There are several treatment options for Reactive Attachment Disorder. In most cases, a combination of treatments is used. Love alone is not enough to cure RAD. Please remember that I am not a therapist or official expert in the field of Reactive Attachment Disorder. I am a mom. Two of my kids happen to have the diagnosis. This article is based on the current research into the treatment for RAD as well as my personal experience. I have not tried everything on this list.
There is no “one size fits all” treatment package I’m afraid when it comes to RAD. What works depends on the child, the family, and a variety of other factors such as other diagnoses.
In many cases, a diagnosis of RAD is not an isolated diagnosis. It often comes alongside other diagnoses such as Sensory Processing Disorder, Post Traumatic Stress Disorder or developmental trauma disorder, ADHD, an anxiety disorder, depression, cognitive delays, or FASD.
In fact, it is not uncommon for kids to have several diagnoses on the list. This is one of the reasons why a treatment plan needs to be customized to the child.
The treatment that we have found the most effective for our kids with RAD was TBRI (Trust Based Relational Intervention). It is based off this theory; “Our children were harmed in relationship and they will experience healing through nurturing relationships” ~ Karyn Purvis.
We used TBRI along with some of the other treatment strategies listed in this article.
The main principles of TBRI include:
- Safe and Structured Environment
- Sensory Needs
- Empowering Principles
- Connecting Principles
- Observational Awareness
- Skills of Attachment
- Playful Engagement
- Correcting Principles
- Proactive Behavioural Strategies
- Responsive Behavioural Strategies
The abbreviated program activity list here (near the bottom) is very helpful.
Choosing to medicate a child is a very personal decision. I share some of our experience with that here. There is no prescription that will magically cure RAD, but there are some that will treat some of the symptoms such as anxiety, aggression, trouble sleeping, and difficulty focusing.
It is certainly more complicated than just treating a symptom with a pill. There are many factors to consider. I suggest consulting a paediatric psychiatrist who specializes in or is at least very familiar with treating attachment and trauma disorders.
Choosing to medicate is a big decision and one where it doesn’t hurt to get a second opinion.
Whether you choose individual and/or family psychological counselling, it is very important to choose a therapist who is trauma informed and experienced in attachment disorders.
If you seek the help of a therapist who does not have experience with Reactive Attachment Disorder, they can be distracted by the child’s coping skills (which can come across as charming) and not recognize the signs of RAD.
Parent-Child Attachment/Trauma Program:
With each of our kids, I attended a one year long program specific to attachment and trauma. I feel so fortunate that our area has such a program.
If you are fortunate to have one in your area, be sure that it is based on the current science of the impact of trauma on the developing brain and the science of attachment.
Play therapy can be particularly beneficial for kids who were very young (babies or prenatally) at the time when their trauma or neglect occurred.
Talk therapy is often not as productive for kids who were preverbal at the time of their abuse or neglect because they hadn’t developed language at that time in order to be able to discuss it later.
The use of sand trays in particular can be useful in helping kids play out some of their past and better process it.
Art therapy can help children process what happened to them. It is a non-threatening approach that works very well with some children.
There is more and more research being done in the area of art therapy. It is becoming easier to access. Again, it is best if you can find a therapist who is attachment and trauma informed.
Animal Assisted Therapy:
One of our sons did animal assisted therapy for over a year. It was extremely therapeutic for him. Where the love of another human can feel so threatening to kids with RAD, allowing themselves to love and be loved by animals can sometimes help bridge that gap.
It is also wonderful for them to build confidence in themselves by taking care of an animal. Therapeutic programs use a variety of animals including horses, dogs, chickens, llamas, donkeys, and even pigs.
Important note: There are some kids with RAD who harm animals. If this is the case with your child, inform the therapists ahead of time. They may not feel that your child is a good fit for the program or they may be willing to have them attend but offer increased supervision.
Neurofeedback is a type of biofeedback that uses real-time displays of brain activity to teach clients self-regulation. It is not something suitable for young children or those with severe cognitive delays. Most commonly, it uses EEG.
Neurofeedback is still a fairly controversial approach. The scientific data at this time points to more of a placebo effect. Neurofeedback can be expensive as well.
EMDR on the other hand has more and more scientific data backing up its effectiveness in treating PTSD. As many of “our” kids with attachment issues also have a trauma history, it stands to reason that EMDR can be an effective treatment for them at least where the root of their trauma is concerned.
This article on adapting EMDR specifically for children with RAD has some excellent suggestions.
EMDR stands for eye movement desensitization and reprocessing. It works best in adults or older children who were verbal at the time of their trauma, so it may not be as effective if the abuse or neglect happened during the very early months or years.
We have found EMDR gives good results. We also use bilateral stimulation with the kids at home if they are having a hard time calming themselves down.
In some cases, it is no longer safe to have a child in the home, either because they are a danger to a parent, a sibling or themselves. In these cases, a period of removing the child from the home for a period of time may be necessary.
Obviously, residential treatment is more of a last resort option. It can further compound the belief the child has that they are not loveable or that anyone who is supposed to love them will eventually leave them, but others in the home deserve to feel safe and sometimes, there really is no alternative.
Sometimes residential treatment can compound the rejection and abandonment issues for a child while other times, it can actually lead to tremendous healing.
Other possible options of treatment for RAD:
- circle of security intervention
- vision therapy
- QEEG brain map
- neuro-reorganization exercises
Important note: Avoid any attachment therapies that involve forcibly holding or physical discipline.
More information about Reactive Attachment Disorder: