Diagnose Reactive Attachment Disorder

Reactive attachment disorder (RAD) is diagnosed in children who show a lack of attachment to their caregivers and who display difficulty in forming normal relationships with others.[1] They also may have some social impairments or show sociopathic tendencies. You can assess reactive attachment disorder in a child by evaluating their emotions, assessing their age and environment, and seeking a professional diagnosis.

Steps

Assessing the Child’s Emotions

  1. Evaluate if they are unresponsive in times of distress. A child with RAD will rarely, if ever, seek comfort when under stress. They are also unlikely to respond when comforted. Since they did not form a normal attachment to a caregiver when they were younger, they will not seek comfort or affection in the way that most children would.[2]
    • For instance, if they fall off of their bicycle, they might show emotion, but they are unlikely to run to a caregiver to soothe them. They have a tendency to deal with their pain on their own.
  2. Assess any lack of emotion in social settings. Children with RAD will often respond with very little emotion or affect to others. Though most children are socialized to laugh and smile based on the people and circumstances around them, children with RAD will typically display a very flat or neutral disposition.[3]
    • For instance, a child with RAD might receive a gift at a birthday party and not crack a smile. But a child without RAD might smile or yell with excitement.
  3. Notice any self-injury. Self-harm is often quite common in children with RAD. If your child has reactive attachment disorder, they might cut themselves, pull out their own hair, or scratch themselves until they bleed. Pay attention to any new marks or scars that you see on their body.[1]
    • Some children will hide these injuries. Notice if your child wears long sleeves even when it is hot outside.
  4. Evaluate any impulsive or aggressive behavior. Children with RAD often have difficulty regulating their behaviors in ways that are socially acceptable. You might notice that they tend to get into or instigate a lot of fights. They might also make rash decisions on a whim without considering the long lasting impacts, like walking out of class before the bell rings or quitting a team when they become even slightly upset.[1]
  5. Assess other harmful behaviors indicative of RAD. In addition to general emotional inappropriateness and trouble with self-regulation, other negative behaviors are likely present in the child with RAD. These include: lying, stealing, destruction of property, gorging of food, and inappropriate sexual behavior.[1]

Evaluating the Child’s Age and Environment

  1. Determine if the child has had changes of caregivers. Reflect on your child’s background and home history. Many children with RAD are in the foster care system and/or had a parent who did not connect with them. These children find it near impossible to connect if a caregiver continually changes or is absent.[2]
  2. Determine if the child was neglected. Before making a diagnosis of RAD, assess the child’s history of neglect. Most children with RAD have an extensive history of neglect, having mothers and fathers who abandoned them, did not care for them, or left them to fend for themselves at an impossibly young age. Find out if this child has faced these circumstances.[3]
  3. Know that these behaviors must have been present before age 5. In order for a child to be diagnosed with RAD, the disorder had to have developed before age 5. The first five years of life are by far the most formative and most of your personality attributes are shaped during that time. If the symptoms of RAD were not present before the child was age five, then a diagnosis cannot be made.[3]
  4. Determine if the behavior has been present for at least nine months. In addition, any behavior indicative of RAD has to have persisted for at least nine months in order for a diagnosis to be made. This is to prevent children who are going through a stubborn or difficult phase from being misdiagnosed. [3]

Seeking a Professional Diagnosis

  1. Find a child therapist near you. Perhaps you are a parent recently reconnected with your child or you are foster parent concerned about the child’s actions. Though you cannot make a diagnosis of RAD yourself, you can take the child to a therapist trained to do so. They will also be able to provide counseling for the child to help them work through their issues.
  2. Prepare to provide details and examples of troubling behavior. Before your visit to the therapist, be ready to discuss the child’s troubling actions. Do not only discuss their actions as it relates to RAD, but discuss their other good or bad qualities as well. Give the therapist a full picture of your child and don’t attempt to sugarcoat anything.[2]
  3. Speak honestly about your home life. In addition to telling the truth about your child, do not refrain from being honest about yourself. Talk to the therapist about what your home is like, both the good and the bad. Honesty is the only way that a true diagnosis can be made.[2]
    • For instance, if there are issues of drug abuse in your home, you should disclose this. Know that many therapists have a duty to report, however, if any abuse is occurring.
  4. Take an evaluation of your parenting style. The therapist may also ask you to to evaluate how you are as a parent. You may be displaying some negative behaviors that you have not considered that only exacerbate your child’s RAD. Be honest in completing this evaluation so that you can improve how you parent.[2]
  5. Consider treatment options. Though there is no standard treatment for RAD, you can implement changes in your home that will improve your child’s behavior. You can take classes to become a more nurturing parent and work to create a more stable environment for your child. You can also ensure that they receive therapy regularly.[4]
  6. Ensure that your child is not autistic before a diagnosis of RAD is given. Sometimes, a misdiagnosis of RAD is given to children who are actually on the autism spectrum. Many of the same behaviors of RAD, like inappropriate emotional responses to certain situations, are also common in children with autism. Explore this possibility before you accept a diagnosis.[5]

Sources and Citations

  1. ↑ 1.0 1.1 1.2 1.3 http://www.personalityresearch.org/papers/wood.html
  2. ↑ 2.0 2.1 2.2 2.3 2.4 http://www.mayoclinic.org/diseases-conditions/reactive-attachment-disorder/basics/tests-diagnosis/con-20032126
  3. ↑ 3.0 3.1 3.2 3.3 http://www.cebc4cw.org/search/topic-areas/dsm-5-criteria-for-reactive-attachment-disorder-rad/
  4. ↑ http://www.mayoclinic.org/diseases-conditions/reactive-attachment-disorder/basics/treatment/con-20032126
  5. ↑ https://www.cdc.gov/ncbddd/autism/screening.html

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