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Reactive Attachment Disorder
vs.
Attachment Disorder


In the media, in court cases, on the Internet, and in child welfare agencies,
there is much confusion about Reactive Attachment Disorder (RAD) and
Attachment Disorder (AD), an unrecognized, fad diagnosis that often poses as RAD.


Reactive Attachment Disorder (RAD)

RAD is a recognized diagnosis which is defined in the Diagnostic and Statistical Manual (DSM-5, Code 313.89) of the American Psychiatric Association. RAD is considered an "uncommon" disorder which is expressed in reaction to extreme neglect and/or abuse as:

  • The child rarely or minimally seeks comfort when distressed.

  • The child rarely or minimally responds to comfort when distressed.


In other words, children with RAD have experienced extreme social and emotional conditions and have become much more withdrawn than we would expect of children their age. While there is no validated therapy specifically for RAD, many experts recommend gentle, patient, consistent and responsive parenting for these children, as for all children with special emotional needs. This disorder can be diagnosed while the child is five years of age or younger; as children get older, their behavior matures and changes in ways that make attachment problems much less evident.

More recent studies indicate that RAD, as defined in the DSM-V, may not qualify as disorder or require treatment. Brian Allen (2016) writes:

“...children placed in appropriate foster care homes who previously displayed the inhibited/ withdrawn subtype of RAD no longer displayed these symptoms when followed up months later (e.g., Smyke et al., 2012). Zeanah and Gleason (2015) recently summarized that ‘in studies of children adopted out of institutions, there are no reports of children with (inhibited) RAD ... suggesting that signs of (inhibited) RAD diminish or disappear once the child is placed in a more normative caregiving environment’. They further opined that these results make it unclear ‘whether additional interventions beyond family placement may be necessary’.”


“Attachment Disorder” (AD): An Over-Reaching Diagnosis & Grounds for DHS Investigation

Foster Cline, MD, the Colorado psychiatrist who first popularized Attachment Therapy in the 1980s, is also credited with inventing “Attachment Disorder” (AD), an unrecognized diagnosis used nearly exclusively by Attachment Therapists. Decades of vigorous marketing of this fad diagnosis to parents and child welfare workers has positioned it as a disorder dreaded by adoptive and foster parents, but also a well-known path to eligibility for "special needs" subsidies. 

Proponents of the AD diagnosis frequently refer to  it as "RAD," leading to public confusion about the two, but they are conceptually very different. There is suspicion that Attachment Therapists who treat problems they have labeled as AD will charge insurance companies for treating RAD instead. Because AD is not a professionally-recognized diagnosis, treatment for AD would not be reimbursed by public or private insurers.

The AD diagnosis is characterized by a laundry list of behaviors, making it a typical “catch-all diagnosis" of the sort commonly identified with quack practices. The list is so overly inclusive that it would encompass any number of disorders, and therefore useless for diagnostic purposes. The list also includes actual normal behaviors for certain age groups. Even “good behavior” may be interpreted as a child "stalking his prey." 

The AD list of signs also contains a number of internal contradictions, as when children are said to lack empathy and cause-and-effect thinking, but yet they are believed able to understand people well enough to be clever manipulators and able to triangulate adults. Likewise both eye contact, or lack of it, are considered problematic AD signs.

Practitioners using the AD diagnosis warn parents that a child with AD is likely to develop many more signs of the disorder in the future if not treated with Attachment Therapy/Parenting, most ominously sociopathy. Lists of AD signs have included the following:

Signs of “Attachment Disorder”

  • Superficially engaging and charming
  • Lack of eye contact on parent's terms
  • Eye contact when lying or angry
  • Empty-eyed
  • A darkness behind the eyes when raging
  • Indiscriminately affectionate with strangers
  • Good behavior [interpreted as the child “stalking his prey”]
  • Views relationships as threatening, or not worth the effort
  • May be a workaholic, as a way of avoiding relationships
  • Not affectionate on parent's terms
  • Resists comforting
  • Resists being held
  • Destructive to self, others, and material things
  • Accident prone
  • Cruelty to animals
  • Cruelty to young children
  • Lying about the obvious or "crazy lying"
  • Stealing
  • No impulse controls
  • Act addicted to their own adrenaline
  • Intolerant of rules and authority
  • Shallow and vain
  • Grandiose or unrealistic fantasies
  • Feelings of being unique
  • Feels unappreciated
  • Feels unwanted
  • Attitude of entitlement
  • Lacks morals, values, and spiritual faith
  • Identifies with Satan
  • Oversensitive to rejection, easily gives in to jealousy
  • Temper tantrums
  • Hyperactive, yet lazy in performance of tasks
  • Prone to depression
  • Passive-aggressive behavior (delaying, forget, or act confused)
  • Developmental lags
  • Failure to gain weight
  • Delayed responsiveness to stimuli
  • Appears listless
  • Poor self-soothing techniques
  • Failure to smile
  • Learning lags
  • Exceptionally bright, but act "dumb"
  • Lack of cause and effect thinking
  • Compulsive caregiving
  • Overly critical of self and others
  • Lack of conscience
  • Lack of empathy and remorse
  • Abnormal eating patterns, e.g. hoarding and gorging
  • Refuses to eat
  • Eats strange things
  • Poor peer relationships
  • Victimized by others
  • Perceives others as unsafe, dangerous
  • Perceives self as victim
  • Preoccupation with fire
  • Preoccupation with blood and gore
  • Self-mutilating
  • Persistent nonsense questions and chatter
  • Argumentative
  • Inappropriately demanding and clingy
  • Abnormal speech patterns
  • Triangulation of adults
  • Controlling and manipulative
  • Bossy
  • Sees others as being difficult to understand
  • Unable to understand the concept of altruism
  • Extreme emotions
  • Limited emotional repertoire
  • Phoniness
  • Never get sick
  • Can’t float in water (Nancy Thomas)
  • Can’t feel physical pain
  • False allegations of abuse
  • Sneaky, underhanded, covert
  • Sneaks things without permission even if he could have them by asking
  • Child 'forgets' parental instructions or directives
  • Presumptive entitlement issues
  • Parents appear hostile and angry
  • Parents feel used
  • Parents are wary of the child's motives if affection is expressed
  • Targets the adoptive mother for abuse
  • Narcissistic behavior
  • Enuresis and encopresis
  • “I hate you” attitude
  • “You can’t make me” attitude
  • Abrupt change in personality
  • Attempted suicide or threats of suicide
  • ADHD and Conduct Disorder
  • Blames others for mistakes or behaviors
  • Presenting as calmer when alone
  • Uncontrollable anger
  • Inappropriate emotional responses
  • Cutting
  • Distant or aloof behavior, resentful
  • Easily misled
  • Lazy, lacks motivation
  • Risky behavior
  • Runs away
  • Sexually active at a very young age (with other children and animals)
  • Smoking or other tobacco use
  • Great theatrical displays
  • Chemical self-medication
  • Street smart
  • Good survival skills
  • Con artist and cunning
  • Revenge motivated
  • Malicious
  • Danger seeking secondary to despair
  • Rejects responsibility
  • Hypervigilant
  • Light sleeper, rises early in morning
  • Dissociation

Attachment Therapists claim children diagnosed with AD are capable of being sexual predators, with the potential to become serial killers as adults. Attachment Therapy proponents have referred to AD as "Ted Bundy Disease."

Belief in the AD diagnosis appears to have promoted child abuse, with parents becoming suspicious and fearful of children with this diagnosis – a diagnosis that claims that the AD child is sneaky, manipulative, is unable to feel pain, and has no conscience.

Much of the AD diagnosis is situational, believing that a child’s background, e.g. adopted or from foster care, causes AD. It overlooks the strong biological basis of attachment and the resilience of children.

Frequently, the feelings of caregivers are considered part of the AD diagnosis, such as:

  • Feel isolated, depressed, frustrated, angry, hopeless, helpless, and stressed
  • Difficulty concentrating
  • Confusion
  • Feeling blamed by family, friends, and professionals

A discussion of AD and RAD is included in the 2006 Report on Attachment Therapy by the American Professional Society on the Abuse of Children (APSAC). The task force that authored this report remarked on the tendency to over-diagnosis a “rare” condition such as RAD, plus the problem of the highly inclusive lists of AD criteria:

Clearly, these lists of nonspecific problems extend far beyond the diagnostic criteria for RAD and beyond attachment relationship problems in general. These types of lists are so nonspecific that high rates of false-positive diagnoses are virtually certain. Posting these types of lists on Web sites that also serve as marketing tools may lead many parents or others to conclude inaccurately that their children have attachment disorders.

It is easy to see that any child is likely to be labeled as AD when concerned parents consult an Attachment Therapist who will claim the condition is common, if not universal, in adopted and foster children. The diagnosis clearly demonizes these children, making parents fearful and suspicious of even normal child behaviors. It sets up a dangerous situation in how parents think about their children and where Attachment Therapy’s harsh parenting is perceived as justified to head off the child's disastrous future.

Attachment Therapists claim that AD is foundational for other mental disorders, and that therefore, AD must therefore be treated first, and by a practitioner who is committed to the AD concept. They may diagnose AD with the use of any of several unvalidated checklists, such as the Randolph Attachment Disorder Questionnaire (RADQ) , the Attachment Disorder Symptom Checklist, Walter Buenning’s Infant and Child Symptom Checklists, and the Evergreen Consultants Check List.

Some parents charged with criminal child abuse have tried to convince juries that their children had AD. As Jean Mercer, PhD — leading critic of Attachment Therapy — commented, "The RAD defense is regrettably becoming more common as a way to extricate abusive, even homicidal, parents from legal difficulties." In a blame-the-child defense strategy, AD is portrayed as a disorder so diabolical that it would unhinge the most loving of parents.

Journalists haven't helped to clarify the situation for the public. They rarely question the AD diagnosis — or even consult the DSM — but rather parrot the portrayal of adopted children as "monsters at home."

Another term for “Attachment Disorder” is used in gay-to-straight Conversion Therapy. In this case it is called “Same-Sex Attachment Disorder.” (Some forms of Conversion Therapy have beliefs and methods similar to those of Attachment Therapy.)

Children can have mental health problems at an early age, but to help them, an accurate diagnosis is necessary. The AD diagnosis is unlikely to help any child, but rather risk the child being subjected to highly abusive therapy and parenting practices.

NOTE: APSAC & the American Psychological Association’s Division on Child Maltreatment recommend that child welfare workers investigate where AD has been diagnosed.


References








  • “Correlates of the Randolph Attachment Disorder Questionnaire (RADQ) in a Sample of Children in Foster Placement,” Cappelletty G, Brown M, Shumate S (February 2005), Child and Adolescent Social Work Journal, 2005 Feb; 22 (1): 71–84. [DOI]