How do you treat children with R.A.D. (Reactive Attachment Disorder)

I’d treat ‘em like any other kids, but then I’m just some schmoe on Fluther, and not anyone with training in the field and worthy of consultation.

I’ve got a contact who got adopted at the age of 14 years of age (she is now 15yo). Her bio father beat the crap out of her, moreso after the mother ran away. She constantly looks for approval from her adotive parents, (more from the male parent) even though it is given constantly. The adoptive parents have 3 other children and one on the way and now she feels a bit threatened by the onset of a new baby.

I feel that if a child is adopted at a much younger age, younger than 4 years, has a much better chance at acceptance and being accepted. Adoptive parents who adopt older children are more likely to over-compensate and try too hard to be “nice”.

Depending on the age of the child, counselling may be in order. I don’t approve of medications, even for nightmares or behavioural problems unless absolutely necessary and every other course of action has been taken or implemented.

There is no best way but I would suggest you offer many cuddles and hugs, affirmations on conduct but not on misbehaviour and no chastisement. Don’t show fear if the child does something unexpected.

How old are the children you are dealing with?

Both of my children have reactive attachment issues. I will write more in the morning, because my two darling bambinos wear these mammas down by the end of the day :)

One girl, age 7 and ¾. Adopted at age 1. The one doctor suspects sexual abuse (prior to the adoption) and neglect (plus abandonment issues).

Controlling her Mom is the biggest issue and freaking out when he Mom isn’t in sight. Freaking out to the point of self-harm.

@jjmah There may be no easy answer. Studies have shown in monkeys that negected monkeys show severe emotional trauma wth various “tics” such as rocking and continued islation even after bing reintegrated into a group. Some actually appear to be able to integrate while some do not, but they all seem to react to the slightest stress stimuli with inappropriate anger resonses and violence towards others in the group or towards themselves. When the females grew enough to become pregant they ignored their babies or actually killed them. We still do not know all there is to know about the effects of neglect and abuse but the reports a this point lean towards neglect being the worse of the two evils as far as negative effects on the survivors. At some point the damage is ireversible. Or, at least we have been unable with our current techniques to revrse or counteract the damage.
I have couple theories of my own and I can find you some articles if you’re really interested. I don’t have them in my bibs any more, I cleaned out my WORD references, but I can find them again,I think. This is a branch of a study that I’ve been doing for over two years now.

Girls are more likely to be emotional and boys are more likely to be withdrawn. You need to create a link or connection with the children but not a dependence. It can be hard to ignore the child if the dependence becomes too demanding but the child has to learn how to cope when you’re not in line of sight. I suggest you talk with her and discuss ways in which she can entertain herself when you are not in the house or if she becomes emotional. if she learns now how to keep her sense of reality, it will be of great benefit to her, later in life. Though it may be difficult at first, she will cope.

Perhaps you could have her write a diary. A diary is a good way of releasing pent up emotions. Other forms of writing such as poetry and stories, can also help a child release emotions without having to cry uncontrollably into a pillow.

You should also consider getting her into an interactive sport or hobby. Dancing, singing, and playing a musical instrument are great forms of distraction, especially when you are not at home.

What happens to children in the earliest, pre-language, stage is critical for future development. This is when trust develops, and if it isn’t there, it is hard to get it back. So that would be the work for the parents. How to do this? You have to re-establish the earliest love relationship/bonding between the mother/father and child. If the child you are talking about is still under three, it will be easier. You would need to spend an enormous amount of time just looking at the child, holding him or her, giving her what she needs. If the child is older, it becomes more challenging, but still possible. You still need to have lots of eye contact, lots of time with the child, lots of acting so incredibly consistently and warmly and sweetly that the child begins to give up the mistrust that she may have developed and begins to trust you.
I heard a remarkable story on the radio about a woman who adopted a seven or eight year old child who after a year with the family became very violent. He was a danger to other children and to the family itself. The mother took on this challenge, and rebuilt the lost trust of the child, at one time actually being tied to the child so neither could be too far from the other. It was an amazing story—she basically had to give the child back the equivalent of what we give a baby in the first year or two of its life. She kept being told it was impossible, and to return the child. And to tell the truth, it sounded pretty difficult. But, the story had a happy ending. They taped the child at his Bar Mitzvah (age 13) where he recounted how he had been given a second chance at a life from his adoptive mother. Pretty remarkable.
This is much easier the younger the child is.

As I am sure you know the way attachment problems manifest in a child are as unique as the families wrestling with the issues.

From a clinical perspective this is a good starting place: Handbook of Attachment: Theory, Research, and Clinical Applications. or Becoming Attached: First Relationships and How They Shape Our Capacity to Love they are a bit dry, but full of knowledge non-the-less.

From an, “Oh shit, how do I do this???”, place I would start with one of these comprehensively helpful books: Help for the Hopeless Child: A Guide for Families or Healing Parents: Helping Wounded Children Learn to Trust & Love. This site is also helpful: http://www.attachmentdisorder.net

In addition to gathering information I think the single most important thing to do is remember to not navigate caring for such a child alone, as a caretaker or parent. Talk, talk, talk. A very lonely and sacred task has been taken on and self-care is just as crucial in this instance as is the care for the child.

For the immediate family, finding professional help that is familiar with modalities involving attachment therapy and play therapy would be something I would call essential. Suggest starting the search here: http://www.theraplay.org/8454.html. While any professional intervention would be helpful a therapist gifted in the art of play and children is the most helpful. I believe this is something that can be eventually weaned off, but it is a time saving/life saving need.

My children have faced neglect and trauma that many an adult could not bare. At each developmental stage my children seem to relive their trauma and require from us various interventions that help them know they have a harbor of safety in us. It is also key in learning to give our whole selves to one another. As any of us know this is a priceless gift. Since a child’s language is play it is crucial to integrate play into the parent-child interaction that encourages trust. There are many examples that I could give but I fear this post is getting too long. PM if you have any interest. I will point you to another book entitled Playful Parenting. It offers concrete examples of how to turn power struggles into play and every day moments into attachment. One doesn’t need to be a parent to see the benefits of what the author suggests.

If you find yourself in an immediate situation with a seven year old child who is wanting to harm self or others, somehow turn the situation into a game.

For example, if she is using an object to cause harm say, in a very excited, exaggerated, and earnest voice, “Oh,insert name, look at me! (wait for eye contact) You didn’t hear???? That has to be hidden away from the fairies!” Then produce a brightly covered cloth and wrap it around the object (even if it is in her hands). Then elicit her help: “Hurry, help me find a safe place!” then quickly move, with her, to a place where the object and cloth can be hidden.

Somehow use redirection to turn the situation into a game and tell the parents to get some help!

Finally, I hope for this child and her family healing. Often, when my son strikes out and cause harm to himself and others, it is the only way he knows to ask “Are you stronger than me? Can you keep me safe???” I hope the adults in your precious child’s life can help show her just that.

edit: @skfinkel, I heard that broadcast, it was on “This American Life” here is a link and synopsis for the curious: http://ukraine.adoptionblogs.com/weblogs/this-american-life-unconditional-love it is quite moving!

I was thinking about this more today and what we wold do to help our daughter navigate being away from us (it was harder for her than our son). I want to point out that thera-play is not like traditional play therapy. The director of training for theraplay is someone I know personally and can connect you with her if you would like to talk things through with a professional. PM me. (if you want to make sure I am not a 400lb hairy ape eating fried chicken all day I can share my facebook with you.)

First we had care takers who really knew their stuff and had several planning sessions to prepare all of us. When at all possible we would have caretakers come and get our children because it was psychologically easier for them to leave us, then have us leave them.
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We would sit down and make a one page ‘schedule of events’ with our daughter. She would color and draw pictures and color things while helping us make the list. For example, (pre-arranged activities with the caregiver.)
1) Go for a walk
2) Color
3) Read a book
4) Put together a puzzle
5) Put our shoes on, our jacket,
6) Mommy picks me up!!

Whether she was being picked up or we were dropping her off before the transition happened we went over the list together. We started with small little outings of 15 minutes or so. We also tried to pick her up instead of having her dropped off because it sent the message that we liked coming to get her and that we planned on keeping her.

We made sure to coordinate tightly with the caregiver and we were at the door as soon as that jacket was zipped!

We would then go home and do some sort of attachment exercise together.
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Of course, this is intensively exhausting and outings were few and far between. Being very careful about how we planned them and taking time to start the process over if we switched caregivers was a worthy investment for all of us.

My children are now 10 and we do not have to be as intensive, but to this day we go over a list of things so they can calculate in their heads when they will be with us again. If it is an extended time, such as overnight, and the caregivers feel new to them (even if it is a loved family member) we send them with family pictures, a way to count the days, and scheduled phone calls.

When it comes to self-harm my daughter used to rub her lips, neck, and pick her skin until they bled. My son would fly into rages that physically endangered others. Professionals taught us proper ways to restrain them and calm them until the bouts passed. We haven’t had to use such last resort interventions in over a year.