When to Seek Residential Treatment for Reactive Attachment Disorder (RAD)

All teens make mistakes and push boundaries. Teens with Reactive Attachment Disorder (RAD) function outside the norm of teen problems and can become unsafe to themselves and others. Often parents are discouraged from seeking residential treatment by well-meaning professionals who make the claim that sending them away re-traumatizes them by breaking the cycle of attachment. Living with an out-of-control teen eventually takes a very real toll on parents and siblings. Reactive attachment troubled teens act out at home usually toward the mothers and sometimes siblings. Parents begin to notice that their support network is weakening. As the child gains more and more control, parents work harder than the child and eventually notice that they are no longer parents, but wardens.

If a child’s maladaptive behavior stems from the inability to develop emotional attachments, would placement outside the home only further traumatize the child? Parents of children that have developed Reactive Attachment Disorder often struggle with this situation yet have exhausted all other resources and must consider a residential facility like Elk River Treatment Program (ERTP). The program’s Family Service Coordinator, Jane Baker, is a licensed mental health professional that specializes in treating children that have developed Reactive Attachment Disorder or have experienced trauma. She joined Elk River’s Treatment Team with 30+ years of experience in private practice because ERTP is where children get the 24 hour care that they need to work on behavioral problems that result from attachment issues, grief, loss and family issues.

Choosing an out-of-home treatment program that is attachment sensitive and competent should not be viewed as sending your child away, but sending your child toward help. Loving parents can admit when a problem is beyond their scope to effect change and the cost for not reaching for help is very high.

Hundreds of adolescents and their families have mended broken bonds with the expert care of ERTP’s clinical team and support staff. Many clients of the adolescent treatment program were admitted by their parents due to behaviors resulting from abuse, neglect or serious disruptions during their developing years; ongoing exposure to violence and chaos; or an ongoing series of events and/or conditions that affected the child’s development of healthy emotional, social and behavioral systems.

Common Symptoms and Behaviors of Reactive Attachment Disorder

Symptoms and behaviors of RAD may include:

• Inability to give or receive affection
• Inability to empathize with others
• Destructive behavior
• Lying
• Cheating and stealing
• Attempting to manipulate others
• Preoccupation with fire, blood and gore
• Cruelty to animals
• Indiscriminate affection toward strangers

Many also engage in behaviors that put their life and body at risk through reckless behaviors that leave parents and others in shock. As children become teens, their high risk behaviors become more extreme, often resulting in involvement in the Juvenile Justice System. They may demonstrate little to no remorse; engage in criminal activity; engage in high risk behaviors; use drugs/alcohol; sexually acting out; and show a lack of accountability because they have difficulty seeing the connection between their own behaviors and consequences.

Parents often describe the behaviors of their children as relentless rejection and pervasive non-compliance across all environments. The power struggles are intense and relentless. Parents may have struggled with managing behaviors for many years depending on the age of the child’s adoption or the age and nature of trauma. The search for help often results in conflicting diagnosis or multiple diagnoses ranging from ADHD, Autism, Sensory Integration Disorder, Mood Disorders, Oppositional Defiant, and /or Conduct Disorder to name a few.

In an attempt to help families and children, cocktails of medication protocols may be prescribed and later abandoned due to lack of progress. As time goes on, parents experience a depletion of their own emotional resources because of the relentless onslaught of opposition and well-meaning, but uninformed advice from friends and family who only see the angelic side of the child without having seen the manipulative and aggressive behaviors first hand. Often parents experience criticism from helping professionals and friends who have a difficult time understanding the child’s survival adaptations.

The behaviors and responses result in pushing people away, going on the attack, trying to “get rid of” siblings, passive resistance, outright opposition, arguing, temper tantrums, and many others. Often these children display these behaviors with an intensity matched only by someone literally fighting for their life. To let an adult get close or love them, risks extreme emotional pain if it does not work out or “these adults will leave me or hurt me, too.”

What Are the Known Causes of Reactive Attachment Disorder​?

Reactive Attachment Disorder (RAD) is a treatable condition that is also referred to as Developmental Trauma Disorder. A child that experiences trauma during the developing years has difficulty forming emotional attachments, according to Jane Baker, ERTP's Family Service Coordinator. “About 75% of what we know about being in relationships was developed in our first five years of life. With good enough and consistent enough care in those early years, a child learns ‘I am safe with adults; adults will take care of me; I am capable, lovable, and worthwhile,” Baker said.

When the basic elements of care such as attention, soothing, comforting, feeding, rocking, holding, smiling, are withheld or replaced with abuse/neglect/emotional absence, a child learns that they are not safe, adults cannot be trusted, and a belief that the child must take care of him/herself at all costs. In effect, the basic building blocks for relationships are either missing or severely weakened.

The conditions that can sometimes lead to disorders of attachment are parental neglect, chronic abuse, parental substance abuse, separation from the primary care givers, multiple placements, sudden death of a parent(s), undiagnosed pain over time, and separation from caregivers due to illness or medical conditions after birth. These events can be thought of as trauma because the event (or series of events) is emotionally and physically overwhelming, or these events are ongoing and chronic in duration.

It is important to remember that not all abuse leads to attachment disorders, but all abuse can contribute to a wearing of attachment," Baker said.

While attachment difficulties are most often represented in the foster and adoptive population, children in biological homes may also demonstrate behaviors consistent with disorders of attachment due to the unrelenting nature of the conditions mentioned above.

What to Expect When Receiving Treatment in the Elk River Program

ERTP provides ethical and effective treatment of Reactive Attachment Disorder and has gained the respect of referring professionals. Lorita Whitaker, a licensed social worker in Marietta, GA has counseled teens with a diagnosis of Reactive Attachment Disorder that have received treatment at ERTP. “I don’t know of another program that can better reach children with bonds that have been broken,” she said.

ERTP's residential setting gives the child a feeling of physical and emotional consistency so they can experience safety in allowing adults to provide care and structure, challenge their need to be in control of everything, and address their trauma and losses while remaining in contact with family. ERTP uses a positive peer culture to model a positive family system. Children are expected to identify their losses no matter if it is adoption losses, abuse, or physical differences. They are given emotional support and are encouraged to explore feelings and thoughts in regard to these losses by expressing them appropriately.

Throughout the program, the values of accountability, integrity, and responsibility are stressed. The facilities are situated on 100+ acres which helps the children get fit, stay active and learn to work together in a similar way that families do. Equine Assisted Therapy, group therapy, mindfulness therapy and many psycho-educational approaches are used including neurofeedback, biofeedback and yoga.

Parents are considered part of the Treatment Team and are provided with weekly update calls, conference calls, letters, and campus visits. Once the initial program has been completed, ERTP also offers a transitional program in which the child can go home to practice their new skills with family and return to ERTP to process their successes and areas that need more attention. Parents may receive guidance in locating resources in their area, learn more effective parenting strategies, and a skill set for managing lapses or relapses. It is the goal of ERTP to help each child progress from being a “treatment” child to being a “family” child.

Why Outpatient Treatment Often Fails with Reactive Attachment Disorder

One of the dynamics that work against successful outcomes in outpatient treatment is that a child will only have superficial motivation to change. Often children learn to manipulate sessions by making promises to change but redouble their attacks on parents while walking to the car. “In essence some children do not have a solid plan or motivation to get better or make changes”, Baker explained.

It is understandable that they would be unwilling to make changes and embrace the love offered by their families. Their ability to trust anyone or to be emotionally safe with anyone has become severely limited. One of the advantages of residential treatment is that the motivation to make changes is built in the process. "Children want to go home and we want them to go home. The path home is demonstrating competency in the Counseling Stages of Change and working through loss through effective grieving," Baker explained. Children who have been deeply wounded and have developed so many maladaptive ways of keeping themselves emotionally safe are not an easy task to effective change. Most need to be in treatment six months to a year depending on the severity of their behaviors and the complexity of the trauma.

If your child is engaging in unsafe behaviors and is putting not only his/her life at risk, but also others in the home at risk, it may be time to consider an out-of-home placement. At Elk River Treatment Program, a deeply wounded child can heal in neutral territory rather than in the home where the risk of emotional intimacy continues to create survival reactions. As a result a child with reactive attachment difficulties will then be able to make good use of the outpatient model to further work through trauma and develop healthy relationships.

Residential treatment should not be considered lightly. It is important to utilize the help available when lesser levels of care have failed, the child is unsafe to himself or others, parents are approaching the point of exhaustion or parents are no longer finding joy in parenting.