persistent failure to initiate or respond in a
appropriate fashion to most social interactions, as manifest
by excessively
inhibited, hypervigilant, or highly ambivalent and
contradictory responses
(e.g., the child may respond to caregivers with a
mixture of approach,
avoidance, and resistance to comforting, or may exhibit
frozen watchfulness)
(2) diffuse attachments as manifest by indiscriminate
sociability with
marked inability to exhibit appropriate selective
attachments (e.g., excessive
familiarity with relative strangers or lack of
selectivity in choice of
attachment figures)

B. The disturbance in
Criterion A is not accounted
for solely by developmental delay (as in Mental
Retardation) and does not meet
criteria for a Pervasive Developmental

C. Pathogenic care as
evidenced by at least one of the
(1) persistent disregard of the
child's basic emotional needs
for comfort, stimulation, and affection
persistent disregard of the
child's basic physical needs
(3) repeated
changes of primary caregiver
that prevent formation of stable attachments (e.g.,
frequent changes in
foster care)

D. There is a presumption that the care
in Criterion C
is responsible for the disturbed behavior in Criterion A (e.g.,
disturbances in Criterion A began following the pathogenic care in Criterion

Specify type:

Inhibited Type: if Criterion A1
in the clinical presentation
Disinhibited Type: if
Criterion A2 predominates
in the clinical presentation

These official criteria translate into the unofficial symptoms that families of RAD kids live with. These two do not negate one another, they are the same... really.

Commonly recognized symptoms are (from the excellent web site;

Symptoms of RAD in Children

Superficially charming and engaging,
particularly around strangers or those who they feel they can manipulate
Indiscriminate affection, often to strangers; but not affectionate on
parent’s terms
Problems making eye contact, except when angry or lying
severe need to control everything and everyone; worsens as the child
gets older
Hyperactive, yet lazy in performing tasks
Argumentative, often over silly or insignificant things
tantrums or rage, often over trivial issues
Demanding or clingy, often
inappropriate times
Trouble understanding cause and effect
Lacks morals, values, and spiritual faith
Little or
no empathy;
often have not developed a conscience
Cruelty to animals
Lying for no
apparent reason
False allegations of abuse
Destructive to property or
Constant chatter;
nonsense questions
Abnormal speech
patterns; uninterested in learning
communication skills
Developmental /
Learning delays
with fire, blood and gore, weapons, evil; will
usually make the bad choice
Problems with food; either hoarding it or
refusing to eat
with details, but ignoring the main issues
or no long term friends;
tend to be loners
Attitude of entitlement and
things without permission even if he could have had
them by asking
Triangulation of adults; pitting one against the other
behind the eyes when raging

Is there hope and healing for R/AD?

When were were attending our foster/adoption classes we were asked what we could handle in terms of special needs. The form listed everything out... physical, mental, emotional and learning disorders. The ONE that we absolutely, emphatically, without a doubt, said "NO" to, was RAD. The one we ended up dealing with, in all of our children, in one form or another was RAD... the ONE and only one that can be healed and overcome completely is RAD. Do not be afraid. There is hope.

Our oldest son is healing and doing great. He is an absolute joy to be with much of the time. There was a time when we wouldn't have believed it was possible.

How do I parent my child with R/AD?

Very carefully!!!! LOL

Parenting a RADish is completely different and upside down compared to parenting a bonded and functional child. The parenting techniques are going to be different than those of your friends and family and will bring your parenting into judgement. Be ready. Suit up in your toughest rhino suit and let the arrows fall to the ground. The parenting and the nurturing is what will bring about the healing. Keep your eye on the goal and ignore the nay-sayers.

These are the parenting tips and techniques, given to us by our AT (Attachment Therapist) that we (try to) use...

Ineffective Discipline
(These are the more traditional parenting techniques that work beautifully
with healthy children and not so much with RAD kids)

Time outs

Avoid Control battles, Win the battles you chose to take
on. Pick and choose carefully

Effective Discipline
(These are the less than traditional methods that work better for RAD

Natural and Logical consequences
Control the battles you wage
Give choices when appropriate
Praise /Accountability
Reduced Anger
Humor and
One Minute Scold

Parenting skills

1) Joining in
2) Paradox (reverse psychology)
3) Natural and Logical Consequences
4) Prescribe
5) Flexible
6) Less talk
7) More action
8) Pick
your battles
9) Inconsistent consistencies
10) Restitution and apologies
11) Nurture ***** Especially nurture after confrontation.

skills are used to move the child forward developmentally. They generate
thinking and sequencing which changes brain functions and creates cause and
effect thinking!

Only work on 3-5 things at a time. Ex. Stealing,
aggression, and sexual behaviors. If you try to change 80 behaviors and you only
change 10 you are still losing the fight. If you focus on only 3-5 battles and
you win them all, then you are winning.

Most of these children are stuck
at the age of trauma. Often prior to age two, this means that they have no cause
and effect thinking. Therefore, you must direct a child as if they are the
developmental age that they are. For example, you would tell a 2 year to go pick
something up if they spilled or dropped it and you would watch or help them if

Use restitution as much as possible to kick start cause and
effect thinking. (tasks, fines, etc. ) Always have them apologize for
inappropriate behaviors even if they do not mean it.

How do I find help for my child with R/AD

10 years ago, when my husband and I were beginning the search for help, it was rare and expensive. There was not a single Attachment Therapist in our state. Thankfully attachment therapy is becoming a more widely accepted and used model of therapy. Some family therapist are even including attachment based family therapy in their offerings.

There are therapists, clinics and Attachment and Bonding centers all over the US now (I don't know beyond those borders)

To find an attachment therapist you can look through the online directories.

Find those that are in your area or closest to you and begin calling. These are only the clinicians who have taken the time to register. Many many more are not listed in these directories. Our own AT is not in the directories. She has a waiting list from word-of-mouth alone. So call and ask and ask and call.

You can also call your state and county mental health office.
Department of Human Resources or Child Protective Services
Children's Hospitals
Just call every counselor/therapist/child psychologist and psychiatrist that you can find in the yellow pages.

There is help and hope.

What is Attachment Therapy and what's the difference?

Attachment therapy is a model that focuses on the bonding and attaching of the client to
their family. It is truthful, respectful and hard work.

What Attachment Therapy is *not*...

Attachment therapy is not play therapy or talk/cognitive therapy. It does not have a goal of creating a trust relationship with the therapist. It is not client driven. That means the therapist is not going to begin a session by asking what the child wants to talk about and work on, they are more likely going to tell the child that they have an issue to work on then lay it out on the table and give them tools to work. It is not private between counselor and client. It includes rather than excludes, the parents/family. It does not walk softly, instead it is open, honest and direct.

It is also not "rage" therapy, "rebirthing" therapy or "restraining" therapy.

Attachment therapy does not harm children or kill them, it gives them life.

I feel a strongly about the subject ;o)

What if my child displays the symptoms but is not diagnosed with RAD?

A child can have Attachment Disorder and not be diagnosed. Just like a child can have the flu and not be diagnosed. The lack of diagnoses does not make the disorder non-existent. Just because there is not official diagnoses does not mean that they don't have Attachment Disorder.

RAD is the disorder or extreme end of the spectrum of attachment. If the left side of the curve is a healthy, bonded, functional child and the far right side (no political references intended)
is severe RAD, that leaves everything else in the middle. So even a child who does not have
the disorder, might have attachment issues that would benefit from Attachment Therapy.

On the other hand a child might have another disorder that shares the same symptoms. This is why seeking psychiatric help early, and from a Dr who is familiar with RAD, Pediatric Bipolar, ADHD, FASD etc., is so important.

Why does diagnoses make a difference?

Because treatment is driven by diagnoses not behavior. Behavior is a symptom and treating symptoms is never effective. For instance, a child who rages might have Bipolar Disorder, RAD or ADHD. Each of those diagnoses might include rages. Rages would be a symptom. But each of those diagnoses would have different motivations for the rages. Just like a sore throat could either be brought on by a cold or a bacterial infection. Treatment has to understand motive or cause, to be effective. If you suspect that your child has RAD (or any other
specific disorder) and your treatment professional tells you it doesn't matter because they are treating the behavior, find a new treatment professional. It does matter.

*I will add to this post as I see the need and have time.

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