The Diagnostic and Statistical Manual of Mental Disorders (DSM) is the handbook used by healthcare professionals in the United States and much of the world as the authoritative guide to the diagnosis of mental disorders.
The DSM “classifies reactive attachment disorder as a trauma- and stressor-related condition of early childhood caused by social neglect and maltreatment. Affected children have difficulty forming emotional attachments to others, show a decreased ability to experience positive emotion, cannot seek or accept physical or emotional closeness, and may react violently when held, cuddled, or comforted. Behaviorally, affected children are unpredictable, difficult to console, and difficult to discipline. Moods fluctuate erratically, and children may seem to live in a “flight, fight, or freeze” mode. Most have a strong desire to control their environment and make their own decisions. Changes in routine, attempts to control, or unsolicited invitations to comfort may elicit rage, violence, or self-injurious behavior. In the classroom, these challenges inhibit the acquisition of core academic skills and lead to rejection from teachers and peers alike. As they approach adolescence and adulthood, socially neglected children are more likely than their neuro-typical peers to engage in high-risk sexual behavior, substance abuse, have an involvement with the legal system, and experience incarceration,” (Ellis, 2020).
What Are the Types of RAD?
Children with Reactive Attachment Disorder cannot be put into one simple box. There are different types of RAD that look unique from one another as well as have different behavioral consequences and sometimes treatment modalities, although generally no RAD is treated similarly despite the type.
The Institute for Attachment describes the four types of attachment disorders underneath the RAD diagnosis:
Avoidant: child seeks isolation, avoids closeness, seldom seeks comfort, avoids relationships, passive-aggressive, avoids feelings, intense sadness and loneliness, believes rejection by mother was justified.
Anxious: child tells ridiculous and obvious lies, fakes emotions, lacks emotion, chameleon, often fools therapists to think they are normal and parents are not [This is a less common subtype.]
Disorganized: child displays odd and bizarre behaviors, has unpredictable moods, excessively excitable, frequent sensory or neurological problems, difficult to manage, lower cognitive abilities. Often seen from dysfunctional orphanages and typically has other mental health issues.
Ambivalent: child openly angry, defiant, destructive, dangerous, superficially charming, lacks empathy, delinquent acts.
[This is the most prevalent subtype in mental health systems.]
The ambivalent type of RAD is seen more often; the consequence of the prevalence is that when left completely undiagnosed and untreated, children with this type of RAD will grow up with maladaptive behaviors and may cause harm to themselves, others, or their community.
Then there is the secure attachment style, which is what most individuals are able to achieve. Secure attachment relationships serve many important functions for children, including areas in:
- Independence and autonomy
- Resilience in the face of adversity
- Ability to manage impulses and feelings
- Long-term friendships
- Relationships with parents, caregivers, and other authority figures
- Prosocial coping skills
- Trust, intimacy, and affection
- Positive and hopeful belief systems about self, family, and society
- Empathy, compassion, and conscience
- Behavioral and academic success in school
- Promote secure attachment with adult partners and with their own children when they become adults (Sroufe et al. 2005)
Attachment Disorders and Criminal Behavior
Starting in 1969, research on individuals with attachment disorders and the correlation between delinquency began and continues to this day. “In sum, attachment theory is a theory of both normal and abnormal development that focuses on the impact of parent-child attachment relationships on healthy development and psychopathology, including juvenile delinquency,” (as cited in Hoeve, 2012). When a child develops abnormally in the way one with the ambivalent type of RAD would, they pose more of a risk of engaging in criminal behaviors.
In the meta-analysis entitled, A Meta-analysis of Attachment to Parents and Delinquency, the study concluded that after 74 published and unpublished manuscripts, the following results were found:
Poor attachment to parents was significantly linked to delinquency in boys and girls. Stronger effect sizes were found for attachment to mothers than attachment to fathers. In addition, stronger effect sizes were found if the child and the parent had the same sex compared to cross-sex pairs of children and parents. Age of the participants moderated the link between attachment and delinquency: larger effect sizes were found in younger than in older participants. It can be concluded that attachment is associated with juvenile delinquency. Attachment could therefore be a target for intervention to reduce or prevent future delinquent behavior in juveniles (Hoeve, 2012).
There are no studies actually proving the causation of criminal behavior due to having an attachment disorder; although, there is a positive correlation in children who have been diagnosed with an attachment disorder to criminal behavior later on in teenage years and in adulthood. While correlation does not imply causation, the behavioral and emotional consequences of RAD, for example lack of emotion, violent outbursts, unpredictable behavior, or lack of empathy are all behaviors that could encourage an increase in criminal behavior.
It is wise to remember that there are four types of RAD and just like in children with autism, it is irresponsible thinking to label them all together in one box. Children with RAD lie on a spectrum, with extreme violence and out of control behavior being on one end. Not all individuals with RAD are violent (ABA Program Guide).
RAD and Adoption
Imagine a parent adopting an infant or a child who was abused and neglected by his birth mother. The child has difficulty letting the adoptive parent hold or console him, he has little interest in playing or being near the parent, he rejects actions of love, destroys belongings in home, and purposefully causes pain to others. The adoptive parent must feel exhausted, worried, guilty, and maybe even regretful. Unfortunately, in many fostering situations, the child will be right back in the system due to foster parents not being equipped to handle the behavioral and emotional struggles it takes to raise a child with RAD. Even some adoptive parents do not know what to do or where to turn.
The longer the child is without a loving home, the longer he has to wait to get help. No matter what, there is hope if the adoptive parents get their child treatment as soon as they notice warning signs of RAD.
RAD in Teenagers
Raising a teenager is difficult enough, but raising a teenager with an attachment disorder has its own set of challenges. According to Institute for Attachment, the following distinguish the average teen with one that has been diagnosed with RAD:
- Early trauma changes the brain
- Healthy attachment contributes to healthy remorse (which teenagers with RAD have little of)
- Peer influence is more powerful for teens with RAD
- Teens with RAD have abnormal social relationships
- Teens with RAD desperately want to attach to others based on their terms rather than to have reciprocal relationships
Parents with teenagers with RAD should consistently model empathy, good decision-making, monitor social groups and activities, and attend counseling with someone who has experience with attachment disorders.
Treatment for RAD is often a marathon; there is no easy remedy and there are often various treatment modalities involved. All hope is not lost for those struggling with an attachment disorder or for those parents raising a child with one. Over the years, more conclusive research has been available and there is more of an understanding in the disorder, which professionals can use when deciding upon a treatment plan.
Master of Education (M.Ed.) | Northeastern State University
Behavior and Learning Disorders | Georgia State University
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