When to Seek Residential Treatment for Reactive Attachment Disorder

All teens make mistakes and push boundaries. Teens with Reactive Attachment Disorder 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 claim that sending them away re-traumatizes them by breaking the attachment cycle. Living with an out-of-control teen eventually takes a real toll on parents and siblings. Reactive attachment troubled teens act out at home, usually toward their 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 see 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 the Elk River Treatment Program (ERTP).

Choosing an attachment-sensitive and competent out-of-home treatment program should not be viewed as sending your child away but as sending your child toward help. Loving parents can admit when a problem is beyond their scope to effect change, and the cost of 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 severe 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 Reactive Attachment Disorder 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 act out; and show a lack of accountability because they have difficulty seeing the connection between their behaviors and consequences.

Parents often describe their children's behaviors as relentless rejection and pervasive non-compliance across all environments. The power struggles are intense and persistent. 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 the trauma. The search for help often results in conflicting diagnoses 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 passes, parents experience a depletion of their 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 firsthand. Parents often experience criticism from helping professionals and friends who have difficulty 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 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 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. 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.

When the essential elements of care, such as attention, soothing, comforting, feeding, rocking, holding, and 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. 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 caregivers, 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 the wearing of attachment.

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

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 diagnosed with Reactive Attachment Disorder who 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 regardless of adoption losses, abuse, or physical differences. They are given emotional support and encouraged to express feelings and thoughts regarding these losses appropriately.

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

Parents are considered part of the Treatment Team and are provided with weekly update calls, conference calls, letters, and campus visits. Parents may receive guidance in locating resources in their area, learn more effective parenting strategies, and develop 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 a superficial motivation to change. They are 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 into the process. Rather than phases of the program, Elk River Treatment Program uses the Counseling Stages of Change for children and parents to identify where they are in the program. The stages are pre-contemplation, contemplation, preparation and action.

Effective change is challenging for children who have been deeply wounded and have developed many maladaptive ways of keeping themselves emotionally safe. Most need to be in treatment for 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 putting his/her life at risk and 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 can use the outpatient model to further work through trauma and develop healthy relationships.

Residential treatment should not be considered lightly. It is vital 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.