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Reactive Attachment
Disorder
(RAD)
Knowledge is the Key to
Understanding
Abby Gould
[email protected]
Learning Objectives
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Understand a working definition of attachment
Distinguish between two subtypes of Reactive
Attachment Disorder (RAD)
Recognize four common symptoms of RAD
Identify three possible strategies teachers can
implement in the classroom to help students with
RAD
What is Reactive
Attachment Disorder?
 RAD is a complex psychiatric disorder in which
individuals have difficulty forming lasting, loving and
intimate relationships.
Markedly disturbed and developmentally inappropriate
social relatedness in most contexts that begins before the
age of five and is associated with grossly pathological care.
(DSM-IV-TR, 2000)
Glossary

Psychiatric disorder - occurs in an individual and is
usually associated with distress or disability that is not
expected as part of normal development or culture
(http://en.wikipedia.org, 2007)
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Markedly disturbed - showing extreme symptoms of
emotional illness or mental disorder
(http://medical.merriam-webster.com, 2007)

Social relatedness - a person’s ability to associate and
interact with society and its members (e.g. A child with
RAD does not possess appropriate social relatedness
as seen in excessive familiarity with strangers.)
(http://en.wikipedia.org, 2007)
Grossly Pathological Care:
Grossly pathological care is defined by:
a.
A persistent disregard for the child’s emotional needs
for comfort, stimulation, and affection
b.
Persistent disregard for the child’s physical needs
c.
Repeated changes of primary caregivers
(Schwartz & Davis, 2006)
Medical Conditions Associated with Grossly
Pathological Care and RAD:
Include: malnutrition, growth delay, evidence
of physical abuse, vitamin deficiencies, or
infectious diseases.
(DSM-IV-TR, 2000)
Two Subtypes of RAD

Inhibited- Refers to children who continually fail to
initiate and respond to social interactions in a
developmentally appropriate way
-Interactions are often met with a variety of
approaches, avoidance and resisting to comforting, often hypervigilant or highly
ambivalent
Example:
A child or infant that does not seek comfort
from a parent or caregiver during times of threat,
alarm or distress.
Two Subtypes of RAD

Disinhibited - Refers to a child who has an inability
to display appropriate selective
attachments
(DSM-IV-TR, 2000)
- More enduring over time than the
inhibited type
Example: A child who displays excessive familiarity with
strangers.
Why is Attachment important?
Attachment is essential for the formation of a healthy
personality which includes:
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Development of a conscience
Ability to become self-reliant
Ability to think logically
Ability to cope with frustration and stress
Ability to handle fear or a threat to self
Development of relationships
Symptoms displayed by
individuals with RAD
Lack of self-control / impulsive
 Speech and language delays
 Lack of conscience / shows no remorse
 Indiscriminately affectionate with strangers
 Avoids physical contact
 Hyperactive

Symptoms of RAD, Cont’d
Aggressive
 Destructive towards self, property and others
 Food issues: hordes, gorges, refuses to eat,
hides food
 Often on guard, anxious, wary
 Prefers to play alone
 Inhibition or hesitancy in social interactions
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Severe Warning Signs in Infants
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Severe Colic
Poor eye contact, difficulty tracking
No reciprocal smile response
Delayed gross motor skill development (sitting, crawling,
etc.)
Difficulty being comforted (extreme crying, constant
whining)
Resists affection and cuddling from caregiver/parent
Appear stiff, display tactile defensiveness
Poor sucking response when eating
Potential Causes of RAD
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Frequent changes in primary caregiver
Extended separation from the parent/primary caregiver
Frequent moves and/or placements in foster care or
institutions
Traumatic experiences
Undiagnosed, painful illness such as cholic, ear
infections, etc.
Young or inexperienced mother with poor parenting
skills
Neglect
Abuse
I’m a foster / adoptive parent . . .
Should I be concerned?
Be sure to learn about the environment of the
orphanage, institution, or foster home
•
High numbers of children and limited staff in the
environment in which the child is being cared for can
hinder the development of a healthy bond between
caregiver and child.
Prevalence
The prevalence of RAD has been estimated at 1%
of all children under the age of five. Children
orphaned at a young age have an increased
likelihood of this disorder. However, since the
onset can be detected as early as two months of
age, considerable improvement or remission is
possible if the child experiences an appropriately
supportive environment.
(DSM-IV-TR, 2000)
Effective Treatments
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Family therapy - helps the parents or caregivers
and other children in the family understand
symptoms of the disorder and effective
interventions.
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Individual therapy - helps the child directly with
monitoring emotions and behavior
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Play therapy - helps the child learn appropriate
skills for interacting with peers and other
social situations
Other possible treatment options
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Medication - for symptoms of the disorder (for
example, anxiety and hyperactivity)
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Special education services within the child’s
school (including a Individualized Education
Plan (IEP)) - specifically designed programs
that can help the child learn skills
required for academic and social success,
while addressing behavioral and emotional
difficulties.
What can I do as a parent ?
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Get information on attachment and helping your
child form a healthy bond. (references that follow
include helpful websites)
If you don’t have much experience in caring for an
infant or small child, take classes or try to
volunteer with young children to increase your
knowledge.
Be active with your child through play, making eye
contact, talking with, smiling at, reading with,
sharing mealtimes.
School Implications
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Children with reactive attachment disorder have
difficulties self-regulating emotions and behaviors.
These children struggle to form typical, reciprocal
relationships with peers and adults.
Self-regulatory and social skills are important
prerequisites for school readiness and academic
success.
The unique school challenge for
children with RAD
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While the school setting is meant to educate,
children with RAD are primarily concerned with
internal feelings of safety, security and trust.
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Greater degree of dependency on the teacher due
to past disruptions in attachment.
How can teachers help a child with
RAD reach academic success?
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Be consistent, predictable, and repetitive
Set clear, concise expectations
Set a classroom routine
Model and teach appropriate social behaviors
Maintain realistic expectations
Ignore “junk” behaviors - that is behaviors that are not
harmful to the child, others or property
More classroom techniques for
teachers
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Be patient with the child (and yourself)
Understand behaviors before punishing
Utilize other resources (school
counselor/psychologist, internet, etc.) to gain
needed information to understand the effects of
Reactive Attachment disorder on the child’s
behavior and emotions
Help the child learn how to regulate his or her
feelings and actions
How do parents help to ensure
school assistance with behaviors?
Children with the diagnosis of RAD are
eligible to receive PA Code Chapter 14
services, which require teachers and
school districts to follow a individual student
plan.
Pennsylvania Code Chapter 14
The state regulation that implements the
federal Individuals with Disabilities
Education Act and explains how children
with disabilities who need special education
can get help from their school districts.
(Education Law Center, 2006)
PA Code Chapter 14 cont’d
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Children with RAD are eligible for the services outlined in Chapter
14 due to speech and language delays, as well as, various other
learning delays. Through this law, children are provided with
specially designed instruction and other related services after a
comprehensive evaluation is completed by the school district.
Although children with RAD can be diagnosed at a young age, they
are still eligible for specialized instruction in their district preschools, kindergartens, DART programs and early intervention
programs.
Parents are involved, along with the teacher and school district
representative, in deciding the special instruction and related
services that the child will receive.
(Education Law Center, 2006)
For more information on
Chapter 14. . .
Contact the Education Law Center at:
(412) 391-5225 (Pittsburgh)
(215) 238-6970 (Philadelphia)
www.elc-pa.org
There is hope . . .
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Keep in mind Reactive Attachment Disorder is
quite rare even in children involved in the foster
system.
RAD can be treated and children often experience
remission, especially if recognized at an early
age.
Support systems and information are available
through various institutions including school
districts, adoption agencies, foster care agencies
and treatment centers.
References
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American academy of child and adolescent psychiatry. (2007).
http://www.aacap.org/page.ww?name=Reactive+Attachment+Disorder&section=F
acts+ for+Family.
American Psychiatric Association. (2000). Diagnostic and statistical manual of
mental disorders (4th ed.) Text revision. Washington, DC: Author.
Association for treatment and training in the attachment of children. (2007).
http://www.attach.org.
Attachment & trauma network: hope & healing for traumatized children and their
families. (2006). http://www.attachmenttraumanetwork.org
Attachment disorder site. (2007). http://www.attachmentdisorder.net.
Education law center. (2006). http://www.elc-pa.org
References cont’d
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Helpguide: a trusted non-profit resource. (2001-2007).
http://www.helpguide.org/mental/parenting_bonding_reactive_attachment_disord
Merriam-Webster. (2007). http://medical.merriam-webster.com
Reactive attachment disorder and detachment issues. (2007).
http://www.radkid.org
Schwartz, E., and Davis, A. (2006). Reactive Attachment disorder: Implications for
school readiness and school functioning. Psychology in Schools, 43, 471-479.
Stoller, J.L. (2006). Parenting other people’s children: understanding and repairing
reactive attachment disorder. Vintage Press.
Thomas, N. L. (2005). When love is not enough: a guide to parenting children with
RAD. Colorado: Families by Design.
Three rivers adoption council. (2007). http://www.3riversadopt.org
Wikipedia. (2007). http://en.wikipedia.org
Contact Information
Abby Gould
[email protected]