What is RAD (Reactive Attachemnt Disorder)
Attachment |
John Bowlby defined attachment as the affectional tie between two people. It begins with the bond between the infant and mother. This bond becomes internally representative of how the child will form relationships with the world. Bowlby stated "the initial relationship between self and others serves as blueprints for all future relationships." (Bowlby, 1975) Recent findings from the field of neuroscience are revealing deeper dynamics to the attachment phenomenon. What has been proposed as attachment theory may in fact be more closely defined as a regulatory theory. In attachment transactions the secure mother is continuously regulating (calming) the baby’s shifting arousal levels and therefore emotional states (Schore, 2001). It is the prolonged state of calm functioning and effective parental soothing in the face of stressful events, which leads to the child's ability to develop self-regulating capabilities. Such capabilities are necessary for forming healthy and significant future relationships. In other words, the ability to self-regulate and be regulated is a prerequisite to the ability to form healthy attachments. (Post,2001). Attachment can thus be defined as the dyadic regulation of emotion (Sroufe, 1996). This new view of attachment functioning creates an entirely different approach to understanding the child with attachment disorder.
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The Stress Response |
Children diagnosed with Reactive Attachment Disorder are responding to events in their early life that may include neglect, abuse, or an event more subtle (see causes below). In addition, the early exposure to such stressors in early life makes them highly sensitive to other stressors during later life, specifically childhood. Due to these events, many children are unable to calm their internal functioning system which is responsible for healthy attachment to a primary caregiver and normal brain development. My explanation is somewhat simplified but may be helpful to you. It does not replace a diagnosis from an attachment therapist.
From conception to age three, the brain is in a state of maximum growth and development. It is during this period of development when calm and healthy interactions with a parental figure are vital. The regulatory system involving the brain/body stress management system is learning from the parent how to effectively manage external stressors. According to LeDoux 1996, vital brain components responsible for healthy stress management and regulation are the hippocampus and amygdala. A healthy developmental stress response cycle looks like this:
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An expressed need is in actuality a neurophysiologic (brain/body) state of stress with an emotional expression. All behavior is driven by a state of brain/body stress which presents itself as an emotion (Post, 2001). What science has told us is that the amygdala is the area responsible for our fight, flight, or freeze response. In essence, the amygdala is our fear receptor and the hippocampus our fear regulator. As the baby has a need, quite possibly a feeling of fear, signals the need by crying, the mother (primary caregiver) comes and calms her baby. This calming interaction leads to regulation of the stress, thereby making the baby feel safe once again. If this cycle is repeated over and over again and the baby's stress responses and needs are consistently met in the proper way by the same caregiver, the baby often develops the vital tools necessary for calming their own internal states of stress when experiencing fearful elements. From the ability to calm ones stress, one is able to trust that the external world, for the most part, is a non-threatening place. He will then be able to continue on in his development. Now, take a look at the disruptive stress response cycle:
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As you compare the Healthy Stress Response Cycle to the Disrupted Cycle, you can see how the baby signals once again from the activating event perhaps by a cry, but this time, the signal is not met by his mother (primary caregiver). Sometimes, the signal or need is met but it is inconsistent, or there are different caregivers who do not fully understand this particular baby. When the cry goes unanswered, essentially when the stress is left without regulation, as in the case of neglect, a persistent state of stress prevails. In this instance, the developing regulatory component of the brain becomes unable to manage the overwhelming stress discharge and can be subject to damage and developmental delay. (See "Potential Causes" below)
If during development, this stress response apparatus is required to be persistently active, a commensurate stress response apparatus in the central nervous system will develop in response to constant threat. These stress-response neural systems will be overactive and hypersensitive (Perry, 1995). In other words, the constant state of stress left unrepaired or regulated will create within the child a system of high sensitivity to external threats, or extreme fear sensitivity. Instead of developing a stress response system capable of self-calming which ultimately leads to a psychological feeling of calm and safety as the baby who experiences the Healthy Stress Response Cycle, this baby develops a stress response system unable to determine safety in the external world therefore causing a constant state of fear and often times aggressive defensiveness. Psychologically this child perceives the world as a frightening place with little place for calm and comfort. It is highly adaptive for for a child growing up in a violent, chaotic environment to be hypersensitive to external stimuli, to be hypervigilant, and to be in a persistent stress-response state (Perry, 1995). For most children this constant state of fear will surface and give the appearance of a need for control, and not trusting. However, it is imperative to this child’s future well-being and development that he not be viewed as a child full of rage and mistrust but rather as a child consumed with a state of uncontrollable terror (Post, 2001).
To expect the child to function as a typical child when his normal development was completely stunted back in infant/toddlerhood is not rational. In fact it becomes a developmental impossibility plaguing therapist and parents who try with a lifetime of uncertainty and emotional distancing. We must view such children in a manner that is not common and provide them with an environment conducive to a corrective regulatory experience (Post, 2001).
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What is Attachment Disorder/Reactive Attachment Disorder (RAD)?
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The exposure to stress with some children has been so significant that they stand outside of any category of severity. These children give trauma a new definition. Most are or have been in foster care, have had repeated life or death experiences, have had several changes in caregivers, all have suffered from some form of emotional, sexual, or physical abuse, and generally they have never been successfully treated. The most popular term for these children is Attachment Disorder, however, most have received every diagnosis available for severe emotional and behavioral disturbances ranging from attention-deficit hyperactivity to bi-polar and depression. In addition, most have received various combinations of psychotropic medication. (Post, 2001)
Children with reactive attachment disorder see the world differently than we do. For these children, life is a constant threat. Such threats can be interpreted through all manner of sensory stimulation. In other words, a sight, sound, smell, taste, or elevation in body temperature can trigger such children into an overwhelming fear state. Because they were unable to develop the necessary ability to calm this fear early in life, they may become violently reactive in this state. It is of little consequence that a new home may provide love, security, and nurturance when such children become frightened. This frightening event is oftentimes not observed by the parent because the brains of such children are hypersensitive and highly reactive. It can and generally does occur within a millisecond and may build up throughout the course of a day, week, or month, presenting as a violent and long-lasting outburst, or period of complete disconnection and dissociation. Even children who have been adopted into a home at a very young age may have already experienced significant enough trauma to impact development and stress response. Biological children who suffer a separation from their primary caregiver due to illness, etc. can be equally impacted if the event is traumatic or overly-stressful.
In the past Attachment Disorder has been defined in very damaging and ill-perceived ways. Such statements as, "The unattached child literally does not have a stake in humanity," "They do not think and feel like a normal person," or "At the core of the unattached is a deep-seated rage, far beyond normal anger (Magid & McKelvey 1988)." The child with an attachment disorder having experienced past significant trauma is tremendously impaired in his ability to calm down. In other words, he is unable to calm the interworkings of his brain and body system responsible for effective stress hormone discharge and soothing. This state is trauma induced and is the brain and body’s natural fear reaction gone awry. In this manner, the fetus, infant, or child is product to an overly stressful environment or event attributing to extreme fear sensitivity (Post, 2001).
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Sypmtoms of Attachment Disorder
(* Keep in mind that these are behaviors driven by fear.
For such children nearly all interaction becomes
a potential threat)
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• Lack of ability to give and receive affection
• Chronic, nonsensical lying – lying about the obvious
• Lack of eye contact
• Lack of cause and effect thinking
• Poor peer relationships
• Self-injurious behavior
• Food issues – hordes, gorges, refuses to eat, eats strange things, hides food
• Vandalism and destructiveness
• Cruelty to animals and/or children
• Indiscriminate affection towards strangers
• Superficially engaging & charming
• Theft
• Fire setting
• Learning disorders
• Toileting issues
• Poor impulse controls (frequently acts hyperactive)
• Parents appear hostile and angry
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| This should not be used for a diagnosis but as a tool. If your child has half or more of these symptoms and he has a history of any of the potential causes as seen below, you should seek out a qualified Attachment Disorder Specialist for Evaluation. (See resource list.) |
Potential Causes of Reactive Attachment Disorder
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• Neglect
• Abuse
• Separation from the primary caregiver
• Changes in the primary caregiver
• Frequent moves and/or placements
• Traumatic experiences
• Maternal depression
• Maternal addiction – drugs or alcohol
• Undiagnosed, painful illness such as colic, ear infections, etc.
• Lack of attunement between mother and child
• Young or inexperienced mother with poor parenting skills
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A special thank you to Dr. Post. www.postinstitute.com
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