





Reactive Attachment Disorder

vs.

Attachment Disorder









In the media, in court cases, on the Internet, and in child welfare agencies,

there is much confusion about Reactive Attachment Disorder (RAD) and

Attachment Disorder (AD), an unrecognized, fad diagnosis that often poses as RAD.





Reactive Attachment Disorder (RAD)



RAD is a recognized diagnosis which is defined in the Diagnostic and Statistical Manual (DSM-5, Code 313.89) of the American Psychiatric Association. RAD is considered an "uncommon" disorder which is expressed in reaction to extreme neglect and/or abuse as:





The child rarely or minimally seeks comfort when distressed.

The child rarely or minimally responds to comfort when distressed.



In other words, children with RAD have experienced extreme social and emotional conditions and have become much more withdrawn than we would expect of children their age. While there is no validated therapy specifically for RAD, many experts recommend gentle, patient, consistent and responsive parenting for these children, as for all children with special emotional needs. This disorder can be diagnosed while the child is five years of age or younger; as children get older, their behavior matures and changes in ways that make attachment problems much less evident.



More recent studies indicate that RAD, as defined in the

DSM-V,

may not qualify as disorder or require treatment. Brian Allen (2016) writes:





“...children placed in appropriate foster care homes who previously displayed the inhibited/ withdrawn subtype of RAD no longer displayed these symptoms when followed up months later (e.g., Smyke et al., 2012). Zeanah and Gleason (2015) recently summarized that ‘in studies of children adopted out of institutions, there are no reports of children with (inhibited) RAD ... suggesting that signs of (inhibited) RAD diminish or disappear once the child is placed in a more normative caregiving environment’. They further opined that these results make it unclear ‘whether additional interventions beyond family placement may be necessary’.”













“Attachment Disorder” (AD): An Over-Reaching Diagnosis & Grounds for DHS Investigation







, the Colorado psychiatrist who first popularized

in the 1980s, is also credited with inventing “Attachment Disorder” (AD), an unrecognized diagnosis used nearly exclusively by Attachment Therapists. Decades of vigorous marketing of this fad diagnosis to parents and child welfare workers has positioned it as a disorder dreaded by adoptive and foster parents, but also a well-known path to eligibility for "special needs" subsidies.



Proponents of the AD diagnosis frequently refer to it as "RAD," leading to public confusion about the two, but they are conceptually very different. There is suspicion that Attachment Therapists who treat problems they have labeled as AD will charge insurance companies for treating RAD instead. Because AD is not a professionally-recognized diagnosis, treatment for AD would not be reimbursed by public or private insurers.



The AD diagnosis is characterized by a laundry list of behaviors, making it a typical “catch-all diagnosis" of the sort commonly identified with quack practices. The list is so overly inclusive that it would encompass any number of disorders, and therefore useless for diagnostic purposes. The list also includes actual normal behaviors for certain age groups. Even “good behavior” may be interpreted as a child "stalking his prey."



The AD list of signs also contains a number of internal contradictions, as when children are said to lack empathy and cause-and-effect thinking, but yet they are believed able to understand people well enough to be clever manipulators and able to triangulate adults. Likewise both eye contact, or lack of it, are considered problematic AD signs.



Practitioners using the AD diagnosis warn parents that a child with AD is likely to develop many more signs of the disorder in the future if not treated with Attachment Therapy/Parenting, most ominously sociopathy. Lists of AD signs have included the following:





Signs of “Attachment Disorder”







Superficially engaging and charming

Lack of eye contact on parent's terms

Eye contact when lying or angry

Empty-eyed

A darkness behind the eyes when raging

Indiscriminately affectionate with strangers

Good behavior [ interpreted as the child “stalking his prey” ]

Views relationships as threatening, or not worth the effort

May be a workaholic, as a way of avoiding relationships

Not affectionate on parent's terms

Resists comforting

Resists being held

Destructive to self, others, and material things

Accident prone

Cruelty to animals

Cruelty to young children

Lying about the obvious or "crazy lying"

Stealing

No impulse controls

Act addicted to their own adrenaline

Intolerant of rules and authority

Shallow and vain

Grandiose or unrealistic fantasies

Feelings of being unique

Feels unappreciated

Feels unwanted

Attitude of entitlement

Lacks morals, values, and spiritual faith

Identifies with Satan

Oversensitive to rejection, easily gives in to jealousy

Temper tantrums

Hyperactive, yet lazy in performance of tasks

Prone to depression

Passive-aggressive behavior (delaying, forget, or act confused)

Developmental lags

Failure to gain weight

Delayed responsiveness to stimuli

Appears listless

Poor self-soothing techniques

Failure to smile

Learning lags

Exceptionally bright, but act "dumb"

Lack of cause and effect thinking

Compulsive caregiving

Overly critical of self and others

Lack of conscience

Lack of empathy and remorse

Abnormal eating patterns, e.g. hoarding and gorging

Refuses to eat

Eats strange things

Poor peer relationships

Victimized by others

Perceives others as unsafe, dangerous

Perceives self as victim

Preoccupation with fire

Preoccupation with blood and gore

Self-mutilating

Persistent nonsense questions and chatter

Argumentative

Inappropriately demanding and clingy

Abnormal speech patterns

Triangulation of adults

Controlling and manipulative

Bossy

Sees others as being difficult to understand

Unable to understand the concept of altruism

Extreme emotions

Limited emotional repertoire

Phoniness

Never get sick

Can’t float in water ( Nancy Thomas )

Can’t feel physical pain

False allegations of abuse

Sneaky, underhanded, covert

Sneaks things without permission even if he could have them by asking

Child 'forgets' parental instructions or directives

Presumptive entitlement issues

Parents appear hostile and angry

Parents feel used

Parents are wary of the child's motives if affection is expressed

Targets the adoptive mother for abuse

Narcissistic behavior

Enuresis and encopresis

“I hate you” attitude

“You can’t make me” attitude

Abrupt change in personality

Attempted suicide or threats of suicide

ADHD and Conduct Disorder

Blames others for mistakes or behaviors

Presenting as calmer when alone

Uncontrollable anger

Inappropriate emotional responses

Cutting

Distant or aloof behavior, resentful

Easily misled

Lazy, lacks motivation

Risky behavior

Runs away

Sexually active at a very young age (with other children and animals)

Smoking or other tobacco use

Great theatrical displays

Chemical self-medication

Street smart

Good survival skills

Con artist and cunning

Revenge motivated

Malicious

Danger seeking secondary to despair

Rejects responsibility

Hypervigilant

Light sleeper, rises early in morning

Dissociation



Attachment Therapists claim children diagnosed with AD are capable of being sexual predators, with the potential to become serial killers as adults. Attachment Therapy proponents have referred to AD as "Ted Bundy Disease."



Belief in the AD diagnosis appears to have promoted child abuse, with parents becoming suspicious and fearful of children with this diagnosis – a diagnosis that claims that the AD child is sneaky, manipulative, is unable to feel pain, and has no conscience.



Much of the AD diagnosis is situational, believing that a child’s background, e.g. adopted or from foster care, causes AD. It overlooks the strong biological basis of attachment and the resilience of children.



Frequently, the feelings of caregivers are considered part of the AD diagnosis, such as:





Feel isolated, depressed, frustrated, angry, hopeless, helpless, and stressed

Difficulty concentrating

Confusion

Feeling blamed by family, friends, and professionals



A discussion of AD and RAD is included in the 2006

by the American Professional Society on the Abuse of Children (APSAC). The task force that authored this report remarked on the tendency to over-diagnosis a “rare” condition such as RAD, plus the problem of the highly inclusive lists of AD criteria:





Clearly, these lists of nonspecific problems extend far beyond the diagnostic criteria for RAD and beyond attachment relationship problems in general. These types of lists are so nonspecific that high rates of false-positive diagnoses are virtually certain. Posting these types of lists on Web sites that also serve as marketing tools may lead many parents or others to conclude inaccurately that their children have attachment disorders.







It is easy to see that any child is likely to be labeled as AD when concerned parents consult an Attachment Therapist who will claim the condition is common, if not universal, in adopted and foster children. The diagnosis clearly demonizes these children, making parents fearful and suspicious of even normal child behaviors. It sets up a dangerous situation in how parents think about their children and where Attachment Therapy’s

is perceived as justified to head off the child's disastrous future.



Attachment Therapists claim that AD is foundational for other mental disorders, and that therefore, AD must therefore be treated first, and by a practitioner who is committed to the AD concept. They may diagnose AD with the use of any of several unvalidated checklists, such as the

, the Attachment Disorder Symptom Checklist, Walter Buenning’s Infant and Child Symptom Checklists, and the Evergreen Consultants Check List.



Some parents charged with criminal child abuse have tried to convince juries that their children had AD. As Jean Mercer, PhD — leading critic of Attachment Therapy — commented, "The RAD defense is regrettably becoming more common as a way to extricate abusive, even homicidal, parents from legal difficulties." In a blame-the-child defense strategy, AD is portrayed as a disorder so diabolical that it would unhinge the most loving of parents.



Journalists haven't helped to clarify the situation for the public. They rarely question the AD diagnosis — or even consult the

DSM

— but rather parrot the portrayal of adopted children as "monsters at home."



Another term for “Attachment Disorder” is used in gay-to-straight Conversion Therapy. In this case it is called “Same-Sex Attachment Disorder.” (Some forms of Conversion Therapy have beliefs and methods similar to those of Attachment Therapy.)



Children can have mental health problems at an early age, but to help them, an accurate diagnosis is necessary. The AD diagnosis is unlikely to help any child, but rather risk the child being subjected to highly abusive therapy and parenting practices.





NOTE: APSAC & the American Psychological Association’s Division on Child Maltreatment

that child welfare workers investigate where AD has been diagnosed.









References











“ A RADical Idea: A Call to Eliminate ‘Attachment Disorder’ and ‘Attachment Therapy’ From the Clinical Lexicon ,” Brian Allen, Evidence-Based Practice in Child and Adolescent Mental Health, 9 May 2016; 1(1).





“ F94.1 Reactive attachment disorder of childhood ,” International Statistical Classification of Diseases and Related Health Problems , Tenth Revision (ICD-10), 2007, Geneva: World Health Organization.





“ Reactive attachment disorder: position statement ,” 2002 June, American Psychiatric Association.





“ A Review of a Review of the RADQ ,” by Jean Mercer, PhD, for Advocates for Children in Therapy.





Attachment Therapy: a treatment without empirical support ,” Jean Mercer, Scientific Review of Mental Health Practice, 2002 Winter;1(2).





“Diagnosis and Attachment Disorder” in Attachment Therapy , Wikipedia.





“Correlates of the Randolph Attachment Disorder Questionnaire (RADQ) in a Sample of Children in Foster Placement,” Cappelletty G, Brown M, Shumate S (February 2005), Child and Adolescent Social Work Journal , 2005 Feb; 22 (1): 71–84. [ DOI ]





“ Report of the APSAC Task Force on Attachment Therapy, Reactive Attachment Disorder, and Attachment Problems ,” Chaffin M, et al, Child Maltreatment , 2006 Feb; 11(1):76-89.





“ Self-Test for Reactive Attachment Disorder: How can you know if your RAD teenager needs to be placed in a residential treatment program? ” Apr 2012, Parenting Children & Teens with Reactive Attachment Disorder website.





“ Reactive Attachment Disorder and Attachment Disorder: Compare and Contrast ,” by Jean Mercer, PhD, ChildMyths, 27 May 2016.





“ Five Ways of Looking at ‘Attachment Disorders ,” by Jean Mercer, PhD, ChildMyths , 17 Feb 2016.









