Reactive Attachment Disorder (RAD or RAD disorder) has increased in the United States. RAD is a condition that prevents the forming of appropriate social relationships. People with it can’t form age appropriate social bonds. Or they attach to someone that is inappropriate. Many psychologists consider RAD disorder to be the least understood DSM disorder. There hasn’t been enough research on RAD. And there are several different definitions of RAD. Often RAD Disorder is confused with other diagnoses such as anxiety, ADD, Autism, Conduct Disorder or Oppositional Defiance. This can make things difficult in trying to diagnose it. From one perspective, the diagnosis isn’t important. If you have read my articles about the Walsh Protocol, you know that the subtype is more important than the diagnosis. Reactive Attachment Disorder is different though. It needs to be diagnosed and treated properly. In this article, I want to explore what RAD Disorder is and how it is different from other conditions. Next, I’ll discuss the physiologic components of RAD Disorder and what can be done from the body’s perspective. Finally, I will offer some treatment ideas as it relates to RAD Disorder. While I’m not a therapist, as a Naturopathic Doctor, I have many tools available to help treat RAD Disorder. Let’s explore what RAD is and the best approaches to helping the body work better to make therapy easier.
What is RAD Disorder?
I have treated many cases RAD Disorder in adults, teenagers, and children. The symptoms of RAD vary. But there is one underlying issue that is the same. The person can’t attach. They don’t have close friends. Their relationships are shallow. RAD Disorder therapy is challenging. It requires dedicating parenting, consistency, love, and a great therapist. But being able to treat RAD Disorder requires an understanding of what it is.
The mainstream medical community has focused on issues within biological parenting. They define it as a failure to thrive and not connecting with a primary adult caregiver. Most medical doctors have limited training in psychology. They miss the nuance that psychologists gain about attachment theory. Attachment theory views RAD disorder as I do above. It is an inability to form appropriate social bonds.
RAD disorder can present with a wide array of problems and may look different in children, teens, or adults. “Disruptive Behavior Disorder” is the broader classification of RAD disorder. I have seen cases that present as a variety of ailments. Some look like ADHD, depression, or anxiety. Others look like Conduct Disorder (CD), Intermittent Explosive Disorder (IED), Obsessive Compulsive Disorder (OCD) or a full-blown anti-social personality disorder (sociopaths). Still others are misdiagnosed as Autism, Asperger’s. The following antisocial behaviors may be seen in any of the above conditions:
- Social interactions that are inappropriate with peers or adults.
- Social avoidance. In other words, they don’t play with anyone.
- The person resists comforting if they get upset. This isn’t the case whereby the person is angry and doesn’t want to be mollified. It’s a pattern regardless of what occurred.
- The person may attach to objects but not other people. There is debate about whether attaching to only pets is an attachment issue.
- Destroying other people’s belongings.
- Lying, cheating or stealing.
- Outbursts, tantrums and aggressive behavior.
- Impatience.
- Inappropriate space understanding either getting too close or not getting close at all.
- Breaking rules, disregarding other’s wishes and outward defiance.
- Observation of antisocial behaviors in different locations. For example, the behaviors will be seen at home, school, and with other caregivers.
- Defiance is common. The defiance can be active or passive. The child may not say “no” when asked to do something. There will be no temper tantrum or screaming. They just won’t do what they are asked.
Reading this list, you may have not been able to distinguish between many disorders. Lots of these behaviors are seen in all the conditions I listed above. So how do you identify a RAD disorder case? The ability to attach is the key factor. People often don’t want to attach when they feel depressed or anxious. But generally, everyone bonds at some point unless they have full-blown Reactive Attachment Disorder.
How Do You Know if Someone has RAD Disorder?
Well a quick test for RAD is how readily and honestly a child apologizes. If the child does it uncoached and means it, typically they don’t have RAD Disorder. If the apology doesn’t come or only comes when a consequence is to be administered then it’s likely RAD.
In general, diagnosis isn’t solely based on RAD disorder symptoms. The diagnosis arises from the cause of the behaviors. RAD Disorder generally arises from a history of neglect. Most RAD cases come from adoptees or people who spent time in foster care. There is trauma and/or a lack of comforting by the primary care givers. This neglect leads to difficulty in bonding.
The Still Face research video gives a poignant example of how a lack of mirroring can upset an infant. It shows a mother and infant in two scenarios. In the first scenario, the mother mirrors and connects with her child. The child is happy and coos. She is laughs and smiles. In the second scene, the mother shows a blank face regardless of what the baby does. The baby tries all the tricks it did in the first scene but the mother stares back blankly. The baby then tries new behaviors. She then gets frustrated arching her back and finally crying. The mother at that point breaks role but the message comes across clearly to the viewer. A lack of mirroring on the part of the primary caregiver upsets the child. Most of us have had this experience. We seek to comfort ourselves in various ways to fill the unmet needs of our infancy. ( A great book on the subject is How to be an Adult in Relationships. I could not do justice to this excellent piece of writing by trying to synposize here.)
For most of us, there was enough mirroring that we can form appropriate attachments, however, impaired they may be. But for other children and adults, there was never this mirroring or love. And as we will see, there are other biochemical imbalances that made this lack of mirroring toxic. No bonds can be forms until the biology, the brain, and the trauma are healed. Balance must be found between mind, body, and spirit for healing as we will see.
How Common is RAD Disorder?
Given that there is no agreement on what it is is, we have no idea how common RAD Disorder really is. The mainstream medical community is right in one respect. RAD cases in birth parents are rare but it does exist. It appears to be less common in children that live with their biological parents . There is usually a mental health issue in the family that leads to neglect. For example, RAD disorder may arise when mom has severe postpartum depression. I have read studies suggesting that antisocial behaviors may arise in boys whose fathers work too many hours. Although this isn’t RAD disorder there are some similar aspects. Families that have two working parents without appropriate childcare may also be at higher risk raising a RAD child. And if one or both of the parents are actively using drugs risk is greater.
My experience suggests it is high in adopted children. Some studies claim that it is as high as 45% in adopted populations. Many of these kids came from neglected households as described above. There are also cases of foreign adoptions too. This isn’t meant to be a critique of these families, adoptions, or policy. I raise the issue with regards to understanding causes and frequency.
What to Do If You Suspect Your Child has RAD Disorder or Behavior Problem?
What do you do if you suspect your child has RAD Disorder? If your child exhibits any of the above behaviors on a regular basis, get help now! Understanding the behaviors, actions and motivations of these issues is essential for treatment. What do I mean by this? Early intervention carries a higher degree of success than waiting. With RAD Disorder ( and Asperger’s) waiting can be detrimental to proper development. It is a lot easier to get a younger child to start following the protocols that I’ll be suggesting. Furthermore, there is more time for parenting and behavior interventions.
How does RAD Disorder Affect the Body?
So far, we have focused on the behavior aspects of RAD disorder. RAD therapy though requires us to understand the physical side of things too. What is happening in the body? My approach depends upon understanding the mind-body interactions. RAD therapy requires a multi-faceted approach. In general, I don’t do this alone. In cases of RAD I work with therapists and parents. My job is to assist with ensuring that the body is in alignment. RAD requires psychotherapy to heal. I have treated ADD/ADHD, depression, anxiety and other mental health conditions. Many cases didn’t need psychotherapy for people to get better. I have seen in my office there was an almost 100% physical component. If they didn’t get better from my treatments, I would refer to counseling or another provider. Often, I did so regardless just because it was indicated. The physical problem needed to be dealt with first.
Reactive Attachment Disorder is different though. It requires psychotherapy from someone who knows RAD in every case. RAD Therapy is a combination of attachment work and trauma work. It also requires a lot of work on the part of the parent. The details of this is beyond the scope of this article. Suffice to say, consistency and fairness are key for emotional healing. The child needs to feel safe enough to reduce their hyper alert state. In general, the parent needs to provide strict boundaries and rule following. (As an aside, over time this hyper alert state will cause problems throughout the body. I’ve done a podcast about adrenal issues that discusses this somewhat. And more information is below.)
Treating RAD disorder before puberty is crucial. Hormonal changes and individuation can make treatment tricky. Success decreases as a result. Teens are non-compliant to parents wishes under the best circumstances. To paraphrase Mark Twain, “when I was 15 my father was a complete idiot but he sure learned a lot by the time I turned 21.” I remind patients’ parents (and myself with my own teens) of this. A teenage with Reactive Attachment Disorder is worse. Tantrums and outbursts increase and compliance and direction decrease. This is why getting evaluated at the earliest suspicion is so important.
Physical Effects of RAD Disorder
When I first started working with children with RAD something curious struck me. They had no physical symptoms. That’s not completely true. They may have had white spots under their finger nails, sleep issues, skip breakfast, or not be able to sit still. But given their histories, most of these kids were on the surface in perfect health. They didn’t report anything being wrong. This flew in the face of everything I had learned about trauma. You see, the majority of the people I had worked with up to this time were traumatized but not RAD. They had all sorts of symptoms. Headaches, joint pain, insomnia, IBS. You name it, they had it. It was a veritable potpourri of health problems. But these kids who had RAD and were adopted had none. What was going on?
Most people with Reactive Attachment Disorder live in a hyper active state. They are on constant alert for any danger that may be nearby, ready to respond at a moment’s notice. This is a result of the flight or fight response that is stuck to the on position in RAD Disorder patients.
How do I know?
These folks have trouble with sleep. They can’t control emotions and/or they are too controlled. And they have no physical symptoms. When we are in fight or flight mode, our body stops working normally. Digestion slows down, our pupils dilate, and we are in a constant state of alert. (see the chart below.) This is because our bodies produce high levels of adrenaline to deal with threats. Most RAD cases stem from trauma. Trauma puts us into a state of hyper-alertness to prevent future traumas. (Not in all cases but that is beyond the scope of this discussion.) The adrenal glands also maintain blood sugar, urine concentration, sex hormones, and more. This is part of the reason that treatment before puberty is so important.
Most people experience fatigue when their adrenal glands are faltering. RAD kids become amped. They may have temper tantrums, cry easily or have defiant outbursts.
Anxiety could be another symptom. This often looks like ADD or ADHD when at school. The person may have trouble sitting still. They move around to stay awake but can’t stay focused. This is much like a tired toddler bouncing off the walls in the living room just before nap time. Bed-wetting and sugar craving also are common. RAD disorder in teen girls will often show menstrual irregularities too. The adrenals control so many aspects of our body that balancing them is important in many cases anyway. with Reactive Attachment Disorder it can be crucial to finding health.
Digestive Imbalance and RAD Disorder
Balancing the adrenals may be an important part of healing in RAD Disorder. With healthy adrenals, energy and hormones function well. But as I mentioned there are aspects of the adrenals that affect digestion. Digestive issues can arise from problems with the adrenals or all by itself. The key player in digestion is the liver. The liver and the adrenals work together to perform many functions in the body. The liver is the garbage collector in the body, helping to remove heavy metals, hormones, and toxins. Some of these could contribute to outbursts in RAD patients. Copper is one of these metals though technically it’s not a toxin. We need some in our body in a particular form to be healthy. But too much copper or too much free copper can be disruptive. High levels can cause anxiety, mood swings, depression, and violent outbursts. The adrenals send a signal to the liver to produce a protein called ceruloplasmin. This protein binds copper until it is needed by the body. If there isn’t enough ceruloplasmin a bad feedback loop can get started. Free copper drives adrenaline production and may wear out the adrenals. Then it can’t send the signal to produce the copper binder. You see where this is going?
I have seen many RAD cases improve by balancing copper and zinc. Zinc counterbalances copper in the body. It also down regulates the adrenals flight or fight functions. Unfortunately, most people are low in zinc. But we can test both copper and zinc to determine if this is where the problem is coming from.
There are other digestive imbalances in RAD disorder that have nothing to do with the liver. Parents of a RAD disorder child don’t know anything about their kids bowel habits. Most of them don’t share this information with anyone. Most of the time, I don’t learn about the typical digestive ailments of kids in the RAD patient. Stomachaches aren’t reported; certainly not nausea, vomiting, diarrhea and constipation either. Younger kids with RAD do have these ailments and the parents do find out about it. Typically, this is the body’s way of eliminating the stress hormones.
There is one exception to the the RAD kid without any symptoms. The RAD kid with EVERY symptom. In this case, the kid (if RAD) may be attention seeking. Either way it is a problem and requires work with a physician who understands the behavior issues.
Digestion is also very important for mental functioning. We don’t totally understand the brain-gut connection and it beyond the scope of this article. But there is research that suggests the gut is the “second brain”. Many neurotransmitters are produced in the gut. Balancing digestion is a key factor in the treatment of any patient but particularly in RAD.
Much of the literature about RAD and the gut focuses on diet. While important, I have found that this can be overwhelming to the already stressed parents. Trying a special diet at the beginning of treatment may be the straw that breaks the parental back. Let’s face it. Most American kids diet is not great. It is filled with high carb, high fat, and lots of artificial colors and preservatives. My experience shows while this is an important part of treatment, it is not the first step in most cases. More on this later.
RAD Disorder, TBI, and the Brain
Finally, to treat RAD you may have to treat the brain. Many children with reactive attachment disorder came from abusive families. Brain development may be impaired. There could be physical damage to the brain in a traumatic brain injury (TBI). Or the child may have been exposed to drugs in utero. Healing the brain is crucial to RAD therapy. Neurofeedback is the best method I have seen to help the brain. It helps improve concentration, focus, decision making skills and emotional control. For a RAD patient this is crucial. There are many types of neurofeedback systems but I have found great success with LENS. And many of the psychotherapists that I have worked with who knew nothing about neurofeedback noted how well therapy went as a result of it.
RAD disorder is likely more widespread than we think. Treatment at an early age is crucial. While I don’t do counseling, I do offer a full assessment, of the brain and the body to help balance both. This allows for a higher chance of success at therapy. The approach I take requires blood and urine tests to see the state of copper/zinc balance. It also looks at methylation state and if the person has pyroluria based on the Walsh Protocol. Often, cases can start improving with supplements that are targeted based on the results. LENS Neurofeedback may be indicated and for the folks in Portland, I do offer that. (If you are elsewhere I can sometimes refer.) In the rare cases that aren’t getting improvement with these approaches I have some other options available.
Let me help you help your child. Call today.
