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| |    Attachment and Reactive Attachment Disorder by Robert Needlman, M.D., F.A.A.P. reviewed by Laura Jana, M.D., F.A.A.P. For most parents, the concept of attachment problems brings to mind a child who does not want to be dropped off at day care or who bursts into tears when his mother leaves the room. This type of attachment is quite normal. In some instances, however, attachment problems are actually a diagnosable disorder. A few years ago, reactive attachment disorder was almost unknown outside the world of psychology. Now there are several Internet sites devoted to the diagnosis. The purpose of this article is to describe attachment and to clarify what is meant by reactive attachment disorder. Attachment Attachment is a simple but powerful idea. When parents respond to their babies' needs, their children come to trust them. Over time, they build up a deep belief that their parents will be there to protect them. Later, when they leave their parents' side--to stay with a babysitter or to go off to school--they carry the idea of their protective parents around with them. Without having to think about it, they make use of this idea when they need to, like when they are feeling insecure or frustrated or worried. This secure base helps young children face the many challenges in their lives. You can see children using their parents as a secure base in many different situations:
Of course, all this doesn't mean that if you have had a difficult relationship with your parents, you can't ever have good relationships with anyone else. People grow and change. But it may take more effort if your initial tendency is not as positive. Reactive Attachment Disorder The idea of attachment has figured importantly in psychology since the '70s, but reactive attachment disorder (RAD) is a fairly new diagnosis. According to the official diagnosis handbook of the American Psychiatric Association, the diagnosis refers to young children who have severely disturbed relationships with other people as a result of the terrible parenting they have received. Children with RAD either avoid forming personal relationships (the inhibited or unattached type) or they seem overly friendly to everyone, without making any distinctions between their parents and strangers (the uninhibited or indiscriminate type). In both cases, there is no real trust. The children treat other people either as threats to be avoided or as suckers to be fooled and manipulated. RAD and international adoption Not all children who are adopted out of foreign orphanages (so-called post-institutionalized children) are destined to have RAD. But the more emotionally and physically deprived they were, and the longer they were institutionalized, the greater their risk is. If your child shows signs of an attachment problem, talk to your child's doctor or see a counselor who specializes in child therapy. The diagnosis and treatment of Reactive Attachment Disorders are relatively new, so not all therapists and psychologists will have a lot of experience dealing with this issue. It's probably worth investing the time and effort to find a therapist who makes RAD a large part of her practice. Talking with other parents of adopted children may be a good place to start; your child's doctor may be able to recommend good local resources as well. Although RAD can be extremely difficult to treat, the situation is not hopeless. With expert guidance and lots of effort on the part of you and your child, things can get better.
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