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Most interpersonal relationships are built on the basis of trust. When an infant or young child has a physical (as in hunger or some kind of discomfort) or emotional need (loving and tender care, smiles, hugs, kisses) which is not met, then the infant starts losing trust in the caregivers. When there is no trust he is unable to build healthy, positive and interactive relationships with them -- and this sets the stage for reactive attachment disorder, or RAD. The implications of this can be far too many. Start with Step 1 below if you know a child that you think may be suffering from this disorder.
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#REDIRECT[[Diagnose Reactive Attachment Disorder]]
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[[Category:Psychological Disorders]]
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==Steps==
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===Recognizing RAD in Babies===
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#Look at how they're thriving. Babies with RAD, quite frankly, won't be – physiologically, emotionally or cognitively. When they are not thriving it shows in various forms:[[Image:Tell if a Child Has Reactive Attachment Disorder Step 1.jpg|center]]
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#*''Physically''. They do not show appropriate growth in form of weight, owing to their poor eating.
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#*''Emotionally.'' Even when they are distressed, they cannot be comforted, as they believe there is no person from whom they can draw comfort, support and warmth.
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#*''Cognitively''. Based on their previous experiences, they manage to form more so accurate representations of how their mother/primary caregiver would respond to them and their needs.
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#Watch how they engage in play. Once more, babies with RAD ''don't'' engage in active play or activity. They are usually the "good babies" who are not difficult to take care of and who don't need a lot of control and monitoring. They don't do much of anything at all.[[Image:Tell if a Child Has Reactive Attachment Disorder Step 2.jpg|center]]
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#*They tend to show dullness and lethargy in their physical movements, as well as play as little as possible with toys or don't bother to explore the world around them. Babies are naturally inquisitive, but babies with this disorder are not.
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#Notice that they do not feel drawn to their mother/primary caregiver. They do not discriminate or differentiate between their primary caregiver and strangers. They have no special affinity to their mother and in fact tend to seek bonding and closeness from adult ''strangers''. This is much unlike healthily attached children, who seek comfort in those they trust and love.[[Image:Tell if a Child Has Reactive Attachment Disorder Step 3.jpg|center]]
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#*You can see how this is going to lead to problems later in life. If a child or teen can find refuge in strangers, the stage is set for problems to brew. This factor of RAD leads to impulsive, radical behavior later in life.
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#Look at the relationship between the caregiver and baby. A secure relationship between the child and the caregiver filled with great sense of affection, attachment and bonding helps the child develop empathy, social skills and skills to regulate emotions effectively. If the relationship isn't secure, these skills will not hatch. How does the caregiver treat the baby? When it cries, does he or she come running? Is there an environment of positivity?[[Image:Tell if a Child Has Reactive Attachment Disorder Step 4.jpg|center]]
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#*This is what Freud felt and said about the relationship between a child and its mother: “The relationship between the mother and child is the prototype for all future relationships.” For this disorder, he wasn't wrong. The means of this relationship will likely determine the rest of the child's relationships throughout the course of his or her life.
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===Recognizing RAD in Children and Teens===
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#Know how "inhibited" RAD manifests. With this subtype of RAD, children fail to initiate as well as respond appropriately to social interactions and are inclined towards avoiding social contacts.[[Image:Tell if a Child Has Reactive Attachment Disorder Step 5.jpg|center]]
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#*When the child's needs are not met, they feel deprived of love and affection, making them perceive themselves as unwanted and unworthy of receiving appropriate care, attention and affection at appropriate times. This makes them feel insecure and unsafe, and when they feel unsafe, they are not confident with others. This gets projected in the self-esteem, which accompanies them at all times.
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#Know how "uninhibited" RAD manifests. Contrary to children with inhibited RAD, there are some other children with RAD who project their social preparedness overly and overtly. They try to seek comfort, support and love from almost all adults, regardless of how well they know them. This kind of behavior is mostly viewed as promiscuous, and may cause adults to take advantage of the child.[[Image:Tell if a Child Has Reactive Attachment Disorder Step 6.jpg|center]]
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#*This is the type of child that has learned to not rely on those they are ''supposed'' to trust and instead seek fulfillment in strangers. Often, the differentiation between inhibited and uninhibited RAD doesn't become clear until later in life.
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#Look for behaviors that indicate a lack of self-control and aggression. Behaviors such as this can be mistaken for [[Recognize the Signs of Attention Deficit Hyperactivity Disorder (ADHD)|ADHD]] (attention deficit disorder). However, RAD also will showcase the following:[[Image:Tell if a Child Has Reactive Attachment Disorder Step 7.jpg|center]]
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#*Compulsive [[Deal With Children Who Lie|lying]] and [[Stop a Teenager from Stealing|stealing]]
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#*Showing indiscriminate affinity to getting involved with strangers and displaying age-inappropriate and risky sexual behaviors
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#**It's important to note that these are not behavioral problems as they might appear to be, but rather the result of improper brain development owing to the neglect and abuse which they had to undergo during the initial months and years of their life.
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#Look at their studies in school. When the first part of establishing the bond itself is not achieved, then the brain – instead of focusing on intellectual aspects of growth – starts focusing on developing survival skills and strategies. This explains why they perform badly at school, in terms of studies. Their brain fails to cover the journey which could ensure its proper development in all aspects. Just as their brains, their learning too is delayed.[[Image:Tell if a Child Has Reactive Attachment Disorder Step 8.jpg|center]]
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#*This slow brain development explains why a child with RAD displays behaviors such as aggression, manipulation, compulsive lying, controlling and withdrawal, as well as why they are so aggressive and are so bad at anger management. They resort to destructive behaviors and do not even show any remorse for their behavior because they just don't know any better.
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#Look at how the child forms friendships. As the child grows, they develop a keen sense of detachment and abandonment and also lose all skills to trust themselves and others. This contributes to their failure to make friends and building long-lasting relationships. The feelings of inadequacy (unwanted, not worthy of being loved and cared for) which started from the time his physical and emotional needs were ignored continue to grow and eat into their self-esteem. This is a vast, vicious cycle that they can't seem to stop.[[Image:Tell if a Child Has Reactive Attachment Disorder Step 9.jpg|center]]
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#*Since their self-esteem is at rock bottom, they don't see why anybody would be friends with them and behave as if they need nobody. This kind of behavior puts off people from befriending them. To fill the void, their loneliness and depression and as a way to calm down their nerves, they often take to alcohol and drugs.
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#Notice how aggressive they are. These children are very controlling, by either being manipulative, aggressive, or arm-twisting. Their brains are busy developing survival tactics and strategies; therefore, they lose the capacity to learn how to deal with others positively and to have positive interactions in order to get what they want.[[Image:Tell if a Child Has Reactive Attachment Disorder Step 10.jpg|center]]
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#*This child does not trust others and their intentions and believes that since they will not come through, the best way to get what they want from others is by being manipulative, aggressive and resorting to some arm-twisting actions. Positive reinforcement and behavior is not something they're familiar with.
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#Look at their impulse control. The child will show tendencies of attention deficit disorder (ADHD), indicating low impulse control. They will not hesitate to do things which normally other children would not (or would at least give serious thought to) and will not even bother to think about the impact and implications such behavior could have on him and others.[[Image:Tell if a Child Has Reactive Attachment Disorder Step 11.jpg|center]]
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#*Take note of their inappropriate and risky sexual behavior. Children with RAD sometimes show behaviors of promiscuity. They show a great affinity to and get sexually involved with total strangers – often multiple people at the same time.
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#Pay attention to their inability to make eye contact. A normal child begins making eye contact from the initial days of their life. They learn it from their mother/caregiver(s) who have been there to look deeply into their eyes with abundant affection and love. Since this did not happen, the child does not understand the significance of maintaining eye contact and will show a lot of discomfort and finds such experiences overstimulating.[[Image:Tell if a Child Has Reactive Attachment Disorder Step 12.jpg|center]]
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#*This is all intertwined with their lack of social skills and desire to not develop close relationships. Everything from their thoughts to their words to their little involuntary habits will indicate that in their world, people just aren't trustworthy.
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===Understanding the Disorder and What to Do===
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#Understand RAD by its definition. Reactive attachment disorder occurs in infants and young children. It is characterized by ongoing and persistent abnormalities in the child’s social relationships that are associated with emotional disturbance and changes to environmental circumstances. Children with this disorder do not display typical childhood responses to stimuli. For example:[[Image:Tell if a Child Has Reactive Attachment Disorder Step 13.jpg|center]]
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#*They often respond to comforting with fearfulness and hypervigilance.
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#*Children can often show interest in peer interactions, but negative emotional responses impede with any forms of social engagement.
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#*The emotional disturbance may be evident with a lack of emotional response, withdrawal reactions or aggression when experiencing or witnessing distress.
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#*An extreme form of reluctance to accept or initiate comfort or affection especially when distressed or excessive and indiscriminate attempts to receive affection and comfort from any adult, including strangers.
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#Rule out [[Recognize the Signs of Autism|autism]] and other pervasive developmental disorders. As reactive attachment disorder is a response to an inappropriate environment that the child is reared within, such children do actually have a normal capacity to demonstrate appropriate social responsiveness, while autistic children do not. Symptoms of RAD resolve themselves over time if the children is given consistent appropriate caregiver responses, whereas autistic/developmentally disabled children require therapies to teach social skills.[[Image:Tell if a Child Has Reactive Attachment Disorder Step 14.jpg|center]]
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#*Children with reactive attachment disorder may display impaired language development. However, this does not mean they exhibit characteristics of abnormal communication as seen in autism.
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#*Children with RAD experience no persistent repetitive and [[Stim|stereotyped patterns of behavior]], nor do they have the passionate [[Encourage an Autistic Person's Special Interests|special interests]] as seen in autism.
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#*Autistic children are socially uncertain rather than socially aggressive, and are unlikely to exhibit manipulative behavior, stealing, or significant lying.
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#Know the history of your child’s experiences with caregiver responsiveness. Having a good understanding of the caregiver responsiveness your child has experienced in their development is not necessary for diagnosis of reactive attachment disorder, but it certainly is recommended for a health professional to draw informed conclusions.<ref>Boris NW, Zeanah CH, Work Group on Quality Issues (2005). "Practice parameter for the assessment and treatment of children and adolescents with reactive attachment disorder of infancy and early childhood" (PDF). J Am Acad Child Adolesc Psychiatry 44 (11): 1206–19</ref>[[Image:Tell if a Child Has Reactive Attachment Disorder Step 15.jpg|center]]
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#*Reactive attachment disorder almost always arises in response to severely inadequate childcare. It can arise due to any or a combination of the below as an ongoing characteristic of the child’s rearing experiences:
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#**Abrupt separation from caregivers usually between six months and three years
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#**A frequent change of caregivers
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#**A lack of caregiver responsiveness to the child’s communication efforts
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#**Severe forms of neglect and abuse
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#**Grossly inept parenting
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#**Consistent disregard for the child’s basic physical needs
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#Know the environments that may lead to RAD. It is true that children are usually resilient to any changes to environment and conditions. They are quite adaptable and flexible and do their best to get accustomed to the existing conditions and situations. However, the following situations may lead to RAD:[[Image:Tell if a Child Has Reactive Attachment Disorder Step 16.jpg|center]]
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#*If the child has a history of having lived for a considerable period in an orphanage or a foster home
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#*If the child has grown up in a home which was governed by incredibly strict principles, rules and rigidity
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#*If they have grown up away from parents and other loved ones in hostels and boarding schools
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#*If the parents were too busy to take care of their child and the child was left under the care of supposed-to-be caregivers
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#*If the child lived/grew up/spent considerable time under the care of a primary caregiver and with whom the child bonded, but got separated from him/her
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#*If the child happened to witness lot of quarrels, fights and arguments happening between the parents
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#*If the parents were grappling with such issues as anger management, stress, [[Help a Depressed Child|depression]], alcohol and drug abuse, or any other personality disorder
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#*If there was physical, sexual and emotional abuse in the home
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#**Again, all these are hypothetical situations. It cannot be said for sure that a child under these circumstances will develop RAD.
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#Know what to do if you think a child has RAD. Keep in mind that while having knowledge of the history of a child’s upbringing is important to help diagnose your child, just because a child has experienced any combination of the above does not mean that they will have reactive attachment disorder.<ref>DSM-IV-TR (2000) American Psychiatric Association</ref> If your child displays any of the above symptoms, too, it does not necessarily mean they this disorder.<ref>World Health Organisation (1992) International Statistical Classification of Diseases and Related Health Problems, Tenth Revision (ICD-10). Geneva: World health Organization</ref>[[Image:Tell if a Child Has Reactive Attachment Disorder Step 17.jpg|center]]
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#*Try your best not to jump to conclusions. Rather, if concerned, take your child to a doctor, child and adolescent mental health professional or pediatrician who can better inform you of their expert clinical opinion. The child can start therapy and soon be on the way to healthy, adaptive behaviors.
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== Tips ==
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*RAD usually develops in kids below the age of 5 years and can grow into their adolescence and adulthood with them.
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*For the record, the symptoms and behaviors of RAD share similarities with other disorders specific to children such as [[Recognize the Signs of Autism|autism]], [[Recognize the Signs of Attention Deficit Hyperactivity Disorder (ADHD)|ADHD]], [[Handle Anxiety in Children|anxiety disorders]], [[Recognize Social Anxiety Disorder|social phobia]], and [[Identify if a Child Has Been Traumatized by an Event|post-traumatic stress disorder]]. Be completely sure before you make any diagnoses.
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== Related wikiHows ==
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*[[Avoid Raising a Bully]]
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*[[Deal with Challenging Behaviour]]
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== References ==
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*Attachment Disorders in Infancy and Early Childhood: A Preliminary Investigation of Diagnostic Criteria
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*Neil W. Boris, M.D.; Charles H Zeanah, M.D.; Julie A. Larrieu, Ph.D.; Michael S. Scheerings, M.D.; Sheryl S. Heller, PhD.
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*Am J Psychiatry 1998; 155:295-297
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*The British Journal of Psychiatry (2007) 190: 490-495 doi: 10.1192/bjp.bp.105.019745
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*Pediatrics Vol. 122 No. 3 September 1, 2008 pp. 667 -673 (doi: 10.1542/peds.2008-1885)
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__PARTS__
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