Tuesday, April 19, 2011

Student Guest Post: Reactive Attachment Disorder

by Jessica D. and Kyra K.

The outrage surrounding Torry Hansen’s decision to send her adopted son back to Russia has focused the discussion on Reactive Attachment Disorder (“RAD”) in institutionalized overseas orphanages. Popular media churns out stories of ‘international adoptions gone wrong’ due to attachment and behavioral disorders resulting from the overcrowding and limited resources associated with orphanages, especially in Eastern Europe and Russia. Yet, this disorder is not exclusive to children left to languish in orphanages. Statistics indicate that 800,000 children with severe attachment disorder come to the attention of the child welfare system every year due to abuse and neglect. This number does not include children with attachment disorder adopted from other countries. These stories fail to delve into why this is happening or what can be done about it, and instead focus on who failed these children who have now ‘gone wrong.’ What happens after the news story ends - what becomes of these children?

Dr. Bruce Perry, M.D., Ph.D., made a career of studying the effects of trauma on child brain development and had become a prominent figure in the RAD community. In The Boy Who Was Raised as a Dog, Dr. Perry explains the signs and causes of RAD in a way that evokes a sympathetic understanding of the biology behind these children. The following are a few excerpts taken from different areas of the book:
“…marked by a lack of empathy and an inability to connect with others, often accompanied by manipulative and antisocial behavior. RAD can occur when infants don’t receive enough rocking, cuddling and other nurturing physical and emotional attention. The regions of their brains that help them form relationships and decode social cues do not develop properly, and they grow up with faulty relational neurobiology, including an inability to derive pleasure from healthy human interactions.”

“…many RAD children can be inappropriately affectionate with strangers: they seem to see people as interchangeable because they were not given the chance to make a primary lasting connection with a parent or parent-substitute from birth. These indiscriminately affectionate behaviors are not really an attempt to connect with others, however, but rather they are more accurately understood as ‘submission’ behaviors, which send signals to the dominant and powerful adults that you will be obedient, submissive, and not a threat.”

“If the child has RAD, the lack of connection goes both ways. There is a reciprocal neurobiology to human relationships- our “mirror neurons” create this. As a result, these children are difficult to work with because their lack of interest in other people and their inability to empathize makes them hard to like. Interacting with them feels empty, not engaging.”

“The anger and despair that their coldness and unpleasant behavior can provoke may be the reason why so many parents are attracted to therapies for it that are harsh and punitive and why therapists often converge on these harmful techniques.”

“The brain needs patterned, repetitive stimuli to develop properly. Spastic, unpredictable relief from fear, loneliness, discomfort, and hunger keeps a baby’s stress system on high alert. Receiving no consistent, loving response to his fears and needs, Leon never developed the normal associate between human contact and relief from stress. What he learned was the only person he could rely on was himself.”
While it is important not to underestimate the challenges that arise from raising a child with RAD, they are not insurmountable. Parents of children with the disorder should arm themselves with effective techniques that chip away at the child’s emotional issues, while simultaneously recognizing that they as parents have individual issues that need to be addressed. Often, the focus is on the child’s inability to attach, while ignoring that some adoptive parents can have attachment issues of their own. First and foremost, it is imperative that a medical professional evaluate the child’s basic physical and emotional needs. This allows both the medical professional and the parents of the child to know the full extent of the child’s issues. From there, treatment should be tailored to the child’s individual needs. Treatment usually involves therapy for the parent and the child, therapy for the entire family, and education classes for the parents about the condition. Treatment can also include medication for various conditions that tend to accompany RAD, like depression and anxiety. It is also important that the parents of the child not use techniques that have been proven to be ineffective and particularly dangerous for children with RAD, including holding the child tightly in an effort to increase bonding, forcing the child to eat or drink, withholding basic necessities such as food as punishment, or triggering anger in children in destructive ways. The most important thing to take away is that proper medical and therapeutic intervention is necessary for treatment of RAD, and that patience and a willingness to help a child succeed will go a long way in healing the child’s wounds.


Anonymous said...

I was so glad to see this quote - “The anger and despair that their coldness and unpleasant behavior can provoke may be the reason why so many parents are attracted to therapies for it that are harsh and punitive and why therapists often converge on these harmful techniques.”

The techniques that I see recommended for RAD leave me shuddering. I don't see how it is remotely possible to help a child who can't attach by constantly punishing the child.

Anonymous said...

It seems all parties in this situation are desperate for something.