Reactive Attachment Disorder
I recently subscribed to an on-line chat group of adoption professionals from all over the country. Topics discussed range from clinical to recruitment issues. A recent posting caused quite a stir. Someone posted a request from a family who wanted to disrupt the adoption of their three-year-old son, whom they had adopted from an orphanage in Eastern Europe. The child was described as cute, funny, charming but high needs, hard to parent and as having Reactive Attachment Disorder. Multiple responses ensued and everyone had an opinion about the situation; but it was not the fact that an adoption of a very young child was about to disrupt that got everyone up in arms -- it was the use of the term Reactive Attachment Disorder.
According the DSM IV, the diagnostic criteria for 313.89 Reactive Attachment Disorder of Infancy and Early Childhood are (paraphrased):
Symptoms that are commonly seen in children with attachment disorders are:
There are multiple factors that can lead to attachment difficulties; if a child experiences one or more during the first three years of life, there is a greater risk for serious damage. In general, if an infant's needs are not met consistently in a loving, nurturing way, normal attachment does not occur. Risk factors include:
When an infant's needs are not met, they learn that the world is an unreliable place where they can depend on no one but themselves to meet their needs. Children with attachment disorders are unable to love or trust others, especially caregivers, and may actually feel that they will die if they give up their control. They become adept at getting their needs met by being charming, sneaky, manipulative- they are masters at surviving in an unpredictable world. While most of us learn to trust caregivers during our first year of life, children who do not have their needs met develop feelings of helplessness, hopelessness and anger. These feelings are internalized, and at the core of every child with an attachment disorder is an unresolved, deep-seated rage.
Many of the behavioral symptoms of Reactive Attachment Disorder are similar to those seen in children with Attention Deficit Disorder with Hyperactivity, Oppositional Defiant, Post Traumatic Stress and Conduct disorders, as well as those with severe depression. Many children who have Reactive Attachment Disorder are incorrectly diagnosed as having some sort of other disorder where similar behaviors are present. It is therefore very important for families to get an accurate diagnosis for their child from an experienced, trained professional.
There are some professionals who feel that Reactive Attachment Disorder is an overused label placed on children from the system who are challenging to parent. In truth, the number of children diagnosed with Reactive Attachment Disorder has increased in recent years.
However, to many families, and the professionals who work with them, Reactive Attachment Disorder is an all too real condition that can rip families apart. To help these families cope with the challenges of parenting a child who does not want to be parented, and to prepare families who may be considering adopting or fostering a child with Reactive Attachment Disorder, professionals and experienced families have many tips:
Eventually, a new adoptive home was located for the cute but challenging three-year-old. This family was well prepared for his behaviors, had a good resource network and was aware that it may take months or years for this youngster to learn to get close to them. But their philosophy reflects the words of Helen Keller, a survivor of Reactive Attachment Disorder herself, "Believe, when you are most unhappy, that there is something for you to do in this world. So long as you can sweeten another's pain, life is not in vain."
Reactive Attachment Disorder Resources
There are numerous resources available to families and professionals who want to learn more about attachment disorders or parenting. The following are available through the MARE lending library:
National Adoption Information Clearinghouse (NAIC), Attachment Disorder: Resources for Professionals (a bibliography)
Foster Cline and Cathy Helding, Can This Child Be Saved? Solutions for Adoptive and Foster Families
Richard Delaney and Frank Kunstal, Troubled Transplants: Unconventional Strategies for Helping Disturbed Foster and Adopted Children
Ken Magid and Carole McKelvey, High Risk: Children Without a Conscience
Gregory Keck and Regina Kupecky, Adopting The Hurt Child: Hope for Families with Special Needs Kids
Richard Delaney, Raising Cain: Caring for Troubled Youngsters/Repairing Our Troubled System
Nancy Newton Verrier, The Primal Wound: Understanding the Adopted Child
Foster Cline and Jim Fay, Parenting With Love and Logic
Other resources not in the MARE library, but are usually available through Tapestry Books:
Robert Karen, Becoming Attached
Martha Welch, Holding Time
Daniel Hughes, Building the Bonds of Attachment
Terry Levy and Michael Orlans, Attachment Trauma and Healing
Carole McKelvey, Give Them Roots, Let Them Fly
Beverly James, Handbook For Treatment of Attachment: Trauma Problems in Children
Elizabeth Randolph, Children Who Shock and Surprise: A Guide to Attachment Disorders
There is also plenty of good information and sites on the internet pertaining to Reactive Attachment Disorder. Just do a search on Reactive Attachment Disorder, or Attachment Disorders.