Sunday, May 09, 2010

Jane McCormick - Mother's Day: PBS's 'This Emotional Life': Reactive Attachment Disorder and Unconditional Love

This is an interesting for mother's day, but I think there is a good "lesson" in this woman's experience. For those not familiar with Reactive Attachment Disorder, here is a brief definition:
RAD is characterized by markedly disturbed and developmentally inappropriate ways of relating socially in most contexts. It can take the form of a persistent failure to initiate or respond to most social interactions in a developmentally appropriate way—known as the "inhibited" form—or can present itself as indiscriminate sociability, such as excessive familiarity with relative strangers—known as the "disinhibited form". The term is used in both the World Health Organization's International Statistical Classification of Diseases and Related Health Problems (ICD-10)[3] and in the DSM-IV-TR, the revised fourth edition of the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (DSM).[4] In ICD-10, the inhibited form is called RAD, and the disinhibited form is called "disinhibited attachment disorder", or "DAD". In the DSM, both forms are called RAD; for ease of reference, this article will follow that convention and refer to both forms as reactive attachment disorder.

RAD arises from a failure to form normal attachments to primary caregivers in early childhood. Such a failure could result from severe early experiences of neglect, abuse, abrupt separation from caregivers between the ages of six months and three years, frequent change of caregivers, or a lack of caregiver responsiveness to a child's communicative efforts. Not all, or even a majority of such experiences, result in the disorder.[5] It is differentiated from pervasive developmental disorder or developmental delay and from possibly comorbid conditions such as mental retardation, all of which can affect attachment behavior. The criteria for a diagnosis of a reactive attachment disorder are very different from the criteria used in assessment or categorization of attachment styles such as insecure or disorganized attachment.

Children with RAD are presumed to have grossly disturbed internal working models of relationships which may lead to interpersonal and behavioral difficulties in later life. There are few studies of long-term effects, and there is a lack of clarity about the presentation of the disorder beyond the age of five years.[6][7] However, the opening of orphanages in Eastern Europe following the end of the Cold War in the early-1990s provided opportunities for research on infants and toddlers brought up in very deprived conditions. Such research broadened the understanding of the prevalence, causes, mechanism and assessment of disorders of attachment and led to efforts from the late-1990s onwards to develop treatment and prevention programs and better methods of assessment. Mainstream theorists in the field have proposed that a broader range of conditions arising from problems with attachment should be defined beyond current classifications.[8]

So with that foundation, maybe this woman's struggle with her adopted child will make a little more sense. RAD is not a minor thing to deal with - it's huge, and hard to overcome.

Mother's Day: PBS's 'This Emotional Life': Reactive Attachment Disorder and Unconditional Love

Jane McCormick, Posted: May 8, 2010

As Mother's Day approaches, I can't help but think of the phrase "unconditional love" and how meaningful those words are when you have a child with Reactive Attachment Disorder. Our son, Alex, joined our family through adoption in April of 1998. He was born in Russia, in 1995 and lived in a Russian orphanage until the time of our adoption. I remember the days we spent getting to know Alex in the orphanage before our official adoption took place a week after we met.

Alex was a beautiful boy who was quite understandably wary of the people who would become his family. He spent time in the playroom with us, played near us, would sidle over to us and look at something we were showing him, but also tried to keep his distance. All of this would be expected, but we noticed that he was quite disconnected from his caregivers, also. He would hold his caregiver's hand when she walked him into the room, and respond to her directions, but didn't seem attached to his caregiver in the same way other children in our group were showing. For example, another little boy Alex's age would cling to his caregiver and cry for her when she left the room. Early on I sensed that we would have many obstacles to overcome in developing our relationship with Alex.

Two very vivid memories stay with me from our time with Alex in Russia. The first was when we were waiting at the court for our final adoption to take place a week after meeting Alex. I remember, in a quiet moment in the waiting room, saying a silent prayer, not for Alex to be perfect, but for me to be everything I would need to be in order to help him. I had already sensed in that short period of time that Alex would need strong parents. Not once did I hesitate or worry about adopting Alex. You see, he was already my son in my heart.

The second memory that confirmed my feeling that Alex was going to need our unconditional love was when we went to the orphanage after our adoption was finalized. We were taken to his area of the orphanage to pick him up. Another couple with us, adopting their two-year-old son at the same time, went first to get him ready to leave. Two caregivers brought him to join them. He was crying, clinging to them, they were crying, too, and had to pry him off and hand him to his parents. It was so difficult to see this poignant scene and I braced myself to experience the same thing when Alex was brought to us. A few minutes later, one caregiver came around the corner with Alex by the hand, released him to us and disappeared. We got him ready and a couple of minutes later, the same caregiver reappeared, reached out her hand. He took it, and she walked him into the room with his peers and said to wave goodbye. He did and then she handed him back to us and we left. The contrast of the two scenarios was stark. This reinforced for me that our son may have some challenges in the area of attachment.

Alex is 14 now. He has faced many obstacles, including Reactive Attachment Disorder, non-specified mood disorder, ADHD, dyslexia, mild cerebral palsy, as well as characteristics on the autism spectrum. Many of his challenges make it difficult for him to have relationships with others, including his family. We have continued to persevere, seek out the help of professionals, and work closely with his school.

So, unconditional love ... Is it possible with a child who does not behave in the usual ways, who rejects you when you try to help, who does not respond when you attempt to redirect him? I say yes! Knowing all of the challenges we have had, occasionally someone will ask me if we would have done things differently -- if we wish we had not adopted Alex. That has truthfully never been an issue for us. Do we have difficult days? Yes, we truly do. But we cling to the little moments; when Alex says, "Love you, Mom," on his way to bed, right after he has argued with me, or when he tells my husband many times every day how he wants to be like him. The day Alex became our son, our love was unconditional. It was no different than if he had been born to us. Adoption is just another way to make a family, and it is forever!

Are you a new or expecting parent, or do you know one? Get a copy of the Early Moments Matter toolkit at and learn about an exciting public service effort to promote early childhood attachment. Help give our next generation the best chance at a life of emotional wellness.

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