Since Sutton was diagnosed with Reactive Attachment Disorder(RAD) {Also known as Attachment Disorder (AD)} I have had so many people ask me what exactly RAD is that I thought I'd try to explain it a little.
My knowledge of Reactive Attachment Disorder is by no means perfect and I am not an expert but I have done a lot of research on the subject and this is my understanding of what it is. RAD is caused by a child not forming a true bond with a primary caregiver. There are many things that can cause this such as: drug use by birth mother, sudden death or separation from primary caregiver (multiple placements in foster care, a sick mother so many relatives care for the baby, neglect, birth trauma, unprepared mother with no parenting skills). The baby's needs are not consistently met so the child begins to feel a sense of being unloved or that people are not to be trusted. This happens very quickly and at a very young age. In Sutton's case we believe it was caused by her not being fed for the first 11 days of her life (her birth mother was so malnourished that she did not produce breast milk) and thus being so sick when she was brought into the orphanage. She required so much attention that she was cared for by someone different almost everyday for 4-6 weeks .
"Children with attachment disorders have trouble trusting others. Trusting means to love--and loving hurts. They have been hurt too deeply. Loving must be done on their terms so that they will not be hurt again. They attempt to control everyone and everything in their world. No one gets into their world, past their barriers, without proving that they are truly trustworthy."
A child learns how to trust and act towards others in the first 4 years of their life. This period is crucial to their ability to respond appropriately to situations as they get older.
" the first two years of life the conscience only responds when the parent is present and in control. In the third year the child responds appropriately only if the parent is present and the parent initiates the action, "Johnny, tell Mary you're sorry." In the fourth year, the child responds to acts of conscience only if he/she knows that the parent is present and will react. The fifth year shows progress in that the child will, when instructed to do right, follow accordingly. In the sixth year, (finally) self control is learned."
"Consider a child in the first days, weeks and months of life. The child is hungry, or wet. What does the child do? He screams out for attention, and in the rage he expresses, the mother comes to the child's aid and feeds or changes the child. Day after day, week after week, the closeness of eye contact, touch, movements, and smiles creates a bond of trust between the child and its mother. But what happens if this cycle is broken? What if the mother doesn't want to respond to the demanding needs of the child? What if there was an undiagnosed condition in the child, that was never appropriately responded to and comforted? In these instances, the child does not learn to trust, does not learn to bond, and proceeds on with the next lesson to learn in life. The neural paths for bonding have been ignored."
Children who develop RAD appear to be very charming and loving to strangers. They are very good at manipulating adults and other children that do not know the child well. They will approach total strangers and ask to be held or loved on yet are unable to hug and kiss the people who are trying to raise them. To an outsider the child appears sweet and misunderstood by the caregivers. The caregivers may appear rigid and uncaring.
Consistency is the key component in helping a child with RAD. Firm, clearly defined rules and consequences help the child feel safe and able to accept the caregivers. Many times these rules seem overly harsh or restrictive to outsiders but are actually very necessary for a RAD child. Without them they lack direction and act out to prove once again that no one can be trusted. They begin to only trust themselves and lack the ability to show empathy or concern for others. They become expert manipulators and learn ways to control people into believing that the caregivers are mean, controlling and unloving. This can happen as young as 5 or 6 years old.
"Needing to control their environment, the RAD child will quickly target the Mother as the one who has to be broken. This is because the mother is the one who instills discipline on a daily level, and ensures that chores and work is performed to standard. It may also be because, "a mother" was the one who let them down in the past, and they target the mother in a sense of pay-back. Father's are charmed into believing that this child is innocent of all accusations, and if the father allows any benefit of doubt to creep in, the child will work that against the rest of the family. Quite often the child will exhibit a "Dr. Jekyl, and Mr. Hyde," disassociation between the family and the father in order to control, and if necessary, split-up the family."
"How do you fix a broken child? In any successful approach to reducing the symptoms of RAD, the child has to attempt to be a part of the fix.
1. An elementary approach to produce bonding is to get the child to agree to ask the parents assistance and permission for everything. The idea here is to restore the bonding of the parent in the first year cycle. The repeated requests to the parent becomes the tool for repeated gratification/relief.
2. A second addition to this method is to require the child to make eye contact when asking for the things in step one. And, when asking, to reinforce the question with the terms "Mom" or "Dad" as necessary.
The child might struggle with these simple requests because of the release of control in their lives over to the parent. Releasing control is a very difficult process for a RAD child.
Be a tough (not mean) parent. RAD kids will not internalize a parent that they feel they can control.
Try to build confliction with the child. Help them to resolve cognitively a secure controlled environment, where they can be safe and secure, and improve upon the unhappiness in their life.
Adding Pizzazz -- praise what the kid does right.
Try to create a fun and unique arena to the family structure. Family movie night, popcorn and candy, or a Sunday drive. Creating fun times are fun for all.
Teaching the child to be compliant leads to reciprocity, start with having the child sit in a designated area (often called practicing "good sitting"). The goal of good sitting is not to degrade or control the child, but to teach the child positive self-control, and not institute a control battle. Adults reinforce the good sitting with Pizzazz."
Therapy is essential to treating RAD. However, traditional therapy does not work.
"Most traditional therapy involves talk therapy, and is based upon the development of a therapeutic relationship between therapist and client. This relationship requires mutual trust, respect, reciprocity, emotional honesty and the ability to formulate thoughts and feelings into words.
Children with Attachment Disorder are unable to make use of such methods because:
They do not trust.
They are not emotionally honest, and in fact are frequently not able to identify their feelings or what is behind those feelings.
They do not respect anyone, including themselves.
They are not capable of reciprocal give and take relationships.
Their backgrounds of abuse, neglect, unresolved trauma or pain, loss and abandonment frequently occurred during the first year or two of life, prior to conscious memory of events.
They do not know why they feel and act as they do.
They are operating in the only way they know how to survive.
Successful therapy needs to be confrontive and intrusive, while yet being loving and supportive. There is a narrow window of opportunity for therapy with AD patients. Therapy is easiest prior to adolescence, (it shouldn't take to much imagination to figure out what happens with hormonal factors thrown in to complicate the AD bonding issues)."
Parenting a AD child is never easy and for the most part you will receive little or no understanding from family and friends, they just can not understand!
"Perhaps the most difficult area of parenting an AD child is in knowing how to successfully parent these kids. Normal parenting skills are insufficient, and a parent cannot rely upon what they automatically would do in day-to-day situations. The AD child does not learn from past experiences, so what was done wrong yesterday, will be repeated today. And, the child will often expertly pit the parents against each other.
Rule #1: Take care of yourself first. You've heard it before, and it is still true.
Rule #2: Never give the benefit of the doubt to the child! Their lies, or jumbled talk will convince expert, after expert of their innocence or demand your attention as they seemingly stumble for a long time trying to put their thoughts into words.
Rule #3: Do not enter into power struggles. AD kids will constantly struggle to control everything. But no one wins in control battles. Set up a scenario so that you'll win in either situation. "
All quotes taking from:
http://members.tripod.com/~radclass/slide01.html
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