Preface

I began my quest for understanding the attachment process, and the relation of attachment in the early years to behavior in later life, about half-way through my career, over ten years ago. I had been working with children with severe behavior problems in a clinical setting, after spending years working with children identified as having severe behavior problems within a public school system. I thought of myself, and was thought of by others, as somewhat of an expert in understanding and correcting problem behavior in children. In fact, I frequently spoke at state, regional, and even national workshops across the nation. I also taught behavior management courses at a local University.

I was bewildered, then, when I was suddenly faced with children whom I could not understand – for whom the usual behavior management techniques were ineffective. Strategies such as time-out had no effect in correcting these children’s behavior. Reward systems simply did not work. Intervention after intervention was useless in bringing change into these children’s lives. They seemed to be able to adapt to whatever consequence was laid out for them and they seemed unmotivated to work for even the grandest reward. Some of these children acted is if they were motivated to achieve a behavioral or educational goal, only to sabotage their success once reaching that goal. 

Most of these children were charming, able to manipulate or con an adult into getting what they wanted without the adult even being aware of what was happening. They could be sweet and loving one minute and raging the next. They often stole or hoarded items or food, lied even when there was no gain or purpose for telling their lies, or, secretly destroy items in their possession for no real purpose other than the destruction itself. Some of these children were diagnosed with Reactive Attachment Disorder (RAD), but most were diagnosed with a combination of labels including Bipolar Disorder, Attention Deficit Disorder (ADD/ADHD), Oppositional Defiance Disorder (ODD), Conduct Disorder (CD), Disruptive Disorder, or Major Depressive Disorder. In retrospect, it is my belief that many of these children were misdiagnosed and that most of the problems they had were the result of having experienced pathological care during their early years of life. I am not alone in this belief. Some experts on attachment believe that nearly all of mental health disorders can be traced back to the early years of life.

I had not heard of RAD before this time, in the early 1990s. In fact, RAD had only been added to the DSM-IV, the psychological “Bible” for diagnosing mental disorders, within the past 20 years. The definition of RAD in the DSM-IV is limited, even today, as is our understanding of the treatment of attachment disorders in general. Since most therapists, caregivers, teachers, child care providers, social workers, or others working with children with pathological behavior do not have a clear understanding of how these children function, they attempt to correct these children’s behavior through traditional therapy or behavior management methods. And like me, they fail and are left wondering why their methods did not work when they used the very methods taught to them from experts in the field of mental health.

Feeling inadequate, many give up on these children, or suffer through years of trying one strategy after another in hopes of breaking through to these children. I wish I had a dime for every time I have heard some one say that they thought all the child needed was love, stability, and perhaps, a good home. These well-meaning individuals thought that they could compensate, somehow, for the RAD child’s past. They were wrong.

In my clinical practice today, most of the children I see are labeled with RAD. I wrote this manual as a way of educating caregivers, teachers, and professionals in child welfare related roles about the treatment of RAD. Most of the children in my practice are wards of the state, having spent years in abusive or neglectful homes. Or, they come from disrupted backgrounds. Some experienced early and lengthy hospitalization where they were separated from their primary caregivers, or they experienced tremendous trauma and pain from surgeries and medical procedures during their early years of life. Some have adoptive histories, either experiencing early trauma or pathological care before the adoption, or having inherited the genetic make-up that made them susceptible to RAD.

I use these children’s stories throughout this book as examples of what RAD looks like and how RAD develops. None of the names used in this book are the actual names of clients, and all demographic information about specific cases has been altered in such a way that no client could ever be identified. Because many of the children and families that I see share similar stories, the cases discussed really don’t even have one source of origin, but might be a combination of stories.

In the first chapter of this book, the process of attachment is discussed based on years of studies based on research from experts in the field, such as John Bowlby and Erik Erikson. Several theories are presenting, including Bowlby’s Attachment Theory and Internal Working Model Theory, Erikson’s Psycho-social Theory, and Symbolic Interactionism. In chapter two, Bowlby’s attachment theory and Erikson’s psychosocial model are used to describe the attachment process.

Chapter three discusses how we learn and how experiences are recorded from a brain-based approach of understanding, as well as how the accumulation of experiences, particularly those of early life, influence all other experiences throughout life. Chapter four and five discusses the many factors that influence the attachment process, including the role of the caregiver, child temperament, relationships with others, and social influences throughout culture and society.

In chapter six, the continuum of RAD behaviors and attachment styles are discussed, as well as assessment strategies for identifying RAD. Chapters seven and six focus on both traditional and nontraditional behavioral interventions in treating and working with children identified with RAD. Finally, in chapter 9, behavior management strategies that are specific to RAD are discussed.

I begin this book by introducing you to the first child I ever met that had an actual diagnosis of RAD, followed by a case description of what RAD might look like in later years. Throughout the book, when giving examples of specific children, I use a male pronoun rather than attempt to use both genders in each example.