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.