anyone had any experience with RAD?

[purpleloosestrife]

had been suggested today in his medical assessment that my foster baby (8mo, but 2.5 months "behind" on development) might have RAD. I know nothing about it - or how to help him.

Anyone know anything to help?

He has gone from not wanting to be held/comforted, to being VERY attached to me/DD and DH but is still not great with strangers. He loves interacting with everybody and will readily smile at them, though he can only "tolerate" direct eye contact for small periods of time. He doesn't really tolerate any hand holding from anyone except me.

He's been with us for about 8 weeks now, and I have worked really hard to get him in a good routine, feel safe, secure and comforted. He sleeps through now ( used to sleep for maybe 40 mins at most, then scream for 2 hours or so and repeat until morning) He has gone from being very unsettled most of the time to being a gorgeous,calm baby most of the time.

I think Lilka knows a lot about RAD. She hangs out in Adoption.

Hi purple

RAD (Reactive Attachment Disorder) is a severe condition. It is the most extreme end of the attachment spectrum, if you have securely attached people at numbers 9-10, attchment disorder is numbers 0-2. The thing is, there's a massive grey area in the middle, which in my experience is where the majority of foster/adoptive children lie. Children with RAD are often completely unable to form an attachment to ther primary carer

At only 8 months, and at only 8 weeks in your care, it's far too early to know how his attachments are doing. He's been traumatised and moved around, so it's reasonable to expect some difficulites including attachment related problems, but he hasn't had time to settle in at yours, he hasn't had the months needed to see an attachment forming. Moderate-severe attachment problems can be observed in young children, and especially with much older children, sometimes it's possible to guess at RAD very quickly, but that's very rarely the case with young babies, and people should only be worried if a little baby is showing grossly innappropriate interactions for a child their age, such as a total intolerance to eye contact, being held, being kissed and so on

He needs at least 6 months in your care before people can begin any proper look at attachment, because it takes months to build relationships with people, even as a little baby. At 8 weeks, he is probably still displaying behaviours based on being moved and feeling frightened, although it's great to hear he's becoming more settled recently. No one knows how he'll be doing at aged 1, 15 months, 2 years etc, and signs of attachment problems get easier to see as they get older and as they have spent much more time in one safe place

Right now, the best thing you can do is to forget scary words like RAD, and focus on keeping doing what you are doing - giving him a secure and calm environment, with plenty of nurturing. That's the most helpful thing possible, since nothing else is useful in a little baby. Hold him, get him lots of loving human contact, and make his world a non-scary, small, and calm one. Show him smiles and lots of laughter. This is most likely to promote him making an attachment to you. Don't be worried about him getting attached - i know sometimes foster parents wonder if it's a good thing since their child will have to leave them. Getting attached to you is the best thing for him. He needs to learn about trust and love and safety and having a mummy now, not later. Later is too late.

Good luck - he sounds lovely :)

thanks for the info - and for replies.

He is lovely.

We laugh and smile a lot. He is, I hope, enjoying life with us.

Good luck to you and your little boy, purple. It sounds like he is making wonderful progress.

Brilliant post Lilkaand I think the phrase RAD is an American thing. As you quite rightly say it is far too early to see whether this baby has been harmed by his pre placement experiences. He will almost certainly be affected if he was with bps for the first 6 months of his life, and indeed he has shown his insecure attachment when first placed with the foster carers.

The only thing I would say is that I think a disorganised attachment (where a child has not been able to find a way to keep himself safe) because of the extent of the abuse or neglect is the most severe type of attachment disorder. I don't know whether this is also referred to as RAD but it is not a term I have come across in terms of looking at attachment difficulties.

You are doing a great job purpleloosestrife- any chance you could adopt him?!

Nana - I did write a post trying to explain my understanding of RAD/AD which is here

Disorganised is an attachment style (there's also Anxious/Ambivalent, Secure and Avoidant), and yes it's often recognised as the causing more severe problems than tthe otehr styles. However you might have an insecure attachment style but not have an attachment disorder because you don't have an inability to form primary attachments (you're say, a 4/5 on the attachment scale not a 1/2). If you had an attachment disorder, you might have a disorganised style of behaviour. RAD is a more commonly used diagnosis in the US, but is used here as well. I think that attachment disorder is diagnosed less in the UK overall though

I've looked at your other post that you linked Lilka

I honestly have not come across RAD and the attachment issue scored on a sort of continuum if I have understood what you posted. I am aware of the differing types of attachment issues that you mention, Secure, Insecure Avoidant, Insecure Ambivalent and disorganised attachment patterns. To be honest I find your explanations confusing although I am sure you know what you are talking about.

I have done courses on "attachment issues" as part of preparation groups for prospective adoptors and foster carers for many years, in collaboration with a clinical psychologist and we have never talked about attachment issues in the way you describe.

We have of course, started off with secure attachments, where the baby's needs from his earliest days and weeks are met in all aspects of his development by the birthparents, and they are attuned to his needs at all times, and thus the baby develops an "internal working model" of the world as a safe place and so long as the secure attachment pattern continues, this will be a protective factor for the child throughout the life span.

When looking at insecure attachments, we talk about the way in which even very young babies will try to find ways of keeping themselves safe although of course this isn't conscious. We give examples of frozen awareness, where a baby will keep very still in the cot or pram to try not to attract any attention from the abusing parents (It is very distressing to see this, as I have seen with a 4 month baby) and her 2 year old brother who sat quiet and still on a chair and moved in a robotic fashion when told do so by the abusing parent.

We look at avoidant and ambivalent attachment patterns and explain that the avoidant attachment pattern is set up when the parent takes little notice of the child; he is left to his own devices, where some children will be demanding and try to get attention, whereas others will keep quiet and try to find a way to get near to the parent e.g. standing by the side of the mother's chair as a way of being physically close. We talk of the ambivalent attachment pattern being where a mother/father sometimes takes notice of the child and sometimes doesn't and again children will make different "decisions" as to how they will get the attention of the parent. We make it clear that children can survive in these sorts of families because they will learn how to survive and whilst these attachment patterns are insecure, they do not mean that the child has an attachment disorder. The way we describe this is the child who lives in such chaos and with such abusing, neglectful parents, that he can't survive and is thus the most damaged child.

We explain that "love is not enough" for these children and they will carry with them the internal working model of the world that they have experienced in their pre placement experiences, and they need special care and attention. We explain that there will often be a big gap between the child's chronological age and emotional age, and the child may need "permission" to regress. The task becomes to change that internal working model and this is going to take time, understanding, and patience by the bucketload.

We also recommend books that they can read on the subject and the clinical psychologist does a lot of work with parents who are already fostering and with adoptive parents, and they do say that they can understand it more, when they actually have the child in placement.

I am wondering now if we have missed something with this notion of RAD andthe explanations that you give, which to be honest I have found difficult to understand - maybe that says more about me than the theory!!

It's probably my explanation!

I've always understood attachment to be a spectrum, and when I went to a centre for therapy with DD, this is how it was explained to me, and it made sense. Kind of like the autistic spectrum, if you accept the theory that everyone on the planet is somewhere on the spectrum. Every human on the planet lies somewhere on the attachment spectrum. I heard statistics saying 60% of the population show secure attachments, and 40% insecure, not sure how accurate that is because I don't know where that stat came from.

So the majority can attach securely. Some people in that majority will have some behaviours that are insecure - some poeple are naturally more clingy/seperation anxious, some people trust their partners much less easily than others, or are more commitment-phobic, some people talk easily about their feelings whilst others clam up and don't talk etc etc. I'm sure we all know quite a few people who can be quite insecure when in comes to forming close relationships. So as you go down the spectrum, emotions/behaviour/thoughts become more insecure, until you have attachment issues (which are noticable and cause problems in your life). And we divide attachment into styles based on patterns on behaviour and thoughts/emotions as you explained, so you might be ambivalent or avoidant etc. And you might have mild attachment issues, or moderate ones or you might have quite severe ones, as you go further down the spectrum, behaviour and emotions/thoughts become more disturbed and abnormal, until you reach attachment disorder/RAD at the bottom of the spectrum, which covers the children/adults who have major problems.

I've heard about 6 different diagnosis/labels for the same basic problem from other adoptive parents!! From RAD (disinhibited) to Avoidant attachment disorder. And I think the difference is not only on the individual psychiatrist or other professional and their preferred label, but also the way the child behaves. A child with Avoidant attachment disorder is probably going to behave differently to a child with disorganised attachment disorder, although they have the same basic problem.

I hope that makes more sense. I think you course sounded good, certainly wish I could have gone on something like it when I was going through approval. I wonder if this is a time thing though - I think we might understand attachment slightly differently now in 2012 than it was understood in say 1995. I remember when I adopted the first time ('96) and into the early 2000's, Nancy Thomas methods were very popular, and attachment therapies were often based around 'holding therapies' and so on - and now that's really out of fashion, and some attachment therapies have (rightly) been discontinued because they can cause great harm. I think our way of understanding attachment, attachment disorders and how best to treat them has changed a lot, and continues to change.