REACTIVE ATTACHMENT DISORDER

REACTIVE ATTACHMENT DISORDER New Hanover County Mental Health Trainers

Diagnostic Criteria • A. markedly disturbed and developmentally inappropriate social relatedness in most contexts that begins before age 5 years and is associated with gross pathological care. • B. The disturbance in Criterion A is not accounted for solely by developmental delay and does not meet criteria for a Pervasive Developmental Disorder. • C. Pathogenic care: disregard of the child’s basic emotional needs & physical needs; repeated changes of primary caregiver

Benefits of Attachment PHYSICAL EMOTIONAL SOCIAL MENTAL SPIRITUAL

ATTACHMENT CYCLE • Interactions necessary to develop a bond: • Eye contact • Skin to skin • Rocking • Providing food • Sucking • Vocalizations

In Children: Able to separate from parent. Seeks comfort from parents. Return of parents met with positive emotions. Prefers parents to strangers. In Adults: Have trusting relationships. Positive self-esteem. Shares feelings with others. Will seek support when needed. Secure Attachment

In Children Avoids parents. Does not seek much comfort or contact from parents. Shows little or no preference between parent & strangers. In Adults Reluctant to become close to others. Worry that their partner does not love them. Become very distraught when a relationship ends. Symptoms of Attachment Impairment

In Children: May be wary of strangers. Become greatly distressed when the parent leaves. Do not appear to be comforted by parent. In Adults: Problems with intimacy. Very little emotional investment in relationships. Unable or unwilling to share feelings. Symptoms of Attachment Impairment

Therapeutic Interventions • Theraplay: play therapy which has the intention of helping parents and children build relationship through games that focus on; engagement, challenge, structure and nurture. • Dyadic Developmental Psychotherapy: verbal therapy which creates a safe setting in which the client can begin to explore, resolve, and integrate a wide range of memories, emotions, and current experiences. Safety is created by insuring that this exploration occurs with nonverbal attunement, reflective, non-judgmental dialogue, along with empathy and reassurance.

SITUATIONS /EXPERIENCES THAT PLACE CHILDREN AT HIGH RISK PARENT CHILD ENVIRONMENT -Abuse/Neglect -Difficult temperament -Poverty -Ineffective Care -Premature birth -Violence; victim/witness -Depression/Bipolar -Medical conditions -Lack of support/services -Postpartum Depression -Hospitalizations -Out of home placements -Severe psychological -Failure to thrive -High stress/chaos in disturbances -Congenital and/or bilogical family and community -Teenage Parenting problems -Lack of Stimulation -Substance Abuse -Genetic Factors: family -Intergenerational history of mental illness, attachment difficulties depression, aggression -Prolonged absence (prison, hospital, desertion)

CHARACTERISTICS OF RAD • Impairment in capacity to attach • Rage, hurt and hatred • Poor impulse control • Lack of spontaneity • Lack of self-identity • Aggression • Temper Tantrums • Hoarding

Layers of Emotions ANXIETY ANGER RAGE SHAME SADNESS/GRIEF

RAD IN SCHOOL • Learning disabilities • Below average IQ • Language delays • Superficial eye contact • Lack of cause / effect thinking • Do not sequence verbal instructions • Develop sophisticated behavior to defend themselves against the world • Difficulty adapting to change

Sammy Student • Problems with regulation of energy or activity level; Fast-paced, slow paced, or fast/slow combination, impulsive or hyperactive • Strong and interfering negative views toward self, school and life • Overly focused on something that is suppose to happen • Gorges or hoards food • Is oppositional, argumentative, defiant • Is manipulative or controlling • Has frequent or intense angry outbursts • Destructive to self, others, and property • Steals • Has poor peer relationships

STRATEGIES AT SCHOOL • Do better with one teacher that knows them well • Good parent/teacher communication – united front • Consistent rules and expectations between home and school • Natural and immediate consequences • Use “time in” vs. “time out” • Utilize Non-Verbal Cues • Stimulated activity followed by low activity • Same rules across the board – in ALL settings

MORE SCHOOL TIPS • Utilize Peer Buddy • Have daily meeting – 30 minutes/during lunch – to talk or not to talk • Minimize downtime which increases structure • Provide for place for eating vs. cafeteria • Be confrontational about feelings (yours and his/her) • Provide list of privileges vs. rights • Teach how to and provide opportunities for play • Social stories to teach relationship skills • Teach and label emotions other than anger

SUGGESTIONS • Utilize written directions with verbal • Teach organizational skills • Teach time management skills • Avoid power struggles • Let them know that total fairness is impossible • Utilize restitution whenever possible • Accountability papers • Give choice between two options (A or B)

Relationship Building • Provide physical and emotional closeness • Children with RAD will tend to sabotage • Utilize matter of fact tone that is free of emotional edge • Love/kindness viewed as a weakness and used against those who offer it • It is important to ignore irritating behaviors whenever possible (whatever you pay attention to you will see more of!)

CHILDREN WITH RAD DEEPLY BELIEVE THAT THEIR VERY SURVIVAL DEPENDS ON THEIR BEING IN CONTROL OF EVERYONE ELSE, IN EVERY SITUATION, ALL OF THE TIME.

“YOU ARE NOT REQUIRED TO DO IT ALL. THAT WOULD BE PERFECTION. DO WHAT YOU CAN DO. THAT OFTEN TURNS OUT TO BE QUITE A BIT.” Rudolf Dreikurs

Resources • http://psychology.about.com • www.attachmentdisordermaryland.com • www.crosscountryeducation.com • www.radkids.org • Why Is Johnny So Detached? Thomas M. Ottavi, Ph.D. • Karen Wheeler, LCSW, RPT-S Integrated Therapy Ass. • Suzanne Rilling, M.Ed., CHt. • Elizabeth Uzcategui, P-LCSW, MSW • Kristine Hancock, IBS Teacher

REACTIVE ATTACHMENT DISORDER