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Reactive Attachment Disorder (RAD)
The diagnosis of Reactive Attachment Disorder (RAD) is rarely given, based on the preceding common diagnosis of Post-Traumatic Stress Disorder (PTSD).
Minnis (2013) found that there is an estimated a 1.4% prevalence rate of reactive attachment disorder (RAD) for all children under five years old.
However, there is a rate of 35% of maltreated toddlers in a foster care placement who have RAD. Most attachment issues will go back to abuse and neglect within the first year of life, (M. Ainsworth, et. al., 1978).
Cinthia & Bill McFeature’s Experience with RAD
Most of our experience in working with children and youth diagnosed with Reactive Attachment Disorder RAD has been in out-of-placements.
When I worked as a Regional Director of a large California-based Therapeutic Foster Care agency, we would do our best to maintain children in placement. We understood that if we moved the child, it would only add another layer of rejection and increase behaviors that would continue the cycle.
Children and youth diagnosed with RAD moved an average of 7 to 27 times and placed in various foster homes, failed adoptions, and congregate care. Foster parents and other care providers have a difficult time working with children and youth who carry this diagnoses.
Mother Teresa said this,
“I have found the paradox of life to be that when we love until it hurts there is no more hurt only more, love.”
It is important that the foster parents or others who are caring for a child with RAD have not experienced love and nurturing in the first year of life and therefore do not understand what love is.
Daniel Siegel (1999) suggests attachment is a “vital function” an infant needs to comprehend dangers around them.
“These relationships are crucial in organizing not only ongoing experience but the neuronal growth of the developing brain”.
In other words, these salient emotional relationships have a direct effect on the development of the domains of mental functioning that serves as our conceptual anchor points: memory, narrative, emotion, representations and states of mind (Siegel, 1999, p. 68).
Consider the basic needs of an infant which revolve around a schedule and require lots of attention. When the baby cries, the parent will pick up the baby and check to see if the baby needs a diaper change or feeding.
But, what happens when the baby cries and no one is there?
The baby will continue to cry and will develop an insecure attachment.
To understand attachment, we must consider the four types of attachment and the characteristics associated.
1. Secure Attachment
Children who raised in a loving home can demonstrate calm and cooperative behaviors.
The child will become anxious around strangers and turn to the caregiver for security.
Older children can express their feelings verbally and develop strategies for coping with stress. Older children will display greater social ability, resiliency, resourcefulness, empathy, and popularity among peers.
Avoidant Insecure Attachment- children who are raised in a home of abuse and neglect where parents are using drugs and present with non-caring, distant, and lacking in emotional sensitivity or empathy, leads to this attachment type.
The children will demonstrate little if any, distress when the caregiver leaves. May see attention from caregiver then reject the caregiver when attention is given. The child will display indifference to both caregivers and strangers.
If the child is distressed, they remain distant from the caregivers, rejecting them and avoiding intimacy and connection.
Ambivalent Insecure Attachment- children raised in an environment of inconsistent and unpredictable behavior by the caregiver will present with this type of attachment.
The child will present with limited exploration of surroundings because of the caregiver cause distress.
The child will appear anxious before separation from a caregiver, presenting extremely upset by the caregiver leaving, however, will be ambivalent upon the caregiver’s return.
Older children will often mix contact-seeking and resistant behaviors such as hitting, kicking, prolonged crying and extreme passivity. The youth will maintain a parent-child relationship characterized by both closeness and hostility.
Disoriented Insecure Attachment- children who are brought up by a caregiver that is depressed or demonstrates other psychopathology will present with both avoidant and ambivalent behavior.
The child may appear obsessed with the caregiver and vacillate between a desire for closeness and distancing due to internalized anger.
Older youth will appear frightened or aggressive. They may exhibit a “fight/flight” pattern of behaviors.
Equine Therapy Treatment
Equine Therapy is just one of many treatment options that we found to be effectual.
We had an opportunity to operate a licensed mental health group home with an equine therapy component.
The youth ages 13 to 17 would care for the horses and then have an opportunity to ride the horses when they earned it based on behavior. We had a riding ring and invited children with various handicaps to come and ride the horses.
The youth would be responsible for walking the horse around the ring with the responsibility of making sure that the rider was safe and having fun.
What we found is that when the youth gave to others that were less fortunate than they were that they felt better about themselves because they were able to give. The attachment with the horses came first, however, after the consistent weekly contact with children who had health conditions, such as; Spina Bifida, severe on the spectrum, and others, the youth began to show signs of attachment.
Equine therapy focuses on trust and building a relationship between the horse and child to strengthen the relationship with the therapist (Ferwin and Gardiner, 2005).
Equine therapy uses horses as a therapeutic tool through a process in which the child learns different ways to trust the horse and the therapist (Ferwin and Gardiner, 2005).
Ferwin and Gardiner (2005) suggest this is done through the child interacting and forming a relationship with the horse, which then teaches the child that forming healthy relationships is a part of the natural development of the stages of life.
It is important to note that a horse mirrors the child’s emotional, behavioral, and physicals reactions and will sense, respond, and react to this, in return bonding with the child. This starts the repair process for a child to learn how to attach and build on their mentalizing and self-reflective skills (Bachi, 2013).
According to Bachi (2013), by watching how the horse reacts to the child, the child is then able to understand how both the child and the horse are affected by each other’s behavior and interactions.
“The use of mentalizing and reflective functioning through a therapeutic intervention can include increasing the client’s sensitivity and appropriate responsiveness to the “others” signals and emotional needs” (Bachi, 2013, p. 192).
Equine therapy then teaches the child non-verbal communication and body experience through the interactions with the horse.
When a child, youth or adult is diagnosed with RAD, it takes lots of courage to give and receive love.
However, when the patient can experience the unconditional love, that comes from a horse, the door opens, and light enters giving hope of building secure attachment.
Cinthia McFeature, Ph.D.
Bill McFeature, Ph.D.
New Roads Behavioral Health
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Ainsworth, M.D.S, Biehar, M., Walters, E., & Wall, S. (1978). Patterns of attachment. Hillsdale, NJ: Eribaum.
Bachi, K. (2013). Application of attachment theory to equine-facilitated psychotherapy. Journal of Contemporary Psychotherapy, 43(3), 187-196.
Frewin, K . & Gardiner, B. (2005). New age or old sage? A review of equine assisted psychotherapy. In The Australian Journal of Counselling Psychology, 6, pp13-17.
McFeature, B. & Herron-McFeature, C. (2017). Integrated health – Heartpath practitioner assessment and intervention for the trauma-exposed patient. Melbourne, FL: Motivational Press, Inc.
Minnis, H., Macmillian, R., Pritchett, et al., Reactive attachment disorder in the general population: not rare but hard to find, “British Journal of Psychiatry. In press.
Siegel, Daniel J. (1999). The Developing Mind: How relationships and the brain interact to shape who we are. New York: The Guilford Press.