Copyright © 1998 by Cynthia Teeters. All rights reserved. 

Reactive Attachment Disorder (RAD) is a diagnosis of a pathological behavioral disorder. When it is diagnosed by a reputable therapist, it represents a very serious challenge to all members of the family. (The definition of RAD given by therapists in the US most well-known for treating this disorder in children differs from the definition given by the DSM-IV diagnostic manual published by the American Psychiatric Association.)

Typically, the parents of children with RAD have intense grief. They are grieving for the losses they have suffered. They are real losses and deserve validation. Living with RAD creates severe pain. No one, neither the child nor the parents, deserves such pain. Therapy, counseling and support are all needed if the family is to stay intact. (A wonderful discussion of grief can be found at the ARCH National Resource Center homepage at http://www.archrespite.org/ARCHserv.htm)

It is believed that RAD appears in some (and only some) children who experience extreme neglect or other types of abuse in early infancy. Neglect and the length of that neglect seem to be the biggest components in the majority of cases. Because the length of neglect plays such an important role, it is widely held that the risk and severity of the disorder increase as the child stays in a neglectful environment. Even though it is identified as an older-child disorder, RAD has been seen in very young children. For example, I just received a report of RAD diagnosed in a little girl from China who was adopted at the age of 8 months and had been living in foster care. Therapy for her should go well because of her age.

RAD is different than attachment issues. Children who move to a new environment grieve for the loss of what was familiar and often what was loved even when the previous environment was abusive. It should take only a few minutes of contemplation to realize that this is to be expected and should be considered normal. It doesn’t matter that the child is living a much better life. For him it is still a major loss.

Grief is hard. It is obviously hard on the person grieving but it can be also especially hard on people hoping to lessen that grief. Grief in children adopted internationally who have a life history may cause the child to be attachment resistive. The older the child, the greater is the potential for this resistance. It should be expected that it ma y take a year or longer for an older child, even in the absence of symptoms of more severe pathology, to become securely attached to his new family. Parents that understand this resistance to attachment and have strategies for easing the transition and promoting attachment will fare much, much better than those who expect attachment to happen easily and relatively immediately.