You may well wonder what Reactive Attachment Disorder is?

Written by on April 3, 2018

To have a very brief understanding of Reactive Attachment Disorder we just need to look at the case of the Romanian Orphanages.

If like me you were born in the 1970s or 1980s, then you may well remember the news images of the Romanian babies sitting in cots?

My grandmother spent months knitting winter hats to keep the children’s heads warm in the colder weather, and I, as a 12 year girl wanted to go and adopt them all.

It wasn’t until many years later that I started to understand the affects that their experiences would have on them in later life.  It was with this and my experience of many years working with some of the most vulnerable and hard to reach children, that I started to gain an awareness of Reactive Attachment Disorder (RAD), what it is and how it affects young people.

During the 1970s in Romania about 100,000 children were placed into orphanages as a result of strict rules banning birth control. Babies and children were pretty much left with little stimulation or personal contact with caregivers.

As a result, many of those that were not adopted went on to display alarming difficulties with social, emotional and mental health. Babies adopted prior to the age of 6 months on the other hand have tended to do reasonably well, compared to children adopted over the age of 6 months who tended to display behavioural and personality disorders.

Babies born to mothers who suffer high levels of stress hormones tend to have reduced brain size and impaired development. The ‘wiring’ of our brains begins in the womb and continues once we are born. To develop into self-confident young adults, it is essential that the nurturing process takes place. Neglect in infancy severely impacts and impedes formation of neurological pathways essential to communication in the brain (Perry, 2002). Neglect has been shown to affect the frontal cortex, the area of the brain responsible for planning, decision making and memory (Perry, 2002).  Caregivers/parents who are inconsistent in their parenting such as brushing the child off, shouting at the child, not responding to emotional states in the correct manner, name calling and be-littling or handing out severe punishments one minute and hugs the next are likely to end up with children who are ‘not wired-up’ properly. This kind of inconsistent parenting alters the brain’s neurological pathways and therefore children expect inconsistency from other adults. The child experiences a range of negative emotions such as rage, shame, manipulation and seeking control of situations and a fear of trust.

This image highlights the extremities of what can happen if a child is severely neglected. It would not be considered unusual to find that a child who has been adopted, for example, may struggle with severe RAD. This will be due to the neglect experienced in the womb, as a baby, and as a small child etc.

To further expand on this image, I want to take you back once again to the Romanian orphanages.  I was once told at a training event a story. I am unable to confirm if this is true, however its an interesting one that highlights the complexities of the human brain. It goes like this…

There were 90 babies within the orphanages. They were spilt into three groups for experimental purposes.

Group 1 were nurtured, i.e. they were fed, cleaned, sung to, played with, talked to etc. all the things that we do as parents with our own children. Group 1 grew up to be functioning members of society.

Group 2 had a slightly different experience. They were fed and bathed. They received eye contact during these times, and even sung to, however they were left in cots and alone for the rest of the time. This is inconsistent caring, and subsequently the whole group experienced a wide range of mental health difficulties, including behavioural issues whilst growing up.

Group 3 were fed and bathed. They received no eye contact what-so-ever. They were left alone. They all died.

‘Children were getting adequate food, hygiene and medical care, but had woefully few interactions with adults, leading to severe behavioural and emotional problems’

A secure attachment is formed when the caregiver responds to the child’s needs. This happens through eye-contact and stimuli such as playing, singing and reading to the child for example. The child feels secure and knows that the caregiver/parent will meets their needs. Secure attachment ensures the brain forms the correct neurological pathways and develops the frontal lobe. This part of the brain allows us to have empathy, understanding, a good degree of decision making and good social skills.

A child with RAD needs the following:

  • A stable and predictable routine
  • Clear limits and behavioural expectations
  • Reward good behaviours every time
  • Follow through with consequences
  • Pick your battles wisely and give choices
  • You need to offer reassurance, even to the teenager
  • When displaying their worst behaviours, the child needs a calming experience not a threat
  • Creating goals for success with clear achievable and measurable short-term outcomes

Importantly look after yourself too! Do not be afraid to ask for help and support from the school, professional services and family and friends. 




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