How to parent a child with attachment disorder

Attachment Disorders in Children: Causes, Symptoms, and Treatment

childhood issues

Parenting a child with reactive attachment disorder or disinhibited social engagement disorder can be challenging. But there are ways to address attachment issues and shape your child’s development.

What are attachment disorders?

Attachment disorders are conditions that can develop in young children who have issues establishing a deep emotional connection—known as the attachment bond—with their parent or primary caregiver. Since the quality of the attachment bond profoundly impacts your child’s development, experiencing attachment issues can affect their ability to express emotions, develop trust and security, and build meaningful relationships later in life.

Children who have attachment issues tend to fall on a spectrum, from mild problems that are easily addressed to one of two distinct attachment disorders recognized in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5): reactive attachment disorder (RAD) and disinhibited social engagement disorder (DSED).

Both types of attachment disorder are common in young children who have been traumatized, abused, bounced around in foster care, lived in orphanages, or separated from their primary caregiver after establishing a bond. These children may have difficulty relating to others and are often developmentally delayed.

However, no matter how detached or insecure your child seems, or how frustrated or exhausted you feel from trying to connect, it is possible to repair an attachment disorder. With the right tools—and a healthy dose of patience and love—you can bond with your child and help them develop healthy, meaningful, and loving relationships.

[Read: What is Secure Attachment and Bonding?]

Reactive attachment disorder (RAD)

Reactive attachment disorder (RAD) can make it difficult to connect with others and manage emotions. This can result in a lack of trust and self-worth, a fear of getting close to anyone, anger, and a need to be in control.

A child with RAD rarely seeks comfort when distressed and often feels unsafe and alone. They may be extremely withdrawn, emotionally detached, and resistant to comforting. Even though the child is aware of what’s going on around them—hypervigilant even—they don’t react or respond. They may push others away, ignore them, or even act out aggressively when others try to get close.

Disinhibited social engagement disorder (DSED)

With disinhibited social engagement disorder (DSED), a child doesn’t seem to prefer their parents over other people, even strangers. They’ll seek comfort and attention from virtually anyone, without distinction, and don’t exhibit any distress when a parent isn’t present.

While they are overly familiar with strangers, children with DSED often have trouble forming meaningful connections with others. They also tend to be extremely dependent, act much younger than their age, and can appear chronically anxious. Having DSED can also put a child at increased risk of harm from strangers.

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Attachment disorder causes

Attachment disorders occur when a child has been unable to consistently connect with a parent or primary caregiver. If a young child repeatedly feels abandoned, isolated, powerless, or uncared for—whatever the reason—they will learn that they can't depend on others and that the world is a dangerous and frightening place.

This can happen for many reasons:

A baby cries and no one responds or offers comfort.
A baby is hungry or wet, and they aren't attended to for hours.
No one looks at, talks to, or smiles at the baby, so the baby feels alone.
A young child gets attention only by acting out or displaying other extreme behaviors.
An infant or young child is mistreated, traumatized, or abused.
Sometimes a child's needs are met and sometimes they aren't. The child never knows what to expect.
An infant or young child is hospitalized or separated from their parents.
A baby or youngster is moved from one caregiver to another (the result of adoption, foster care, or the loss of a parent, for example).
The parent is emotionally unavailable because of depression, illness, or substance abuse.

[Read: Child Abuse and Neglect]

Sometimes the circumstances that cause attachment problems are unavoidable, but the child is too young to understand what has happened and why. To a young child, it just feels like no one cares. They lose trust in others and the world becomes an unsafe place.

Although it is never too late to treat and repair attachment issues, the earlier you spot the symptoms of insecure attachment and take steps to repair them, the better. Caught in infancy before they become more serious problems, attachment disorders are often easy to correct with the right help and support.

[Read: Building a Secure Attachment Bond with Your Baby]

Your infant may have attachment issues if they:

Avoid eye contact.
Don't smile.
Don't reach out to be picked up.
Reject your efforts to calm, soothe, and connect with them.
Don't seem to notice or care when you leave them alone.

Cry inconsolably.
Don't coo or make sounds.
Don't follow you with their eyes.
Aren't interested in playing interactive games or playing with toys.
Spend a lot of time rocking or comforting themselves.

It's important to note that the early symptoms of attachment disorders are similar to the early symptoms of other issues such as ADHD and autism. If you spot any of these warning signs, make an appointment with your pediatrician for a professional diagnosis of the problem.

Comforting a crying baby

It's common to feel frustration, anxiety, and even anger when faced with a crying baby—especially if your baby wails for hours on end. In these situations, you need to remain calm and centered so you'll be better able to figure out what's going on with your child and how best to soothe their cries.

Common signs and symptoms in young children include:

An aversion to touch and physical affection. Children with reactive attachment disorder often flinch, laugh, or even say “ouch” when touched. Rather than producing positive feelings, touch and affection are perceived as a threat.

Control issues. Most children with reactive attachment disorder go to great lengths to remain in control and avoid feeling helpless. They are often disobedient, defiant, and argumentative.

Anger problems. Anger may be expressed directly, in tantrums or acting out, or through manipulative, passive-aggressive behavior. Children with RAD, for example, may hide their anger in socially acceptable actions, like giving a high five that hurts or hugging someone too hard.

Difficulty showing genuine care and affection. For example, children with disinhibited social engagement disorder may act inappropriately affectionately with strangers while displaying little or no affection towards their parents.

Lack of inhibition. A child with DSED, for example, may be overly talkative or physical with unfamiliar adults, excited to interact or even leave with strangers, and fearless about places or situations that are strange or threatening.

An underdeveloped conscience. Children with reactive attachment disorder may act like they don't have a conscience and fail to show guilt, regret, or remorse after behaving badly. There’s evidence that left untreated attachment disorders may even lead to personality disorders in adulthood.

Parenting a child with attachment issues

Parenting a child with insecure attachment or an attachment disorder can be exhausting, frustrating, and emotionally trying. It is hard to put your best parenting foot forward without the reassurance of a loving connection with your child. Sometimes you may wonder if your efforts are worth it, but be assured that they are.

With time, patience, and concerted effort, attachment disorders can be repaired. The key is to remain calm, yet firm as you interact with your child. This will teach your child that they are safe and can trust you.

A child with an attachment disorder is already experiencing a great deal of stress, so it is imperative that you evaluate and manage your own stress levels before trying to help your child with theirs. HelpGuide's free Emotional Intelligence Toolkit can teach you valuable skills for managing stress and dealing with overwhelming emotions, leaving you to focus on your child's needs.

To help a child with attachment issues, it's also important to:

Have realistic expectations. Helping your child may be a long road. Focus on making small steps forward and celebrate every sign of success.

Stay patient. The process may not be as rapid as you'd like, and you can expect bumps along the way. But by remaining patient and focusing on small improvements, you create an atmosphere of safety for your child.

Foster a sense of humor. Joy and laughter go a long way toward repairing attachment problems and energizing you even in the midst of hard work. Find at least a couple of people or activities that help you laugh and feel good.

Take care of yourself. Reduce other demands on your time, make time for yourself, and manage stress. Rest, good nutrition, and parenting breaks help you relax and recharge your batteries so you can give your attention to your child.

[Read: Relaxation Techniques for Stress Relief]

Find support. Rely on friends, family, community resources, and respite care (if available). Try to ask for help before you really need it to avoid getting stressed to breaking point. You may also want to consider joining a support group for parents.

Stay positive and hopeful. Be sensitive to the fact that children pick up on feelings. If they sense that you're discouraged, it will be discouraging to them. When you are feeling down, turn to others for reassurance.

Making a child with an attachment disorder feel secure

Safety and stability are core issues for children with attachment problems. They are distant and detached because they feel unsafe in the world. They keep their guard up to protect themselves, but it also prevents them from accepting love and support. So, before anything else, it is essential to build up your child's sense of security. You can accomplish this by establishing clear expectations and rules of behavior, and by responding consistently so your child knows what to expect when they act a certain way and—even more importantly—knows that no matter what happens, you can be counted on.

Set limits and boundaries. Consistent, loving boundaries make the world seem more stable and predictable and less scary to children with attachment issues. It's important that they understand what behavior is expected of them, what is and isn't acceptable, and the consequences if they disregard the rules. This also teaches them that they have more control over what happens to them than they think.

Take charge but remain calm when your child is upset or misbehaving. Remember that “bad” behavior means that your child doesn't know how to handle what they're feeling and needs your help. By staying calm, you show your child that the feeling is manageable. If they are being purposefully defiant, follow through with the pre-established consequences in a cool, matter-of-fact manner. But never discipline a child with an attachment disorder when you're in an emotionally-charged state. This makes the child feel more unsafe and may even reinforce the bad behavior, since it's clear that it pushes your buttons.

Be immediately available to reconnect following a conflict. Conflict can be especially disturbing for children with attachment disorders. After a conflict or tantrum where you've had to discipline your child, be ready to reconnect as soon as they're ready. This reinforces your consistency and love, and will help your child develop a trust that you'll be there through thick and thin.

[Read: Conflict Resolution Skills]

Own up to mistakes and initiate repair. When you let frustration or anger get the best of you or you do something you realize is insensitive, quickly address the mistake. Your willingness to take responsibility and make amends can strengthen the attachment bond. Children with attachment issues need to learn that although you may not be perfect, they will be loved, no matter what.

Try to maintain predictable routines and schedules. A child with an attachment disorder won't instinctively rely on loved ones, and may feel threatened by transition and inconsistency—when traveling or during school vacations, for example. A familiar routine or schedule can provide comfort during times of change.

Repairing attachment disorders by helping your child feel loved

A child who has not bonded early in life will have a hard time accepting love, especially physical expressions of love. But you can help them learn to accept your love with time, consistency, and repetition. Trust and security come from seeing loving actions, hearing reassuring words, and feeling comforted over and over again.

Identify actions that feel good to your child. If possible, show your child love through rocking, cuddling, and holding—attachment experiences they missed out on earlier. But always be respectful of what feels comfortable and good to your child. In cases of previous abuse, neglect, and trauma, you may have to go very slowly because your child may be very resistant to physical touch.

Respond to your child's emotional age. Children with attachment disorders often act like younger children, both socially and emotionally. You may need to treat them as though they were much younger, using more non-verbal methods of soothing and comforting.

Help your child identify emotions and express their needs. Children with attachment problems may not know what they're feeling or how to ask for what they need. Reinforce the idea that all feelings are okay and show them healthy ways to express their emotions.

Listen, talk, and play with your child. Carve out times when you're able to give your child your full, focused attention in ways that feel comfortable to them. It may seem hard to drop everything, eliminate distractions, and just live in the moment, but spending quality time together provides a great opportunity for your child to open up to you and feel your focused attention and care.

Supporting the health of a child with attachment issues

Your child's eating, sleep, and exercise habits are always important, but they're even more so for kids with attachment problems. Healthy lifestyle habits can go a long way towards reducing your child's stress levels and leveling out mood swings. When children with attachment issues are relaxed, well-rested, and feeling good, it will be much easier for them to handle life's challenges.

Diet. Make sure your child eats a healthy diet full of whole grains, fruits, vegetables, and lean protein. Be sure to skip the sugar and add plenty of good fats—like fish, flax seed, avocados, and olive oil—for optimal brain health.

[Read: Healthy Food for Kids]

Sleep. If your child is tired during the day, it will be that much harder for them to focus on learning new things. Make their sleep schedule (bedtime and wake time) consistent.

Exercise. Any type of physical activity provides a great antidote to stress, frustration, and pent-up emotion, triggering endorphins to make your child feel good. Physical activity is especially important for an angry child. If your child isn't naturally active, try some different classes or sports to find something that is appealing.

Any one of these things—food, rest, and exercise—can make the difference between a good and a bad day for a child who has an attachment disorder. These basics will help ensure that your child's brain is healthy and ready to connect.

Professional treatment

If your child is suffering from a severe attachment issue, such as either type of attachment disorder, seek professional help. Extra support can make a dramatic and positive change in your child’s life, and the earlier you seek help, the better. Start by consulting with your pediatrician, a child development specialist, or an organization that specializes in child development or attachment disorders.

Treatment for attachment disorders usually involves a combination of therapy, counseling, and parenting education. These are designed to ensure that your child has a safe living environment, improves their peer relationships, and develops positive interactions with you, their parent or caregiver. While medication may be used to treat associated conditions, such as depression, anxiety, or hyperactivity, there is no quick fix.

Your pediatrician may recommend a treatment plan that includes:

Family therapy. Typical therapy for attachment problems includes both your child and you. Therapy often involves fun and rewarding activities that enhance the attachment bond as well as help parents and other children in the family understand the symptoms of the disorder and effective interventions.

Individual psychological counseling. Therapists may also meet with your child individually or while you observe. This is designed to help your child directly with monitoring their emotions and behavior.

Play therapy. Helps your child learn appropriate skills for interacting with peers and handling other social situations.

Special education services. Specifically designed programs within your child's school can help them learn skills required for academic and social success, while also addressing behavioral and emotional difficulties.

Parenting skills classes. Education for parents and caregivers centers on learning about attachment disorders as well as other necessary parenting skills.

Authors: Melinda Smith, M.A., Lawrence Robinson, Joanna Saisan, MSW, and Jeanne Segal, Ph.D.

- References
  “CEBC » Search › Topic Areas › Dsm 5 Criteria For Reactive Attachment Disorder Rad. ” Accessed August 12, 2021. https://www.cebc4cw.org/search/topic-areas/dsm-5-criteria-for-reactive-attachment-disorder-rad/
  “CEBC » Search › Topic Areasdsm5 › Dsm 5 Criteria For Disinhibited Social Engagement Disorder.” Accessed August 12, 2021. https://www.cebc4cw.org/search/topic-areasDSM5/dsm-5-criteria-for-disinhibited-social-engagement-disorder/
  Zeanah, Charles H., Angela Keyes, and Lisa Settles. “Attachment Relationship Experiences and Childhood Psychopathology.” Annals of the New York Academy of Sciences 1008 (December 2003): 22–30. https://doi.org/10.1196/annals.1301.003
  Maria G, Kroupina, Rowena Ng, Claire M Dahl, Ann Nakitende, and Kathryn C Elison MSW. “Identifying Reactive Attachment Disorder (RAD) and Disinhibited Social Engagement Disorder (DSED) in a Clinical Sample of High Risk Children.” Journal of Psychology & Clinical Psychiatry 9, no. 3 (May 3, 2018). https://doi.org/10.15406/jpcpy.2018.09.00530
  Humphreys, Kathryn L., Charles A. Nelson, Nathan A. Fox, and Charles H. Zeanah. “Signs of Reactive Attachment Disorder and Disinhibited Social Engagement Disorder at Age 12 Years: Effects of Institutional Care History and High-Quality Foster Care.” Development and Psychopathology 29, no. 2 (May 2017): 675–84. https://doi.org/10.1017/S0954579417000256
  Zouwen, Marion van der, Machteld Hoeve, Anne M. Hendriks, Jessica J. Asscher, and Geert Jan J. M. Stams. “The Association between Attachment and Psychopathic Traits.” Aggression and Violent Behavior 43 (November 1, 2018): 45–55. https://doi.org/10.1016/j.avb.2018.09.002
Around the web
Last updated: October 24, 2022
Supporting children with attachment difficulties - information for parents/carers
As children grow up, they develop attachments to their main care givers. It is thought that children develop different types of attachments, depending on the relationships they have in their early life.
‘Nurturing adult attachments provide children with protective, safe havens and secure bases from which to explore and engage with others and their environment’ (Bowlby, 1988).
It is now thought there are four attachment styles, secure attachment, and three insecure attachments, which are described as ambivalent attachment, avoidant attachment and disorganised attachment.
Current research suggests that at least one third of children have an insecure attachment with at least one caregiver (Bergin and Bergin, 2009).
Children with attachment problems are likely to have difficulties relating to others, and managing their own emotions. They may have a lack of trust and self-worth and get angry easily. They may not wish to get close to anyone, and are likely to want to be in control of situations.
Parenting a child with insecure attachments can be quite difficult, as they are likely to find it hard to develop a trusting relationship with you.
Please see below some suggestions that may help (https://www.helpguide.org/articles/parenting-family/attachment-issues-and-reactive-attachment-disorders.htm):
Have realistic expectations. Helping your child with an attachment disorder may be a long road. Focus on making small steps forward and celebrate every sign of success.
Patience is essential. The process may not be as rapid as you’d like, and you can expect bumps along the way. But by remaining patient and focusing on small improvements, you create an atmosphere of safety for your child.
Foster a sense of humour and joy. Joy and humour go a long way toward repairing attachment problems and energizing you even in the midst of hard work. Find at least a couple of people or activities that help you laugh and feel good.
Take care of yourself and manage stress. Reduce other demands on your time and make time for yourself. Rest, good nutrition, and parenting breaks help you relax and recharge your batteries so you can give your attention to your child.
Find support and ask for help. Rely on friends, family, community resources, and respite care (if available). Try to ask for help before you really need it to avoid getting stressed to breaking point. You may also want to consider joining a support group for parents.
Stay positive and hopeful. Be sensitive to the fact that children pick up on feelings. If they sense you’re discouraged, it will be discouraging to them. When you are feeling down, turn to others for reassurance.
Help your child to feel safe and secure:
Set limits and boundaries. Consistent, loving boundaries make the world seem more predictable and less scary to children with attachment problems such as reactive attachment disorder. It’s important that they understand what behaviour is expected of them, what is and isn’t acceptable, and what the consequences will be if they disregard the rules. This also teaches them that they have more control over what happens to them than they think. Take charge, yet remain calm when your child is upset or misbehaving. Remember that “bad” behaviour means that your child doesn’t know how to handle what he or she is feeling and needs your help. By staying calm, you show your child that the feeling is manageable. If he or she is being purposefully defiant, follow through with the pre-established consequences in a cool, matter-of-fact manner. But never discipline a child with an attachment disorder when you’re in an emotionally-charged state. This makes the child feel more unsafe and may even reinforce the bad behaviour, since it’s clear it pushes your buttons.
Be immediately available to reconnect following a conflict. Conflict can be especially disturbing for children with insecure attachment or attachment disorders. After a conflict or tantrum where you’ve had to discipline your child, be ready to reconnect as soon as he or she is ready. This reinforces your consistency and love, and will help your child develop a trust that you’ll be there through thick and thin.
Own up to mistakes and initiate repair. When you let frustration or anger get the best of you or you do something you realize is insensitive, quickly address the mistake. Your willingness to take responsibility and make amends can strengthen the attachment bond. Children with reactive attachment disorder or other attachment problems need to learn that although you may not be perfect, they will be loved, no matter what.
Try to maintain predictable routines and schedules. A child with an attachment disorder won’t instinctively rely on loved ones, and may feel threatened by transition and inconsistency—for example when traveling or during school holidays. A familiar routine or schedule can provide comfort during times of change.
Help your child feel loved
Find things that feel good to your child. If possible, show your child love through rocking, cuddling, and holding—attachment experiences he or she missed out on earlier. But always be respectful of what feels comfortable and good to your child. In cases of previous abuse and trauma, you may have to go very slowly because your child may be very resistant to physical touch.
Respond to your child’s emotional age. Children with attachment disorders often act like younger children, both socially and emotionally. You may need to treat them as though they were much younger, using more non-verbal methods of soothing and comforting.
Help your child identify emotions and express his or her needs. Children with attachment disorders may not know what they are feeling or how to ask for what they need. Reinforce the idea that all feelings are okay and show them healthy ways to express their emotions.
Listen, talk, and play with your child. Carve out times when you’re able to give your child your full, focused attention in ways that feel comfortable to him or her. It may seem hard to drop everything, eliminate distractions, and just be in the moment, but quality time together provides a great opportunity for your child to open up to you and feel your focused attention and care.
Access appropriate support
Some children with attachment disorders need professional support, like family therapy, psychological counselling, play therapy, etc. Parenting classes may also be helpful. Please ensure you speak to a professional involved in your child’s life who can help, like an early years setting, health visitor, school, school nurse, etc.
Attachment disorder in foster children: what is it?

Psychological attachment is a feeling of closeness, which is normally formed in an infant in relation first to the mother, and then to other significant adults, first of all as a habit, as a result of continuous contact, repetition of significant experiences. It is closeness with the mother that helps the child build relationships with other people later in life. But how is the feeling of affection formed in children who find themselves in foster families? Let's figure it out together.

In infancy, the child is not yet aware of himself as a separate person, but perceives himself as part of the mother. Only with the passage of the crisis of the 1st year does the baby begin to feel like a separate person. Of course, in a situation where the baby from birth has not had contact with his own mother, he has certain problems with the formation of a sense of affection.

There are situations when a child was born and lived in his own family, but then for some reason he lost it. If this family was dysfunctional - the parents abused the baby, were alcoholics, did not care for the child, then the feeling of affection might not form at all. Such children are distinguished by aggressiveness towards those who are weaker than them, and in communication with adults they usually fawn.

If the child lived in a prosperous family, then the feeling of attachment was formed, but with the loss of the parents it underwent some changes. The consequences of such a break in the formation of attachment can be smoothed out by a quick replacement of the attachment figure with a new one (placement of the child in the family). If a child is placed in an orphanage or an orphanage with an "impersonal" type of upbringing, then this only increases the negative consequences. Attachment disruption can also be affected by frequent changes of adults caring for the child (caregivers or nannies in the child's home, or transfers from group to group within the same institution, or transfer from one institution to another). There is another scenario: afraid to experience the pain of loss again, the child communicates with adults cautiously and does not allow intimacy.

Depending on the age of the child at which he/she is placed in a foster family, the specifics of his/her stay in the previous places of residence (family, orphanage, boarding school), personal characteristics and many other factors, the formation of a child's attachment to a new family may proceed in differently.

A feature of all foster children is wariness towards new parents: children do not trust adults, fearing a new betrayal. Often parents complain about the defiant and provocative behavior of the child, they say that the baby does not appreciate their efforts, does not treat them with gratitude, but only misbehaves and hooligans. This behavior of the child is explained by the fact that he tests new parents for strength - can they withstand it, but do they love anyone, will they not betray him?

An adopted child, having got into a family, will not show affection, at best he will show anxiety in the absence of new parents or their attempts to leave home. But this does not mean that attachment cannot be formed. For this, it is important for adoptive parents to have a good understanding of the origins of attachment disorders, as well as to master the methods of “therapeutic education”. Similar methods are used by the teacher-psychologist of KSAEI TsPMSS of Tchaikovsky (Perm Territory) Shamardanova E.A.
1. The main rule of "therapeutic education" for parents is to take care of yourself first!
2. Do not expect problems, but anticipate them, be proactive.
3. All adults in the family, at school, in therapy should work as a team. Don't let a child with an attachment disorder turn you against each other.
4. The environment in your home should be safe for the child, both emotionally and physically.
5. To help your child learn actionable lessons from his misdeeds, create "natural consequences." But when such consequences "arrive", show empathy for your child.
6. Avoid being sarcastic and irritable when communicating with your child, speak to him in a friendly way, even when you are not happy with his behavior. Even if you scold, use words that encourage the child to think, and not offend his dignity.
7. Encourage your child to express any of his feelings with words, not with destructive actions.
8. TV should be a very rare occurrence in your child's life.
9. Give your child only choices that are acceptable to you.
10. Be consistent.
11. Avoid arguing with your child about “who is in charge”.
12. Soberly assess the capabilities of your child and give him the rights and obligations to the extent that he can handle.
13. Keep your sense of humor.
Raising a child with an attachment disorder requires a special attitude, perseverance, creativity and strength. Of course, the foster parent is not responsible for the problems with which the child appeared in his family, but it is he who is responsible for creating the conditions for the healing of his child.

Ekaterina Safonova

Attachment disorder: 8 tips for parents and guardians

Photo from army.mil

It is human nature to strive for another person, establish close relationships, become attached to someone who shows warmth and care. It is in the nature of a child to become attached to parents, grandparents, brothers and sisters, or to those who in their lives replace blood relatives.

Man is a social being, and therefore, even in conditions when parents neglect their duties, not satisfying the basic needs of the baby for food, comfort, affection, in the overwhelming majority of cases, he still loves a cruel mother or a father who drinks heavily and does not want to be separated with them.

But it happens in a different way. The difficult conditions in which the early development of the child proceeds can lead to a disease that is difficult to treat.

Most often, this problem is faced by adoptive parents whose child has experienced trouble in the birth family, and then ended up in an orphanage. The situation is even more difficult when the child has already been adopted by the family and then returned back to the children's institution.

However, there are cases of RRP in families with many children, where no one helps the mother and some of the children receive very little attention and care. The disorder can develop if the child was separated early from the parents for a long time as a result of a long hospital stay, or if the child spent most of the time with a mother suffering from depression or other serious illness that prevented her from properly caring for the child.

What is reactive attachment disorder?

Photo courtesy of phillypsychology.com

This is a condition in which a child does not form an emotional attachment to parents or persons acting in their stead. Symptoms of the disorder appear before the age of 5 years, often as early as infancy. This is lethargy, refusal to communicate, self-isolation. A small child is indifferent to toys and games, does not ask to be held, does not seek solace in physical pain. He rarely smiles, avoids eye contact, and appears sad and apathetic.

As they grow older, signs of self-isolation can manifest themselves in two seemingly opposite types of behavior: disinhibited and inhibited.

With disinhibited behavior, the child seeks to attract the attention of even strangers, often asks for help, does things that are not appropriate for his age (for example, comes to bed with his parents).

Misunderstanding, lack of patience, a strong negative reaction to the child's behavior on the part of a significant adult can cause irritation, anger or an outburst of aggression on the part of the child, and if the violation persists in adolescence, alcohol abuse, drug addiction and other types of antisocial behavior.

With inhibited behavior, the child avoids communication and refuses help. In some cases, both types of behavior, both disinhibited and inhibited, are alternately observed in him.

Reactive Attachment Disorder can manifest itself in forms that sometimes cause despair in adoptive parents: the child constantly lies, steals, behaves impulsively, shows cruelty to animals and a complete lack of consciousness. He does not express regret or remorse after unacceptable behavior.

Diagnosing RRP is not an easy task. Some features of this disorder can be seen in attention deficit hyperactivity disorder (ADHD), anxiety disorder, autism, and post-traumatic stress disorder. In order to make an accurate diagnosis, it is necessary to observe the child's behavior in various situations over a certain period of time, analyze his biographical data, and evaluate the interaction of parents with the child.

Even harder to treat him

Photo from helpguide.org

Psychiatrists sometimes prescribe drugs to children with RAD, but in some cases they can only slightly improve the background against which the therapeutic interaction with the child will proceed.

A child's parents or guardians play a key role in treatment. It is they who, with the help of doctors and psychologists, will have to create such an environment in which he can experience a healthy addiction, believe that an adult can be relied upon, and begin to trust him.

Experts believe that the therapeutic environment has 3 essential components: safety, stability and sensitivity.

In order to overcome the consequences of those events that caused the child's inability to form close and warm relationships, an adult must have enough time and patience to listen and hear the child with an open mind and without trying to judge him.

The child needs boundaries, but they must be set in a context of understanding and empathy. Only if the child feels emotional safety , that is, he understands that his story about himself will not cause a negative assessment from an adult, he will be filled with confidence and tell his foster mother or psychologist about the difficult experiences of his early childhood.

The second component after safety is stability . The figure of an adult for the formation of a primary attachment must remain the same. It takes a long time to establish trust between a significant adult and a child with RAD. Changing such a figure, moving from one foster family to another, not only slows down the process, but also aggravates the disorder.

Having gone through the painful experience of ignoring his needs, the child must learn to be aware of them again, as well as the fact that the same person can satisfy them over and over again: feed, give clean clothes, put in a warm bed, play, listen and comfort, help with the performance of tasks. Such children are often afraid that the new mother will abandon them or die, and only after a long period of stability do these fears subside.

Some children need at least a year of stability to start trusting their significant adult, others become imbued with trust in foster parents after a few months. It depends on the temperament of the child (it is important, for example, whether he is an extrovert or an introvert), as well as how well the child and his new parent fit together in various ways.

Photo from wisegeekhealth.com

Long separations between a foster child and mother are undesirable: they can activate his defensive reaction, which is self-isolation.

And finally sensitivity . This is the emotional availability of an adult, his attentiveness to the needs of the child. Adoptive parents should be informed by specialists that while the mental development of a child with RAD may be age appropriate, his emotions often remain immature, which means that in the process of attachment formation, the need for an adult may be greater than that of a healthy child of the same age.

During this transitional period, parents must be very patient, be prepared for unexpected behaviors that are signals that the child is going through some earlier stages of development and attachment.

For example, a child who behaved suspiciously and aloofly suddenly begins to obsessively follow his mother, constantly report his fears, climb on his knees or come to sleep in his parent's bed - in a word, behave as if he suddenly stood on 2-3 years younger. In this case, parents should accept the situation and meet the child's need for greater dependence on them.

It is important for adoptive parents to understand the logic of changes happening to the child. Some adopted children initially seem emotionally cold, as experience has taught them that it is not safe for them to express their feelings and communicate their desires. At the same time, the child gives the impression of being completely obedient, because he does not show any irritation or discontent, does not talk about his needs.

Feeling himself safe, he intuitively feels that adults accept him and will not refuse him, which means that it is quite safe to declare your desires in any form, up to whims and tantrums.

If before the child remained indifferent to whether the mother was at home or she had gone somewhere, now he may burst into tears, cling to her and not let her go if she was about to leave without him. This is not easy for parents, but such behavior should be seen as a positive sign: attachment is gradually formed, the child overcomes the destructive consequences of his difficult early childhood.

In the case of RAD, the task of the psychologist is primarily to educate the parents and support them in creating a safe and stable environment for the child at home, but activities with the child can also be useful. Play therapy and other techniques can help the child to realize their own needs, to build trusting relationships with a new significant adult.

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At the same time, parents should be wary of offerings to work with their child using methods that are collectively called Attachment Therapy.

Not only does this therapy lack scientific evidence and documented efficacy, it is also not safe.

Attachment therapy combines a number of violent methods, the most famous of which are holding therapy (holding) and rebirthing (“rebirth”).

In "rebirth", the baby's body is wrapped in a blanket and forced to crawl through compressed pillows, simulating passage through the birth canal. It is assumed that "having been born again", he overcomes past negative experiences and is ready for intimacy with his mother. In 2000, a 10-year-old girl suffocated during such a procedure in Colorado (USA), and this therapy has since been banned in the state.

Until now, there are many adherents of holding therapy for the treatment of autism and RRP, among them the well-known psychologists in our country, Dr. OS Nikolskaya and M. M. Liebling.

The essence of therapy is that the mother forcibly holds the child in her arms and, despite his resistance, tells him how much she needs him and how much she loves him. It is assumed that after a period of resistance, when the child tries to escape, scratches and bites, relaxation occurs, during which contact is established between mother and child.

Critics of the method argue that it is not ethical, as it is based on physical coercion, and can provoke a regression in the development of the child. Indeed, how can trust be established on the part of a child in an adult who uses physical violence against him?

Raising a child with a reactive disorder is associated with enormous emotional costs, sometimes with stress for parents who blame themselves if they do not see positive changes in the child's condition and behavior for a long time.

If your child is diagnosed with RRP

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1. Remember that there are no miracle cures to achieve a breakthrough in a child's condition in a short time. There is no substitute for a therapeutic home environment, security, stability, and your willingness to respond emotionally to your child's needs.
2. Be sure to find an opportunity and a way to restore your own emotional balance. A child with RAD is already stressed, and your anxiety or irritability can make it worse. To feel safe, the child must feel your calmness and firmness.
3. Set the boundaries of what is permitted. The child must understand what behavior is unacceptable and what consequences await him in case of violation of the rules. It is important to explain to the child that your rejection does not apply to him, but to certain of his actions.
4. After a conflict, be ready to quickly reunite with your child to let him feel that the reason for your dissatisfaction was a particular behavior, but you love him and cherish the relationship with him.
5. If you were wrong about something, don't be afraid to admit your mistake. This will strengthen your bond with your child.
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