Reactive Attachment Disorder

Devon Burton, OTAS

RAD is a condition often found in children who have had very traumatic  experiences in early life.  These children have problematic and disoriented relationships with adults. They are usually too cuddly with adult strangers, they comfort-seek from adult strangers, they have an unforeseeable reunion response to their caregivers,  and are emotionless to their surroundings, also known as frozen watchfulness.  Usually these children are over friendly with strangers but distant and distrustful to people they know well. These children also fail to seek comfort when distressed, minimal social or emotional response, and episodes of irritability, sadness and fearfulness.  

Signs and Symptoms

For RAD, the etiology is within the diagnosis. The child must have  had a traumatic or deprived care-giving experience that produces the behavioral and emotional symptoms. There are differences in opinion on where the condition starts. Some suspect the behavior comes from an evolutionary advantage, there for RAD being a coping skill, not a mental disorder (Evolutionary advantage is when your body changes traits in order to survive).  However, some suspect that inadequate care during critical periods of development cause the condition. There is also speculation that the disorder have neurological consequences that affect the brain and social functions. 

Etiology

In short, the prognosis for children diagnosed with RAD is not good.  However, children placed in a stable, loving home may show signs of improvement in behavior and emotional expression. There is speculation that certain aspects of development happen at very specific times and may be impaired for good. 

Prognosis

Children diagnosed with RAD have many difficulties in multiple areas of occupation. These children have significant issues in social and educational environments. They lack the social skills needed to be adequate in the learning environment, which often leads to bullying- either the child being the bully or the child being bullied. RAD children also have high diagnosis for learning disabilities. 

It is also typical for these children to have difficulties in their home life, even with the presence of supportive adoptive parents.

RAD children also will most likely struggle in a work setting and have conduct and impulse issues that result in legal trouble. 

Implications for Function and Treatment

Typically children diagnosed with RAD will be in close contact with therapists, school counselors and other health care professionals. In Occupational Therapy in particular, an initial intervention may be useful to prepare the foster and adoptive parents for behaviors they may experience with their children, to minimize the shock factor.  The OT practitioner should also prepare parents for realistic expectations to minimize disappointments if the relationship they had hoped for is not met. 

Play therapy with the children can have many benefits. Play therapy can provide a safe place for the child to show emotions without knowing it. Education in exercise can also be a great stress reliever.  Gross motor play can be helpful in the classroom and may help them to find positive interests.  

Implications for Occupational Therapy

Bonder, B. (2015). Psychopathology and function. Thorofare, NJ: SLACK Incorporated.

Works Cited