So what is RAD?

First, thank you all for the warm reception and outpouring of well-wishes as I have embarked on this journey. It has already been an interesting experience and I was amazed at how much lighter I felt after just that one post. Definitely reinforces that I am on the right path. So bless you and thank you again.

It seemed like a good idea here, still at the beginning, to do some educating on what exactly RAD (Reactive Attachment Disorder) is and why it has been so horrible for August and those who love him.

The official DSM definition (i.e. the way doctors, insurance companies and hospitals describe it) is:

The newest guide to diagnosing mental disorders is the DSM-5, classifies this as a Stressor-related disorder which can only be caused by social neglect during childhood (meaning a lack of adequate caregiving). Disinhibited Social Engagement Disorder is similar to Reactive Attachment Disorder but presents with externalizing behavior and a lack of inhibitions in behavior, rather the internalizing, withdrawn behavior and depressive symptoms present in Reactive Attachment Disorder. [2]:265 It is also recognized as an emotional disorder which begins during childhood. [1], [2]

Reactive Attachment Disorder DSM-5 Diagnostic Criteria Code 313.89

A. consistent pattern of inhibited, emotionally withdrawn behavior toward adult caregivers, manifested by both of the following:

  • The child rarely or minimally seeks comfort when distressed.
  • The child rarely or minimally responds to comfort when distressed.

B. A persistent social and emotional disturbance characterized by at least two of the following:

  • Minimal social and emotional responsiveness to others.
  • Limited positive affect.
  • Episodes of unexplained irritability, sadness, or fearfulness that are evident even during nonthreatening interaction with adult caregivers.

C. The child has experienced a pattern of extremes of insufficient care as evidenced by at least one of the following:

  • Social neglect or deprivation in the form of persistent lack of having basic emotional needs for comfort, stimulation, and affection met by caregiving adults.
  • Repeated changes of primary caregivers that limit opportunities to form stable attachments (e.g., frequent changes in foster care.)
  • Rearing in unusual settings that severely limit opportunities to form selective attachments (e.g. institutions with child-to-caregiver-ratios.)

D. The care in Criterion C is presumed to be responsible for the disturbed behavior in Criterion A (e.g., the disturbances in Criterion A began following the lack of adequate care in Criterion C.)

E. The criteria are not met for autism spectrum disorder.

F. The disturbance is evident before age 5 years. G. The child has a developmental age of at least 9 months. 

So what does this all mean? It boils down to this. Children who were abused, neglected or traumatized or in some way had inadequate caregiving from birth to age 5 may develop an inability to form healthy relationships. And this will continue even if an appropriate caregiver is introduced later on.

Doesn’t sound so bad maybe. But here’s some more common terms for how RAD looks:

  • anxiety
  • trouble sleeping
  • lack of boundaries
  • hypervigilant
  • extreme dependence
  • acts much younger than chronological age
  • underdeveloped conscience, lack of remorse
  • inappropriate responses (laughing or smiling when something is sad)
  • fake, not genuine
  • academic struggles
  • difficulty showing affection
  • disobedient
  • defiant
  • argumentative
  • controlling
  • bullying
  • aversion to physical touch
  • tantrums or rages
  • sensory issues or sensory processing disorder
  • withdrawal
  • lack of eye contact
  • not asking for help when hurt, sick or needing assistance
  • socially indiscriminate
  • manipulative (can be excellent at triangulating adults)
  • frequent lying
  • blames others for their mistakes
  • irresponsible
  • physically and verbally aggressive or abusive
  • mood swings
  • depression

The ones in purple are the ones I have experienced with August over the years. Most of them consistently.

The doctor that diagnosed him when he was nine explained it to me like this. When children are little, babies and toddlers, they cry and a caregiver does something to care for them. As an infant this is mostly meeting basic needs like food or sleep or a diaper change. But it is also providing soothing and comforting even when the infant doesn’t understand. This is a critical time because on both an emotional and physiological level they are learning how to trust. They learn when they are suffering, someone will care for them and they can trust that this care will happen every time. Their brain also is forming connections as it grows that help them learn that it is OK to trust.

If this constant caregiving isn’t present during these crucial formative years then the child does not develop the ability to trust. They have no assurance that when they are hurt or hungry that anyone will care and provide for their needs. The synapses in their brain are actually “pruned” and the brain does not learn that trust is something they can develop with any caregiver.

This is what August experienced. He was born to a teenage mother, from all accounts a prostitute, who didn’t know who the father was. There was no record of any pre-natal care. From infancy, August was left with friends, relatives or neighbors while his mother continued her life. He had a grandmother living in the home who moved away when August was one. At the time August was removed from his birthmother, records indicate he had probably been alone in his home (an apartment) for maybe up to two weeks. Neighbors alerted the authorities and he was found. He spent a month in the hospital with pneumonia before being placed in an orphanage. He was two years old. His information indicated he was the height and weight of a one-year-old. He couldn’t walk, talk or sit up. The doctor we had review his information when we were considering his adoption said if she’d seen this information she wouldn’t have expected he’d survive. He’s a fighter!

So after a year in the orphanage he was walking, talking, beginning to learn, and on the charts for height, weight and head circumference (though barely!) But even though the orphanage saved his life, he didn’t have a dedicated caregiver. So his emotional healing  was not as successful.

So this is what happened and what I didn’t know would set the stage for many years of tears and laughter, heartache and joy, anger and frustration and feelings of hopelessness. But mostly feeling so sorry for this poor child who had no say in what had happened to him and now was burdened with not even being able to enjoy the life that he should surely be ecstatic to have.

One of the best descriptions of what it’s like to be a child with RAD came from Nancy Thomas, who is considered one of the leaders in Attachment Therapy. She writes:

THE FROZEN LAKE  By Nancy L. Thomas

“In order to understand what an unattached child feels like, one must understand his perspective. Imagine that you are the young child who must cross a frozen lake in the autumn to reach your home. As you are walking across the lake alone, you fall suddenly and unexpectedly through the ice. Shocked and cold in the dark, you can’t even cry for help. You struggle for your very life, you struggle to the surface. Locating the jagged opening, you drag yourself through the air and crawl back into the woods from where you started. You decide to live there and never, never to return onto the ice. As weeks go by you see others on the lake ice skating and crossing the ice. If you go onto it, you will die.”

“Your family across the pond hears the sad news that the temperature will drop to sub-zero this night. So a brave and caring family member (that is you, the parent!) searches and finds you to bring you home to love and warmth. The family member attempts to help you cross the ice by supporting and encouraging, pulling and prodding. You, believing you will die, fight for your life by kicking, screaming, punching and yelling (even obscenities) to get the other person away from you. Every effort is spent in attempting to disengage from this family member. The family member fights for your life, knowing you must have the love and warmth of home for your very survival. They take the blows you dish out and continue to pull you across the ice to home, knowing it’s your only chance.”

“The ice represents the strength of the bond and your ability to trust. It was damaged by the break in your connection to someone you trusted. Some children have numerous bonding breaks throughout their young lives. This is like crashing them into the ice water each time they are moved, scarring and chilling their hearts against ever loving and bonding again.”

This has been much longer than I expected but I hope it has given some sense of the starting point of life with August and a reference point to understand how this beautiful child came to us so broken and unable to heal. I will add some additional references for those who might want to learn more about RAD.

Until next time,

Shannon

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