There is one question I receive more than any other, when discussing my daughters and the trauma they endured, before they became members of our family.
What is Reactive Attachment Disorder or RAD?
So few have ever heard of it, which is extremely concerning for so many reasons.
But...
Some never do.
What is Reactive Attachment Disorder or RAD?
A child can learn to cope with Reactive Attachment Disorder or RAD, but that all depends on the child's cognitive abilities. It also depends on if Reactive Attachment Disorder or RAD is the only diagnosis the child has.
Many children with Reactive Attachment Disorder or RAD have other mental health and developmental diagnoses which complicate things significantly.
Some have Fetal Alcohol Syndrome or experienced drug exposure in the womb making the brain function more complicated.
There are some doctors and specialists that believe in neuroplasticity, which means the brain can change and heal over a significant period of time.
When possible, this take decades.
Reactive Attachment Disorder or RAD can be a life long struggle.
So how does one end up with Reactive Attachment Disorder or RAD?
What happens in utero?
We often think that a human's life begins at birth. But before birth, an infant grows in the mother's uterus for about 40 weeks. That is a LONG time.
During that time, everything that happens to the mother, happens to the infant. When the mother feels stress, the infant feels stress.
When the mother endures trauma, the infant endures trauma.
This doesn't even account for what a mother is putting in her body, and how she takes care of herself.
When she is neglectful of herself, she is neglectful of the infant.
The infant's brain begins to develop around the 6 week mark during pregnancy.
So much of the brain's formation is dependent on the mother's lifestyle and choices during pregnancy.
Even before an infant is born, the brain may have experienced so much trauma that it is already altered.
What happens during infancy?
Once an infant is born, it thrives based on the caregiver's ability to meet its needs, and establish a secure attachment.
When a baby cries because its hungry, the caregiver feeds it. The crying stops. Caregiver and infant bond.
When a baby cries because it needs a diaper change, the caregiver changes the diaper. The baby stops crying. Caregiver and infant bond.
When a baby cries because it desires to be held and comforted, the caregiver holds the baby. Once again the baby stops crying. The two form a relationship of trust and love.
With every need that is met, the infant and caregiver are forming a stronger attachment with one another.
The baby learns to trust that the caregiver will respond with love each and every time, meeting every need.
But...
What happens when a caregiver doesn't respond?
What happens when a caregiver responds only part of the time?
What happens when a caregiver responds negatively to the infant?
A baby may learn there's no point in crying, because no one will come. So the crying stops.
A baby may not understand what to do, and remain in distress all the time, because the caregiver's response varies, and the infant doesn't know what to expect.
A baby may learn that crying results in pain inflicted by others, so it smiles all the time instead.
During these crucial months of brain development any one of these situations is extremely dangerous.
When the growing brain has to reprogram itself to survive, without needs being met by a caregiver, for an extended period of time, changes in the brain can become permanent or hardwired.
The infant learns through experience that caregivers can not be trusted.
No loving attachment is formed.
Instead caregivers become a threat to survival.
So now what?
An infant who has not formed a secure attachment with a caregiver, and can not work through the trauma they've experienced, develops Reactive Attachment Disorder or RAD.
The brain has been altered to the point that the damage may be permanent.
This can be diagnosed by the age of three years old, if seen by the proper professionals.
Reactive Attachment Disorder or RAD can be the result of neglect and abuse suffered by a child who is in foster care or an orphanage.
It can also occur if a mother has post partum depression without any supports.
In some cases it occurs as a result of medical trauma experienced for an extended period of time during the first months of life.
There are multiple situations that can result in this disorder.
Now please understand, Reactive Attachment Disorder or RAD occurs when an infant does not have a consistent caregiver who provides for its needs in a nurturing way.
This caregiver does not have to be the mother.
If the mother is unable to care for her child, anyone can step in and do so.
The infant's brain can develop properly, so long as someone can be consistent at all times.
In rare cases, Reactive Attachment Disorder or RAD may have already established itself at birth.
No one knows how Reactive Attachment Disorder or RAD will affect each individual brain.
Every brain is different.
Reactive Attachment Disorder operates on a spectrum.
Some cases are mild.
Some are severe.
What does Reactive Attachment Disorder or RAD look like?
Both of our daughters came to us at about six months of age through foster care. (They are not related.)
In both cases, the damage to the brain was already done.
Both were diagnosed with Reactive Attachment Disorder or RAD at three years of age.
But no one could tell from just looking at them that they had Reactive Attachment Disorder or RAD.
If people saw anything, they saw parents who appeared to be losing their minds.
Infancy
Princess would not let me feed her or change her.
She would scream inconsolably for hours on a daily basis no matter what I did.
I could not bathe her without her experiencing significant distress (except for in the kitchen sink).
No matter how much I showed her love and tried to comfort her, it didn't work.
Sunshine also screamed for hours a day.
She did not know when to stop eating.
As a result, she was constantly vomiting while crying for more food.
Sunshine could not tolerate being held.
It was as if it hurt her.
I can remember only two times she ever fell asleep in my arms.
No matter how much I wanted to console her, she was inconsolable.
Both girls had horrible night terrors that we could not stop, no matter how hard we tried.
My husband and I pushed through all of this with hope, that after a significant amount of time, the love that we were giving our girls, would help heal their hearts and brains.
The Toddler Years
We could identify PTSD episodes in Princess and Sunshine as early as two years old.
Through nightmares and sensory experiences, we were able to develop a pretty good understanding of the trauma and neglect they'd experienced as an infants.
Sleep issues were significant.
Both exhibited a delay in motor skills and had significant sensory issues.
Princess and Sunshine still struggled with food issues.
Sunshine couldn't get enough, and would steal and gorge her food to the point of gagging and vomiting daily.
Princess would refuse to eat for hours.
Mealtime was a nightmare.
To say that the two were defiant was an understatement.
EVERYTHING was a battle.
And no, it wasn't in that terrible two and horrible three way.
They would not let us care for them.
When it normally takes a toddler a few times to understand rules and boundaries, it took the girls a thousand times.
They could not trust anything we did, nor could they trust us to take care of them.
We continued parenting in the best ways we knew how, and sought out help from a therapist that specialized in trauma.
No matter what our girls were struggling with, we were determined to help them. Our love was unconditional. We had hope that we could help them heal.
The Preschool Years
Defiance escalated to an oppositional defiance diagnosis level.
The girls would scream, yell and refuse the simplest and necessary tasks for hours.
We started to see destruction to property, harming of one's self and others, sexually acting out, cruelty to animals, and more.
Both girls displayed a huge lack of safety awareness that would often manifest itself similar to ADHD.
Princess avoided contact with everyone.
Sunshine had to hug and kiss anyone she met continuously.
Relationship boundaries of any kind were so incredibly hard.
Nightmares, PTSD episodes, and panic attacks were occurring on a daily basis in both girls.
Princess was in therapy at age three. Sunshine wasn't cognitively ready yet.
My husband and I worked closely with our therapist.
We read every resource we could get our hands on, willing to learn how to parent in the ways our girls needed.
Hope would keep us going on our most difficult days.
Six Years Old
At six years old Princess took an interest in self injurious behaviors and sharp objects.
Room searches and lock boxes were a necessity.
She needed to be supervised around the clock, during the day, at arm's length.
An alarm was put on her bedroom door at night.
Six years of age was also the year Princess was threatening to kill me on a regular basis.
It stopped when I finally told her to just get it done and over with.
Princess' longest screaming fit lasted eight hours that year.
Princess would destroy property the minute someone wasn't looking.
At six years old Sunshine was taken from our home in a police car, and admitted to an inpatient pediatric psychiatric ward.
She wanted her family dead, and was physically attacking me multiple times a day, on a daily basis.
Sunshine started at a day program, in an effort to delay residential treatment at such a young age.
We had an intensive in-home therapist in our home at least three hours a week.
Both girls were expert liars and enjoyed stealing from others.
And all of this because we tried to love them.
They couldn't handle it.
Their brains viewed us as the ultimate threat.
Still, my husband and I kept moving forward with hope.
If we could just help them move past this phase of brain development...
If we could just figure out how to help our girls.
They could and would get better.
Eight Years Old
Princess' self-injurious behaviors increased.
She talked about wanting to kill herself.
Constant supervision was required.
Princess could pick a fight about anything, and was sure to do so every chance she got.
Sunshine ended up being taken from our home, in a police car, and admitted to an inpatient pediatric psychiatric ward TWICE in one month, for attacking me, to the point of leaving bruises and bite marks.
From there she was transferred to a residential treatment facility where she remained for six months.
She only returned home for six weeks before she needed to return to a residential treatment center again for wanting to kill her brother Dinomite and me.
Eight years old has been by far one of the hardest years of parenting children with Reactive Attachment Disorder.
But with each one, hope has not been lost.
We're working through things.
We advocate for our girls.
We continue to love unconditionally.
Preteen Years
We've been fortunate that Princess has simmered down since eight years old.
This isn't to say that she didn't struggle during the preteen years.
Puberty was a very difficult time for her.
She still struggled daily with all that Reactive Attachment Disorder or RAD does to mess with her brain, but she's decided she wants to be part of our family.
It's okay that we love her.
Princess blows me away so often now with her desire to attempt to attach. It's no longer too scary.
To Princess love means safety, and we provide that.
Princess is beginning to heal.
Sunshine's preteen years have been extremely difficult.
She has been in five residential placements.
The brain resets during puberty.
This is usually the most difficult time for a child with Reactive Attachment Disorder or RAD.
Depending on how long a child has lived through the trauma and neglect, will determine how long it takes the brain to settle again.
Our main goal is to ensure that no matter where Sunshine is, we are still her family.
She deserves a family.
We have hope, that like her sister, eventually her brain can begin to heal.
Teen Years
Though we haven't experienced all of the teen years with our girls yet, I have many friends who have experienced this difficult time.
Things will either become far worse or they'll tone down.
Nothing you've seen in a horror movie is off the table when it comes to the extreme lengths these children will go to push away love.
Some set fires.
Others become involved with crime, sex, drugs, and alcohol.
Still there is hope!
Princess is doing incredible!
She is healing.
Most days she is able to participate in day-to-day life, in and outside of the home feeling safe and okay.
Princess loves her family.
Our relationship with Princess has come such a long way.
Parenting a child with Reactive Attachment Disorder or RAD is the HARDEST thing an individual will ever do, but it's worth it.
How the Reactive Attachment Disordered or RAD Brain Works
The most tragic thing about Reactive Attachment Disorder or RAD is that it's not the child's fault the brain is wired the way it is.
There is this constant negative working model cycling inside the child's head.
The caregiver shows love and support.
Then, the child's Reactive Attachment Disordered or RAD brain is triggered. Love and support are too scary.
The child provokes the caregiver, because the brain is craving the same response it was given during those early months of life.
Neglect and/or abuse feels better.
It's calming.
It's their normal.
Please note that in a situation where an infant is experiencing significant medical trauma and pain, and can not be held or cared for by caregivers, the infant's brain can and sometimes does identify this in the same way it would abuse and neglect, even though medical procedures and distance from loved ones is necessary.
When caregivers give in to the child's provoking, they satisfy the Reactive Attachment Disordered or RAD brain.
But, they also feed the brain's thoughts of worthlessness.
This cycle continues over and over again day in and day out.
A caregiver doesn't want to, and can not become a neglectful and/or abusive caregiver.
But, doing the opposite, showing unconditional love and support no matter what, doesn't work either.
The child can not accept that love.
Not because they don't want to, but because their brain is now wired not to accept it.
Both situations are equally dangerous.
This same negative working model can occur with siblings of children with Reactive Attachment Disorder or RAD.
It is crucial that parents identify this and set up safety plans to keep everyone safe.
The negative working model can also occur with anyone who tries to form a close relationship with the child with Reactive Attachment Disorder or RAD.
The closer the person tries to get, the more behaviors they will see.
The Caregiver's Job
It's the caregiver's job not to give in to the negative working model, no matter how severe the behaviors become.
Hope for healing is a necessity.
At the same time, the caregiver needs to find safe boundaries when showing love and affection, so as not to trigger the Reactive Attachment Disordered or RAD brain.
In some cases this may mean no physical affection, per the child's request.
In other cases it may mean loving from a distance, as a child receives residential treatment, where both the child and the caregiver can remain safe.
Parenting in this way feels backwards and upside down with a lot of judgment from others.
It means loving someone who may never be able to love, or even treat you kindly.
A child with Reactive Attachment Disorder or RAD usually has one main target in the household.
In most cases it's the caregiver who fulfills the role of mother.
The child may act completely normal and innocent with the caregiver who fulfills the role of father, but then go to the extreme of trying to hurt or kill the mother figure.
This can lead to significant marital problems and triangulation scenarios.
When it comes to others in the child's life, so long as they don't get too close, they may not see any of the Reactive Attachment Disorder or RAD behaviors at all.
Caring for a child with Reactive Attachment Disorder or RAD is an emotional rollercoaster that may come with PTSD, an anxiety disorder, depression and more.
But, despite all of that, you're saving a life, one day at a time.
Though it is incredibly hard, it can be worth it.
Every child deserves a chance.
Every child deserves to be loved.
There is hope of healing.
Children with Reactive Attachment Disorder or RAD do not want to behave the way they do.
They wish more than anything that they could control that part of their brain that has been damaged.
They wish they could accept love.
They wish they could handle having a family, even when they don't seem to.
It is so important for the caregiver to understand this. Don't lose hope!
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