Reactive Attachment Disorder

Reactive attachment disorder or RAD is associated with adopted children. It can sometimes develop sometimes even when an adoption occurs in the first few days after birth if there has been a disruption in the baby’s support by a caregiver for more than a few days. Life situations other than adoption can also create disruptions in early childhood that are often missed. Certainly not all adopted children have RAD, but it’s important to be aware of the symptoms.

There are many misconceptions about RAD. It’s often misdiagnosed by health professionals, including MD’s and therapists. Many don’t have the experience or training to recognize the problems that can occur because of early attachment issues.

RAD describes disorders of mood, behavior, and social relationships. It arises from a failure to form normal attachments to primary care figures (often the mother) in early childhood. It typically occurs during early development between ages 0 and 2 years old. As the child matures, it can show up increasingly as problems with social expectations, interactions and/or behaviors.

Why Is It So Hard to Diagnose?

It may take years before some of the problems show up – which makes the diagnosis much harder. As social engagement and school demands increase, the problems often start to grow, but because it wasn’t identified earlier, the diagnosis may be completely overlooked.

We list some of the common symptoms below. Mild cases may be missed all the way through high school and college, but their increasing struggles aren’t hard to recognize.

Common Symptoms of RAD: (courtesy of Sebern Fisher, LMH)

(RAD is often misdiagnosed as ADD/ADHD or Oppositional Defiant, which is far more pervasive).

  • Lack of cause-and-effect thinking
  • Lack of empathy
  • Poor social cueing
  • Lack of remorse
  • Preoccupation with blood and gore
  • Fascination with knives
  • “Primary process lying” (lying about something that the other person can easily recognize as a lie such as: I didn’t drop the bread – when the other person was standing right there and saw the person drop the bread)
  • Gaze aversion
  • Tactile defensiveness
  • Controlling behaviors
  • Cruelty
  • Explosive rages
  • Impulsivity
  • Insensitivity to pain
  • Co-morbidity with speech pathology
  • Learning disability
  • ADHD

The Role of Neurofeedback in RAD

A growing number of attachment therapists have been trained in neurofeedback and find it extremely helpful in the treatment process. In fact, it’s not a core tool for many of these therapists.

There have been presentations for over eight years at the ATTACH national conferences. The results – helping kids with severe problems to gain control – have been seen in hundreds of cases.

RAD is a brain issue, and neurofeedback is one of the most powerful tools for the brain. It helps the person learn to regulate their brain and manage emotions, and improves the parts of the brain that create calm.

At their root, many attachment problems – per Dr. Daniel Schore, of UCLA — are in fact problems of self-regulation. The person simply can’t calm down and can’t manage emotion.

As an alternative to medications, neurofeedback can often help reduce or eliminate drugs prescribed for RAD as the brain becomes more stable.

CASE Examples

Below are two case examples from the EEG Spectrum website. EEG Spectrum is one of the leading companies for training health professionals in neurofeedback. [Note that Michael Cohen, Director of Center for Brain, taught the main course for EEG Spectrum for many years and has helped train numerous RAD therapists.]

Case example: Kyle Age 4
> View case

Case example: E – 25-year-old female, Reactive Attachment Disorder in Adulthood
> View case

ARTICLES, More Information.

Here are some articles about RAD and neurofeedback by Sebern Fisher, M.A. LMH. Sebern is a brilliant psychotherapist who played a critical role in bringing neurofeedback to the field of attachment therapy. Her articles are insightful and very educational.

> Neurofeedback: A Treatment For Reactive Attachment Disorder
> Case Studies From The Field
> When Love Is Not Enough