How Common is Reactive Attachment Disorder (RAD)?
Last September, my colleague Suzette Lamb, LPC-S and I sat at the Irving Convention Center in Irving, TX listening to Daniel Siegel, MD, a pioneer in the field of Interpersonal Neurobiology. Dr. Siegel’s work has been instrumental in my understanding and conceptualization of attachment – as well as trauma, memory integration, and affect regulation. To say that Suzette and I were excited to be in Irving would be a gross understatement! I took copious amounts of notes, typing as fast as I could. At one point in the lecture, Suzette and I stopped and turned to each other. She tilted her legal pad in my direction and used her pen to point to the exact same phrase I had also just typed out. “Reactive Attachment Disorder is extremely rare.”
Why does the Diagnosis Matter?
One of the primary purposes of assessment and diagnosis is to inform clinical treatment. The treatment for depression is different than the treatment for schizophrenia. The treatment for anxiety is different than the treatment for ADHD. Proper diagnosis assists the clinician in determining the appropriate course of treatment. Keeping this in mind, it is much more helpful to assess a child’s attachment patterns while concurrently considering the impact of early trauma as opposed to labeling a child with Reactive Attachment Disorder. These two pieces of information- attachment patterns and the impact of early trauma- are more powerful pieces of information than a label of Reactive Attachment Disorder when determining how to help a child heal. (Heal trauma, heal attachment, heal trauma, heal attachment…repeat).
Reactive Attachment Disorder could not exist without early relationship trauma. Unfortunately, when a child is diagnosed with RAD, it is easy to lose sight of the child’s tragic beginnings, focusing instead on the current maladaptive behaviors that led to the diagnosis. Reactive Attachment Disorder has become a description of the child. It has come to be synonymous with “hopeless,” “unable to attach,” and even “sociopathic.” It is talked about as if the child merely chooses not to attach. Although I doubt this was the intention when RAD first made its way into the DSM, it is the unfortunate outcome. RAD has become a diagnosis that is all-too-quickly suggested for any child with a history of attachment trauma. The most serious negative impact of this diagnosis that I have seen is how it shifts a parent and professional’s view of the child away from the trauma.
Disorganized Attachment Pattern
Attachment patterns develop between a child and their caregiver. The ideal attachment pattern is a secure attachment. There are three types of insecure attachment: anxious/ambivalent, avoidant, and disorganized. The child with a disorganized attachment pattern is stuck in the unsolvable dilemma of being terrified of their attachment figure. One part of their nervous system protects them from danger and screams “RUN!! GO AWAY!” while simultaneously another part of their nervous system compels them to seek safety and proximity from their primary attachment figure. The disorganized child cannot solve this contradiction- to be compelled both toward and away from the same person- and the result is a disorganized attachment; there is no solution or adaptation possible for the child.
Rather than asking yourself “Does my child have Reactive Attachment Disorder” it is more helpful to ask yourself what style of attachment your child demonstrates. If your child experienced abuse or neglect, he likely has a disorganized pattern (85% of children who experience abuse or neglect develop a disorganized attachment pattern) (Dan Siegel, MD).
Impact of Trauma
The second thing to consider when doing assessment and treatment planning for a child with early developmental trauma is “How was my child’s brain and nervous system impacted by trauma?” “What current behavioral problems are the result of early trauma being triggered?” “What is the PURPOSE of my child’s behaviors when I consider how that behavior served them during the trauma?”
Reframing the child’s behaviors helps us find our empathy. Understanding the origins of their behavior helps us know where to begin with trauma resolution, linking up those implicit and explicit memories. These ‘stuck’ memories and a dysregulated nervous system (due to trauma and neglect) are what is contributing to the behaviors commonly associated with RAD. Instead of asking ourselves WHY our children cannot let go of these maladaptive behaviors, we should ask ourselves when this behavior was adaptive.
I agree with Dr. Siegel that RAD is extremely rare, much more rare than is currently diagnosed. Regardless of the accuracy of the diagnosis, consider your child’s attachment pattern (is it disorganized?) along with their history of early trauma. You may find that this is more helpful information to consider than a diagnosis of Reactive Attachment Disorder.
Like what you read here? To get more trauma momma support, click here to sign up for my monthly newsletter!