It was a typical day at our counseling office when I got her phone call. Even though several years have passed, I can still hear the intense distress in the voice. Immediately after I answered the phone, the woman said, “Hello. Please don’t bull*hit me. Do you know what you’re doing?”
Given her abrupt disposition, another therapist may have dismissed the woman that day.
But I knew the voice well—that of a mother of a child with reactive attachment disorder. Most people, including clinicians and parents, don’t recognize reactive attachment disorder symptoms. Therefore, the disorder is often misdiagnosed and mistreated. So parents of these children feel lost, defensive, and overwhelmed after months of ineffective help.
Although the woman didn’t yet know the name of her child’s disorder, she knew something was very wrong. She was scared for the safety of herself and her family. She was defensive after so many professionals promised to help, only to judge her. She was heartbroken that her dreams of adoption did not match her family’s reality.
Her son’s well-meaning therapist had the best intentions. But the clinician was treating for an oppositional defiant disorder rather than reactive attachment disorder. She told the mother to use behavior modification techniques with her son—traditional parenting tactics such as time-outs for talking back or sticker charts to reward finishing chores. But things were getting worse by the day.
Yes, to use the wrong treatment makes matters worse for any ailment. Crutches won’t help a wound that needs stitches. Likewise, to treat reactive attachment disorder like attention deficit disorder, autism, oppositional defiant disorder, or intermittent explosive disorder won’t help the child.
Admittedly, many other disorders mimic reactive attachment disorder symptoms. That said, it’s vital to know how to decipher them.
Whether you’re a parent or fellow therapist, consider the following in children with reported behavioral issues (“reported” is a keyword as children with reactive attachment disorder don’t often behave the same ways with other adults as they do with their parents).
4 simple ways to spot reactive attachment disorder symptoms:
1. Is there a chance that the child experienced early physical or emotional neglect or abuse?
According to the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition: DSM-5, reactive attachment disorder is a stress-related and emotional disorder that can only be caused by neglect or abuse during childhood. Let this be your first red flag. As you do, realize that you may not know the full history of the child so you may need to make an educated guess. Social services do not always fully disclose the history of foster care children, for example.
2. Does the child rarely go to his or her primary caregiver during emotionally difficult times?
A child with reactive attachment disorder avoids and denies comfort from his or her primary caregiver, perhaps with difficult or aggressive behavior.
3. Is there a social and emotional disturbance in the child’s interaction with a primary caregiver or peers?
You may notice that the child is not socially or emotionally engaged during a time of play (or is bossy or mean). He or she may provide limited positive reciprocation during playtime with other children. Or perhaps the child has episodes of unexplained frustrations or crabbiness, sadness, or fearfulness even during non-threatening interaction with an adult caregiver or peers.
4. Has the child experienced a pattern of insufficient care?
One of the six risk factors of an attachment disorder is repeated changes in primary caregivers. Even at a young age, many transitions in foster care homes can break trust in the attachment. Other circumstances that create an attachment disorder is when caregivers do not meet a child’s basic needs. For example, perhaps the child lived in an orphanage and regularly cried alone for hours at a time.
If you believe your child or client has reactive attachment disorder symptoms, seek an accurate diagnosis for greater efficacy and treatment planning immediately. “In my 15 years of practice, my experience has been that psychological evaluations can play a pivotal role in the treatment of children struggling with attachment issues,” said Dr. Bruce Grant, psychologist, and CEO at Discovery Counseling and Assessment Center in Sharpsburg Georgia. “A good psychological is a snapshot of a child's emotional, cognitive, relational, and behavioral functioning. It can give parents and treatment providers a look into what is driving a child's behaviors and get everyone on the same page.”
To correctly recognize reactive attachment disorder symptoms does not offer promise. But it does give greater hope for effective help. And parents and their children deserve that chance, at the least.
As a licensed professional counselor and certified Theraplay practitioner, Julie Fox Evans is a child and family therapist who helps children build and enhance attachment, self-esteem, trust in others, and joyful engagement. Trained in trust-based relational intervention, she does so for children from “hard places” specifically. Julie performs comprehensive child and family assessments and is certified in eye movement desensitization reprocessing, an eight-phase protocol that assists individuals in reprocessing their traumatic experiences. Julie’s passion is to assist those who are in difficult places so that life enrichment and resolution is more achievable. She practices at Discovery Counseling and Assessment Center in Sharpsburg, Georgia.