Reactive Attachment Disorder
We hear about it a lot in foster care context, so I think it is important we first understand what it is…and what it is not before diving in further. Because we often assume foster care = attachment concerns, RAD gets placed on many children (without any formal diagnosis) purely due to this preconceived notion. While RAD is caused by social neglect during childhood), it does not mean every child that has suffered neglect will have RAD. It also does not mean that just because you have a child struggling behaviorally that has experienced neglect they have RAD. -- The dumbed down DSM-5 diagnostic criteria is as follows:
1. Consistent pattern of inhibited, emotionally withdrawn behavior toward adult caregivers, seen by rarely seeks or responds to comfort when distressed.
2. Two of the following to be met: (1) minimal social and emotional responsiveness to others, (2) limited positive affect, and/or (3) episodes of unexplained irritability or fearfulness even with nonthreatening interaction.
3. Has experienced a pattern of extremes of insufficient care by at least one of the following: neglect or deprivation by caregiver, repeated changes of primary caregivers, or living in unusual settings like institutions.
4. 1’s behavior didn’t manifest until after 3’s neglect.
5. Doesn’t meet criteria for autism, and it is evident before age 5 years and at least 9 months. -- Behaviorally, affected children are unpredictable, difficult to console, and difficult to discipline. Children may seem to live in a “flight, fight, or freeze” mode. Most have a strong desire to control their environment and make their own decisions. -- Do you think this fits a child you care for? Stop. Find a pediatric psychologist, make an appointment, and speak to them about your concerns. They will likely do a psych evaluation, and they will guide you through that process. Have a diagnosis? Now what? Especially when looking in the lens of wanting to facilitate connection. How does this happen with a child where their brain reacts negatively – sometimes violently – to that connection? We will talk about that tomorrow! Drop your questions below.