Try imagining meeting someone who does not have an emotional bond or connection with anyone or anything in his

or her life. First, you probably wonder, do these people really exist? Unfortunately, there are very many children today that experience this loss of emotional connection and are suffering from the disease of Reactive Attachment Disorder (RAD). Now, how do these children behave? Would you know if you met a child with RAD immediately? What causes RAD to develop in children? And what, in the unlikely circumstance, that a child you know or your own child is diagnosed with RAD would you do to help this child? These are all completely normal questions to be pondering about Reactive Attachment Disorder because of its rarity and obscurity. It is very difficult to envision a child who is not capable of loving the people and things around them because we tend to think of children as being sweet and compassionate towards their surroundings. Because of the severity of this disease, it is important that researchers, doctors, and psychologists actively work together to find treatment options for those inflicted by this disorder. Reactive Attachment Disorder is defined as, a rare but serious condition, in which infants and young children don't establish healthy bonds with parents or caregivers, (Mayo Clinic Staff, 2011). Normally, a child is born with the innate ability to love and become attached to the people in their lives. Children with RAD lack this ability and it usually becomes apparent early in life. There are many things that can cause this disorder to develop. After much research has been done, it is found that the main cause of this disorder is physical and emotional trauma very early in the childs life (Zeanah & Smyke, 2008). An example of childhood trauma could be neglect, abuse, and abandonment. Very often, because of these traumatic events in their homes, these children are put into foster care or orphanages.

It is widely known that the quality of parental care that a child receives early in life is of great importance to their mental health later on in their life (Zeanah & Smyke, 2008). A secure, quality attachment benefits the child throughout their life because they have better social relationships, less conflict in their lives, and more stability in their lives. Children rely on their parental figures to always be there when needed and they create a set of expectations about the parents availability and responsiveness to situations called an internal working model (Kail, 2012). Parents who provide appropriate responses to life situations are the parents who have a secure attachment with their child often had parents that reacted the same way. People who had parents that valued their relationship grow up and reflect these same values on their child creating a stable secure attachment. The parents of children with Reactive Attachment Disorder did not have these important secure, stable relationships with their own parents and therefore, also dont have them with their own children. These types of parents had a bad relationship with their parents and often describe their childhood experiences with anger or confusions. This is often known as preoccupied adults (Kail, 2012). These parents often are suffering from some sort of difficulty in their own life such as alcoholism, depression, or abuse (Zeanah & Smyke, 2008). The repercussions of the hardships of the parents life become apparent in the childs life. In some cases, the child will suffer from the same hardship as their parent once did, have a hard, unstable life, or in extreme cases, they might develop RAD. Bad home life and unstable relationships among family members is extremely cyclical and it can be very hard to break that cycle.

It is important to note that the parent is not one hundred percent at fault for the development of Reactive Attachment Disorder. There are plenty of children in the world who have had horrible relationships with their parents and awful upbringings, but who do not develop RAD and go on to have a successful and healthy life. There are other factors that go into the development of RAD. Although the relationship between child and parent is very influential in the development of Reactive Attachment Disorder, the theory of temperament is also a factor in this disorder. Temperament refers to the behavioral style exhibited by infants or young children in response to a range of stimuli or contexts ( Zeanah & Fox, 2004). This is basically the way a child reacts to situations and how he or she interacts with other people. There are 3 different temperament types that help describe a person. Easy, Active, and Slow to warm up, are the 3 different types (Hunter). Easy children tend to be happy and are adaptable, while not easily upset. Active children are fussy, easily upset and often have irregular sleeping and eating habits. They are also fearful of new situations or people. Also, Slow to warm up children can react negatively to new situations and are often fussy and less active but they tend to become more positive as they are repeatedly exposed to new situations (Hunter). Children who are the active type may do things that annoy their parent. For example, an active child may cry for a long time several different times in one hour and they are not easily consoled even after the mother has already arrived. This parent may not be able to keep running back to the crying child so sometimes this leads to neglect of that child. This could be very hurtful to that child if the neglect continues (Hunter).

So we know now that parenting styles and neglect are two main causes of RAD but there are also more severe causes as well. Children who have severe cases of Reactive Attachment Disorder most likely suffered from extreme emotional, physical, or sexual abuse. As a very small child they were beaten or sexually assaulted by one of their parent figures (Chapman, 2002). Even if the child is not old enough to speak yet this trauma can still have a huge impact on their future and can severely set them back during their learning period. Without a strong attachment with their parent figure, children do not have anything to attach to. If their parent is abusing them and showing all negativity than how is the child supposed to know anything different than that? Another main cause of this disorder is when children are put up for adoption and move around through fosters homes their whole childhood. It is said that Approximately 2% of the population is adopted, and between 50% and 80% of such children have attachment disorder symptoms (Becker-Weidman, 2006). A study by Michelle A. Stinehart talks about how children who are in foster homes have such a high risk of developing Reactive Attachment Disorder (Michelle A. Stinehart, 2012). Children move many times between homes and they have several different caregivers during those times. These children lack the ability to attach to someone and create a bond with them. Because there are so many people in the childs life, they become unable to learn how to create a close relationship with one person. Often in the orphanage institution setting, children are isolated and are given very little attention, which also causes a disruption between the exclusive relationship between a child and their caregiver (Michelle A. Stinehart, 2012). Again this diagnosis does not apply to all children who are in foster homes or

orphanage institutions. But, children in this situation have a high rate of developing this tragic disorder. It is hard to believe that a sweet innocent child actually lives with a very severe case of this disease and has put many people including themself in danger because of it. A well-known documentary about RAD is a case about a young girl named Beth Thomas. The documentary was an interview constructed by Beths psychiatrist revealing her abuse as a young child and her harmful tendencies that she has towards herself and other people around her. Beth was a victim of sexual abuse when she was 19 months old. Her and her brother Jonathon were left with their sadistic father after their mother died when they were 1 year old. Soon after this, Child Services became responsible for Beth and Jonathon. Tim and Julie, two very sweet people who were involved with the church and could not have children of their own, then adopted them. At first the couple were told that the children were normal and healthy, but soon after they adopted they learned that these children were far from that. Tim and Julie quickly started learning about Beth and Jonathons background and it started to explain a lot about how Beth had been acting. In the interview Tim stated that Beth was having nightmares about a man who was falling on her and hurting her with a part of himself (Marilyn, 2010). It was then clear that she had been sexual abused during the first months of her life and both of the children were severely neglected by their father. The severe abuse and neglect of her father and death of her mother, Beth has was never able to develop a sense of conscious, love, or trust for anyone (Thomas, 1990). She did not understand what it meant to have a relationship with someone or trust someone enough to rely on him or her to

take care of her because she never felt those emotions herself. But her lack of love or trust was not the biggest issue for Beth and her family. Throughout the documentary we are shown how violent and sexually inappropriate Beth is towards everyone around her, especially to her younger brother. There were many instances where Beth tried not only to harm her brother, but also to kill him. She speaks a lot about how she would often stick pins in Jonathon and on extreme occasions she would smash his head over and over in the cement floor (Marilyn, 2010). Jonathon was taken to hospital and had to get stitches to close a gash on his head. Not only did Beth harm him physically but also sexually assaulted him on many occasions (Thomas, 1990). Beths biological father sexually abused her a lot so Beth is repeating what was done to her. The physical abuse did not stop at Jonathon; Beth also tried to kill her parents and their pets multiple times. Although Beths actions are horrific she shows no emotion and no remorse for her actions. Throughout the interview Beth stays calm the entire time as she talks about all the things she has done (Thomas, 1990). Beth does not think she has done anything wrong. Beth had so much rage in her because of her biological father and she took it out on her family everyday. Despite how much Tim and Julie tried to love her, Beth did not understand it. All she wanted to hurt them like her father had hurt her. Since she was so neglected she as no connection with anyone in her life and she does not trust her parents to take care of her. She thinks of herself as a bad person and she will continue to act this way and see herself as this way until someone can change that (Thomas, 1990). So how do we help someone that has experienced this much pain and trauma? Treatment for this disease is not very precise. In order to help a child suffering from Reactive

Attachment Disorder one must have a combination of counseling, medication, and education about this particular disorder (Mayo Clinic Staff, 2011). Every child who has this disorder is very different. Doctors do not have a standard treatment plan for RAD because each child can relate very differently to it. But, the goals for the child are similar. The common goals for children who are trying to recover from RAD are to form trust worthy relationships with people as well as create a strong stable environment for that child. These children need to feel safe and they need to have positive interactions with people that care about them. The greatest treatment is to teach children control and to teach them they are not in control of everyone. In the documentary with Beth Thomas one of her therapists says she took Beth in to her home and completely monitored her. Beth had absolutely no control, she had to ask to get a drink of water or use the bathroom (Thomas, 1990). It is important to establish who is in control so that child can learn obedience and begin to respect people when they tell her what to do. People who suffer with this disorder also have no respect for themselves. They think of themselves as bad people who cannot do anything right. One of the biggest goals for RAD is to regain that self-esteem in the child so they can like themselves again and be happy with themselves. Once they can understand their own emotions they can express empathy for others. Within the medical community, strides are being made towards the bettering of treatment options for the children and for a better understanding of the children with Reactive Attachment Disorder. Therapy for the child and parents is the main treatment option for RAD. The main goal of therapy for RAD is not to, treat anger and behavior in order to create a bond*but+ create a parental bond which in and of itself changes the anger and behavior,

(Buenning, 2014). The most important bond a child can have is with their parent and it a child does not have this then they can never make bonds with other people. It is important that we keep developing new techniques to treat this disease and keep researching to find a better understanding of it.

Emily Perlitch Children are RAD Prof. Abplanalp PSYC- 2120-001 April 28, 2014

Works Cited Buenning, W. D. (2014). Practical Therapy for RAD Children. Retrieved April 27 , 2014, from Reactive Attachment Disorder Treatment: http://www.reactiveattachmentdisordertreatment.com/ssi/article3.html Chapman, S. (2002, June). Reactive Attachment Disorder . Retrieved April 27 , 2014, from Attachment Disorder: http://onlinelibrary.wiley.com/store/10.1111/14678527.00246/asset/14678527.00246.pdf?v=1&t=huilexmq&s=1fd1cde3c9aa1c2902ff28750326d 614b122d580 Hunter, L. T. (n.d.). Understanding Temperament in Infants and Toddlers . Retrieved April 27, 2014, from Center on Emotional and Social Foundations for Early Learning : http://csefel.vanderbilt.edu/resources/wwb/wwb23.html?utm_source=News+and+Notes+from +the+Field+No.+7+-+10-14-12&utm_campaign=news+%26+notes+Vol1&utm_medium=email Kail, R. V. (2012). Children and their Development . Upper Saddle River : Pearson. Marilyn. (2010, October 30). Children of Rage Beth Thomas and Mary Flora Bell. Retrieved April 27, 2014, from 40 Years of Faulty Wiring : https://jl10ll.wordpress.com/tag/beth-thomas/ Mayo Clinic Staff. (2011, July 06). Reactive Attachment Disorder. Retrieved April 27, 2014, from Mayo Clinic: http://www.mayoclinic.org/diseases-conditions/reactive-attachmentdisorder/basics/definition/con-20032126 Michelle A. Stinehart, D. A. (2012, August 9). Reactive Attachment Disorder in Adopted and Foster Care Children: Implications for Mental Health Professionals. Retrieved April 27, 2014, from Sage Journals : http://tfj.sagepub.com.librarylink.uncc.edu/content/20/4/355.full.pdf+html Thomas, B. (1990). Child of Rage. (D. K. Magid, Interviewer) Zeanah, C. H., & Smyke, A. T. (May 01, 2008). Attachment disorders in family and social context. Infant Mental Health Journal, 29, 3, 219-233. Zeanah, C. H., & Fox, N. A. (2004). Temperament and Attachment Disorders. Journal Of Clinical Child & Adolescent Psychology, 33(1), 32-41. Becker-Weidman, A. (January 01, 2006). Treatment for Children with Trauma-Attachment Disorders: Dyadic Developmental Psychotherapy. Child and Adolescent Social Work Journal, 23, 2, 147-171.