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Recognizing the Signs of Reactive Attachment Disorder

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Last month, I was asked to take part in a year-long blog series on Special Needs parenting. The other bloggers participating are women that I greatly admire so I eagerly agreed to take part. The theme for the first month was “recognizing signs”. I knew it would be easy to write about recognizing the signs of Sensory Processing Disorder in my kids or even to write about recognizing the signs of Aspergers in Einstein or the signs of hearing loss is Dancing Queen. I could also have written about seeing the signs of PTSD in two of our kids. I did not expect to be writing about the signs of Reactive Attachment Disorder because it is hard for me to talk about. RAD is the one diagnosis that I probably struggle with the most, both because it is the most challenging and because it is one that I never imagined we would be living through.

In the adoption world, Reactive Attachment Disorder or RAD is the worst case scenario. It is the diagnosis you are warned about but the one that you think could never happen to your family. Like many disorders, there is a spectrum with some children being more severely affected than others. I remember watching a documentary in a College Psychology class about RAD and the girl in it having no conscience and trying repeatedly to murder her adoptive parents. RAD is the stuff nightmares are made of. It is considered to be the most severe form of childhood mental illness.

Recognizing the Signs of Reactive Attachment DisorderIn our years as foster parents, we did take care of a few children who had been diagnosed with RAD, but it is different to know that you are the foster parent, a temporary home for that child, that you can take care of them and meet their needs but at the end of the day, if an emergency arises or if it becomes too much for you to handle, there is a social worker you can call who can step in.

When we began our journey to international adoption, we knew that the possibility existed for our child or children to have RAD but we still didn’t think it would happen to us. One of the reasons that we chose to adopt from Ethiopia was because we knew that children are generally highly regarded in their society, the children were well cared for in the Orphanages (unlike the horror stories you hear of in Eastern European Orphanages) and we heard that it was unlikely for these children to have issues with attachment. We were naive.

Any time a child is separated from their primary caregiver, moved to an Orphanage where they are one of dozens or hundreds of children and then moved to a different Orphanage, there are going to be attachment issues. Add in some childhood trauma and an adoption fraught with challenges and Reactive Attachment Disorder is almost a guarantee.

When we adopted from Ethiopia, we already had two biological children and three adopted children so we were not new to parenting or to adoption. We were well versed in attachment and knew that in adopting older children, we would have to be actively working on attachment. We had plans in place for helping these children transition to our family and to help them attach to us. We assumed that with enough love, enough effort and enough time, we could help them heal and attach. 

Even while still in Ethiopia with our kids, we could see that the challenges were much more than we had anticipated. It was obvious that they were terrified of us. They flinched or lashed out anytime we got near them. By the time we got back to Canada, we were all exhausted.

We settled into our new life at home with seven kids and began to work at helping them adjust. That meant teaching them English, getting medical attention for things like parasites and fungus and play therapy. Over the months, they seemed to be settling a bit and we thought that we could see light at the end of the tunnel. That was not to be. Or the tunnel is just much longer than we thought.

I don’t want to share specifics or much of a timeline because I am attempting to walk that line between helping others who are walking this road and protecting the privacy of my children. I will share a few personal things from our story further down, but the following lists are general signs of Reactive Attachment Disorder. Not all signs will be present in all children with RAD.

In our two kids who are diagnosed with RAD, they each present quite differently and they each have signs that the other does not. Neither of them has all of these symptoms.

Signs of Reactive Attachment Disorder:

  • anxiety
  • trouble sleeping
  • lack of boundaries
  • hypervigilant
  • extreme dependence
  • acts much younger than chronological age
  • underdeveloped conscience, lack of remorse
  • inappropriate responses (laughing or smiling when something is sad)
  • fake, not genuine
  • academic struggles
  • difficulty showing affection
  • disobedient
  • defiant
  • argumentative
  • controlling
  • bullying
  • aversion to physical touch
  • tantrums or rages
  • sensory issues or sensory processing disorder
  • withdrawal
  • lack of eye contact
  • not asking for help when hurt, sick or needing assistance
  • socially indiscriminate
  • manipulative (can be excellent at triangulating adults)
  • frequent lying
  • blames others for their mistakes
  • irresponsible
  • physically and verbally aggressive or abusive
  • mood swings
  • depression

Children with RAD are at higher risk for SPD, cognitive delays, malnutrition, language delays, depression, anxiety disorders, and ADHD.

We saw signs of RAD in our Ethiopian born kids from the beginning but we were in denial for a long time. I believed that with enough love, we could “fix” them. One of our kids showed classic signs of “mommy shopping” from the beginning, being overly affectionate with strangers and giving her best self to those outside our family. She was literally willing to go with anyone and still shows these boundary issues almost seven years after her adoption. She has gone into strangers’ homes, strangers’ garages and would be willing to go into a stranger’s vehicle. We always have to supervise her for this reason.

Our kids showed many other signs as well. It became obvious that our efforts towards attachment were not going as planned. Things came to a crisis point and we were finally able to get professional help for our two kids from Ethiopia who were both diagnosed with RAD, PTSD (post traumatic stress disorder) and one also diagnosed with an anxiety disorder and the other with ADHD (both things are in the list of diagnoses that children with RAD are at higher risk for).

The kids each took part with us (separately) in a year-long intensive group for kids with trauma and attachment issues. We worked in the program with a team of professionals including a psychiatrist, OT, therapists, and others to help them find some healing. We came to the agonizing decision to add medication as a piece of the therapy puzzle. Even with medication and years of therapy, the kids have significant daily challenges.

We want to help them to reach healing in their journey. On bad days, I wonder if healing is possible but I have seen glimpses that give me reason to hope.

Hope for Reactive Attachment Disorder:

Last November, we conducted a therapy camp for five of our kids at home based on many of Karyn Purvis‘ principles and methods. For one week, we unplugged, had therapy activities and exercises scheduled every 15 minutes or so for 9 hours a day plus family connection time every other waking hour. It was intensive, exhausting, challenging, and worth every second. We saw tremendous gains in all of our “campers” in things such as communication, problem solving, sensory issues, and self image. We also saw gains in positive attachment signs such as willingness to ask for and accept help, eye contact and giving us glimpses into who they really are.

Of everything we have tried, it has been the Karyn Purvis model that we have found the most success with. We attended her Empowered to Connect conference in 2015 in Minnesota, have bought and watched all of her 13 videos many times, read her book The Connected Child and read many of the articles she has written. Sadly, Karyn Purvis passed away after a long battle with cancer but her legacy in working with children from hard places lives on. You can access articles, short videos, and articles on Empowered to Connect. The videos we have found especially helpful are on the TCU website.

Join me for a free 5 email series, Little Hearts, Big Worries which will provide you with resources and hope for parenting your child.

Parenting with Special Needs Series image

I am pleased to have joined a fabulous group of bloggers to bring you this series on Parenting Special Needs Children. Be sure to read their stories on recognizing signs in their children.

10 Early Signs of Autism | Natural Beach Living

How to Recognize Signs of a Mood Disorder in Young Children | Every Star is Different

Recognizing the signs – Childhood Trauma  | STEAM Powered Family

Recognising signs as a first time special needs parent | My Home Truths

Hemophilia, Juvenile Arthritis, and Allergies… Oh my | Grace and Green Pastures

Myths About Recognizing Developmental Delays | Life Over C’s

Recognizing the Signs of Reactive Attachment Disorder | The Chaos and The Clutter

7 Sanity-Saving Tips if You Think Your Child has Special Needs | B-Inspired Mama

When They Say It’s Just Your Parenting | This Outnumbered Mama

Signs That Your Early Reader Has Hyperlexia | And Next Comes L

How to Deal with the Unexpected Learning Disability | Kori at Home

Forgiving Myself for Denying the Signs of Autism in My Daughter | Parenting Chaos

Ripples on a Pond: Warning Signs of Early Childhood Development Problems | 3 Dinosaurs

Comments

  1. Such a great post and you handled it so well! Finding the balance between hope and reality is so hard sometimes. I love the idea of a therapy camp! I may need to get notes from you on that! Lol. Thank you for writing about something so personal! It will help so many people.

  2. Thanks for sharing the reality of RAD and some of the struggles you have experienced as a family. I do hope the light at the end of the tunnel is not all that far away now. I’ll be sharing this on my page so other parents who many be experiencing similar challenges can access your journey and the work of Karyn Purvis. Thanks so much for sharing x

  3. Thank you for sharing your story and your struggles. I’m thrilled to hear you have seen so many gains from your therapy camp. I hope the progress continues.

  4. My daughter was diagnosed with rad last year, there was speculation between the disorder or only problems they only now said it really was the disorder and that the eldest one had problems. Their behavior seems miles apart though. Your article was really inspiring and I really want to try such a camp too. It’s only that we haven’t that many expertise with rad in the Netherlands and I was asking help for her behavior for two year before they offered me help, really frustrating and I questioned myself constantly. ill definitely look into your links and I hope it will help my girls too. If I may ask I hate medicin and that’s why I like to adapt their diet accordingly, do you have any more advise in that? We stopped a year ago with too much sugar candies, and even in the drinks we looked into it, and it helped a lot I must say. And what can you advice in the learning department we rehearse a lot with numbers and letters, but nothing seems to really stick (they do like to practice though) we found counseling and they specialize in rad but we haven’t really started, they want to start with play therapy to get to know her and then they want to start emdr therapy. Do you think that’s wise? I feel like the more I learn the less I know about it. Thanks for your article!

    • Roxanne, I know that when you first get a diagnosis of RAD for your child, it can be very overwhelming. We found that EMDR was quite effective, in particular when it came to trauma based issues for our children with RAD.

      We did have to resort to medication with some of our kids but we try some dietary changes first. Sugars and food dyes are the big things to watch out for when it comes to that.

      With learning, I find that trauma impacts learning more than RAD does but early trauma and RAD often go hand-in-hand so there’s a very real possibility that what is impacting her learning is that the trauma is interfering with her accessing her whole brain. I recommend reading the book The Whole Brain Child for more information on this. Also, doing activities with her that help her brain cross the mid-line (things like touching her opposite toe to hand) will help this process as well.

      We had fairly good success with one of our sons with play therapy. The key is to find a good therapist who understands Reactive Attachment Disorder and early childhood trauma.

  5. Debra Halpin says:

    This makes me so sad because now I feel I didn’t do enough for my daughter. My daughter was born in the US and adopted at birth. Literally! She was born at 3:40 am on Sept 4th and in our home by 6:00 pm that evening. Very different, I know. Her problems started at about age 6 when she was diagnosed with ADHD. She had many social issues as a result and we switched her to a public school for the resources available. She finished elementary school with an IEP but never developed lasting friendships. When she hit middle school, she became more depressed, started cutting, and would get up and leave classrooms. She confided to the counselor that she wanted to hurt herself and it was downhill from there. After 3 hospitalizations in acute care, we decided she needed more than the revolving door these hospitals offered as well as out-patient therapy. We hired an ed consultant and sent our daughter to a residential treatment program. Over the years, including recently, she has been in 3 different places. Most recently, and after a 2-1/2 year reprieve, she had a relapse so significant we had no choice but to find her a young adult program. I am so sad for her and for us. There were so many indications from your checklist. Perhaps if we identified the core reason we could have concentrated more on that and saved her from the placements. Also, by sending her away are we only making her attachment disorder worse? Your article has made me feel that by trying to “save” her from herself, we only made things worse.

    • I’m so sorry to hear about your daughter. It sounds like you have all had a very rough time of it but it also sounds like you have done everything you knew to do. It is very common for children who are adopted at birth to have signs of attachment or trauma issues that go undiagnosed because even some experts assume that if the adoption happened at birth, there was no trauma. Pre-natal trauma is absolutely as significant. But it doesn’t help your daughter for you to carry around the guilt of something that you could not have known. I would suggest that now that you do know that perhaps this is a piece of the puzzle for her, you check out the resources at http://empoweredtoconnect.org Sending hugs and prayers your way. This road is certainly not an easy one.

  6. Our daughter was adopted from Eastern Europe at 1 year old. She is now 14. She definitely triangulates and is a master manipulator. She likes whomever gives her what she wants. She has lied to the point of blaming her siblings and both parents of abuse. This has caused endless grief for our entire family. We have tried several therapists but she tries to manipulate them as well. She comes across to the outside world, at least upon first impression, as innocent, reserved, and happy-go-lucky….as long as anyone she encounters gives her what she wants, whether that is a material object, an activity she enjoys, or all of their attention. In school, she will distract others with nonsense speak, “tantrums”, or simply getting up and leaving the class. She never looks anyone in the eye. School testing puts her as above average in many verbal skills; yet she pretends to not understand anything so as to get out of having to complete in class assignments. She has figured out that if she behaves in a not normal manner, she will be dismissed from class to go work out her anxiety in the school’s special room. It is full of fun activities to help reduce kids’ stress, need to move, etc. Needless to say, her manipulations have landed her in the special room more than in her required classes. We have sought treatment for RAD for several years with little success. The hardest part is the level of resentment that has built with her siblings now. At the least, this article lets us know we are not alone and at the most, there may still be hope.

    • Susan, you are certainly not alone. So much of what you describe is very familiar to me. I hope that you are able to find some helpful resources in your area and a therapist who truly understands RAD and is not fooled by the manipulation. Sending hugs.

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