Diagnosing Reactive Attachment Disorder: Don't Try This at Home

Rather regularly, I get blog comments, e-mails, and even phone calls from mothers who have read about RAD on the Internet and know that this is exactly what their children have. It doesn’t matter that much of the on-line information is not actually descriptive of Reactive Attachment Disorder; many of these parents are positive that they know what’s wrong, and all they need is to find someone who specializes in attachment disorders to treat the children and get rid of the disorders. Can I suggest a suitable person, they ask, because they are having trouble finding such a specialized therapist.

No, I can’t, and here’s why.

1.     1.  Unless you are looking at DSM-5, you will probably not find on the Internet much that actually describes Reactive Attachment Disorder. Most of the material that purports to do this focuses on disobedience, surliness, aggression, theft, and cruelty to others. These are all serious matters, and a family with a child or children presenting these  problems is certainly in need of good professional help. However, the behaviors are symptoms belonging to a range of other diagnoses, and not to RAD. Note: it’s possible that the children have attachment disorders in addition to these other problems, but the attachment disorders are not the cause of the very concerning behaviors, and “fixing” the attachment problems does not “fix” the antisocial behaviors.

2.    2.  Well-trained clinical psychologists may have most experience and interest in working with one problem area, but they are competent to deal with the full range of childhood mental health issues. Such a professional begins the process of diagnosis by considering all the difficulties that may be behind disturbed moods and behaviors. He or she will pay attention to the child’s cognitive and language development and to areas where the child is behind, up to, or beyond what would be expected at this age. The psychologist needs to be open to consideration of a full range of problems that may be present. To make best use of this professional help, parents need to bring in the best information they can about how the child seems to feel and to act in specific circumstances, and they too need to keep open minds about the causes of problems rather than trying to “cut to the chase” by insisting on one diagnosis or demanding that a therapist focus on a problem as the parent sees it.

3.      3. When children show disturbed relationships with others, and especially when there is antisocial behavior involved, parents need to realize that the child lives and acts within a network of family and other social connections. One possibility behind disturbed behavior is that events or actions of others in the family are making it difficult for the child to reach his best levels of thinking and behavior. These factors can range from marital tension and disagreement to sibling conflict and school pressures to inappropriate disciplinary methods. A therapist who addresses such problems is not assigning blame or pointing to anyone’s guilt, but is dealing with the fact that a child’s mental health problem is bound to be, in one way or the other, a problem of the whole family. Working with the child means working with the family, little as most stressed-out parents care for this idea. These facts also mean that the most accurate diagnosis of a child’s problems is only the beginning of the discussion.

4.      4. The assumption that many, even most, child problems are derived from attachment difficulties distracts parents from seeing the whole child, and unfortunately it can also distract some professionals in the same way.  A 2013 paper by the British psychologists Matt Woolgar and Steve Scott outlined a number of cases in which psychological staff focused on children’s attachment  issues to such an extent that they failed to notice  serious problems that were unrelated to attachment. When parents go out of their way to find professionals who state a specialty of working with attachment issues, and who also are willing to accept a parent’s statement that a child’s problem is Reactive Attachment Disorder, chances of  inappropriate exclusive concern with attachment are much increased.

When a child shows serious mood problems or frightening antisocial behavior, it’s a mistake to jump to the conclusion that Reactive Attachment Disorder is the problem. In fact, it’s a mistake to jump to any conclusions, or even to reach them without a thorough evaluation of the child and the family. Please don’t depend on a diagnosis you reached at home with the help of friends or the Internet, or search for a therapist who will concentrate on a narrow set of problems as instructed.  Look for a professional with thorough training in clinical work with children and adolescents and let that person make the complete assessment that is needed before a therapeutic plan can be created.