REACTIVE ATTACHMENT DISORDER

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REACTIVE ATTACHMENT DISORDER

• New Hanover County Mental Health Trainers

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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 childs
  basic emotional needs physical needs repeated
  changes of primary caregiver

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Benefits of Attachment

• PHYSICAL
• EMOTIONAL
• SOCIAL
• MENTAL
• SPIRITUAL

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ATTACHMENT CYCLE

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

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Secure Attachment

• 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.

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Symptoms of Attachment Impairment

• 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.

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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.

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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.

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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)

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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

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Layers of Emotions

• ANXIETY
• ANGER
• RAGE
• SHAME
• SADNESS/GRIEF

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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

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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

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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

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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

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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)

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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!)

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• 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.

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• 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

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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