When we received the call to foster a sibling group of three children, my husband asked me what my main concerns were. I told him I was worried that we had no car seats, diapers, or cribs. He laughed and said, “That’s just a shopping trip.”
We didn't know about reactive attachment disorder back then.
We felt like a good and resourceful team that could handle whatever the children brought our way. I didn’t think it’d be easy, but I did believe we could manage with supportive professionals, family, and friends. Sadly, I now realize how naïve I was.
For better and worse, I am not who I was at the start of our reactive attachment disorder journey. I know far too much about the extremes a severely traumatized child will go to feel safe. I, like most, know far too little about how to successfully treat a severely traumatized child. I know the toll it takes on those who care for that child. And I know the importance, and difficulty, of finding those who understand and accept how challenging the journey is for the entire family.
Here are some of the hard things I’ve learned as a parent of a child with reactive attachment disorder:
1. I am the parent of a child with special needs.
It took me years to get it. I believed a parent could easily identify a disability or challenge for a child with special needs. A wheelchair came to mind, for example. Our foster care training did little to dispel this misunderstanding. We were taught that traumatized children are slightly more difficult than parenting any other children.
But traumatized children most definitely have special needs. They need different parenting styles and therapies, school support such as 504 or individualized education plans, and structured schedules.
We changed everything to meet our child’s special needs. We didn’t go out much, knowing that even minor changes in plans could derail our child for the entire day and end in hours-long rages. We couldn’t be in crowds because our child wandered without any regard for where we were. And any overstimulation led our son to implode.
For better and worse, I am not who I was at the start of our reactive attachment disorder journey. I know far too much about the extremes a severely traumatized child will go to feel safe. I, like most, know far too little about how to successfully treat a severely traumatized child.
If I had known about and agreed to become a special needs parent from the beginning, my heart may not have broken as badly. I would’ve understood that my child couldn’t accept my love. My expectations would’ve been different.
I suppose I don’t know if I would have signed up for this journey if I knew then what I know now. But, if I did, at least I would have understood what was coming.
2. It’s not just ADHD, or maybe it’s not ADHD at all.
The first diagnosis my son received was attention deficit hyperactivity disorder (ADHD). It came after two years of seeking professional help and repeatedly being told that he was too young to diagnose, his behaviors were normal, or that he didn’t remember his early life trauma.
At the time, I did not believe ADHD was the correct diagnosis. An ADHD diagnosis could account for hyperactivity, distractibility, and insomnia. But it surely did not account for the ability to turn rages on and off like a light switch, preoccupation with bodily functions, and behaviors purposefully targeted at me. But it was the only diagnosis anyone would give.
Initially, ADHD medications were like a miracle for our son. He was pleasant, present, and agreeable nearly overnight. Everyone noticed the difference in him. Unfortunately, the effects were temporary. After a few months, the positive effects of the medication were no longer noticeable. The clinician increased his dosage in response. It had no discernible effect.
I’ve learned that most kids with reactive attachment disorder get misdiagnosed with ADHD at first. After all, RAD can look like ADHD sometimes. It works for clinicians who don’t want to label a young child with other diagnoses or, frankly, simply don’t know what else it could be.
Even if clinicians do recognize other diagnoses, standards of practice warrant that other mental health diagnoses cannot be given until adolescence. ADHD is one of the few diagnoses they are willing to use for children, whether it’s the right one or not.
3. While there aren't medications for reactive attachment disorder, some can help.
Because reactive attachment disorder is a learned response to early life trauma that affects brain development, no medication will cure it. Medication can, however, help calm a child’s nervous system so they’re better able to engage in therapy. While this is incredibly helpful, it’s just a start.
Eventually, we found somewhat effective medications through genetic testing for our son. They weren’t a cure. But the combination helped mediate our son’s more troubling behaviors.
4. Love, patience, and consistency are not enough.
A child’s fear of attachment is at the core of reactive attachment disorder. They learn early in life that the world is not safe and they cannot trust adults to keep them safe.
A common misconception is that love, time, and consistency in a safe environment lead to healing. In a perfect world, the theory makes sense. Unfortunately, it’s not that simple.
While love, patience, and consistency could indeed help the child, it is these very same things that reactive attachment disorder repels out of an innate survival mode. It is the entire crux of the very serious brain disorder.
From the beginning of our parenting journey, my husband and I told our kids that our number one job is to keep them safe. It made things easy to explain to small children and reinforced the role of parents as protectors. While it’s a simple concept that most of us take for granted, we learned that our son could not accept it.
When our son was age 7, coyotes were roaming behind our fence. He ran out of the house, opened the fence, and started mimicking the coyote’s cries. After a warning from me, our other children stayed safely in the house. My husband tried to lure our son back into the house, but he kept creeping closer and closer to the coyotes. As my husband and I became more fearful, our son yelled, “I won’t let you keep me safe!”
Thankfully, our son was still small enough for my husband to pick him up, kicking and screaming, and carry him back to the house away from the coyotes. But as our son got older and bigger, it became impossible to keep him safe because he wouldn’t allow us to do so.
We learned that, no matter how patient we were, we can’t love away a serious brain disorder.
5. Trauma-informed and RAD-informed are two different things.
Trauma-informed care is a popular theory that mental health professionals throw around a lot these days. It emphasizes an adult leading the child with compassion, empathy, and validation. The assumption is that both parties–adult and child–are willing, wanting, and able to build trust and heal.
But, again, children with reactive attachment disorder respond poorly to those things.
Trauma-informed care makes things worse for kids with RAD, even though most professionals pointed us in that direction. The more that caregivers pour out empathy and compassion onto children who cannot handle it, the more the child feels triggered and the further they escalate.
We were taught that traumatized children are slightly more difficult than parenting any other children. But children with RAD most definitely have special needs. They need different parenting styles and therapies, school support such as 504 or individualized education plans, and structured schedules.
But traumatized children most definitely have special needs. They need different parenting styles and therapies, school support such as 504 or individualized education plans, and structured schedules.
Lack of parental and professional education increases the risk of caregiver burnout, parental blame, and disrupted placement. Children with a RAD diagnosis may require caregiving that focuses less on emotional intimacy and vulnerability–the opposite of trauma-informed care–at least at the beginning.
6. Children with reactive attachment disorder are skilled at perceiving others’ vulnerabilities.
Because a child with reactive attachment disorder is stuck in survival mode, the child becomes an expert at reading people. This skill helps them to maintain control and remain emotionally distant. For the child’s primary caregiver, whom the child with RAD often rejects the most, this dynamic feels incredibly personal.
Over the years, my son exhibited many different behaviors to get me to react. If I didn’t react or stopped reacting, he would try a new behavior. A behavior I was never able to normalize was unsanitary elimination habits. However, I knew this behavior was specific to me because he did not weaponize his excrement when out of our home.
Again, a child with RAD behaves from survival mode. It is not personal. They have simply discerned the behaviors that elicit what they need from others. This discernment is chameleon-like, as the child presents different behaviors depending on the situation or the people present. Such behaviors are difficult to explain to others, such as family members, teachers and therapists.
7. Caregiver self-care is an absolute necessity while parenting a child with reactive attachment disorder.
Parenting a child with reactive attachment disorder for any length of time is exhausting and can lead to burnout and even post-traumatic stress disorder. This exacerbates the disorder and the resulting chaos. Outlets for self-care, rest, and rejuvenation are essential.
For me, my best self-care happened during a two-year professional obligation that took me out of town once a month. I was doing something I enjoyed with people who respected and liked me during those monthly excursions. My colleagues and I went to the movies in the evening. I had a reputation for falling asleep in the theater, through everything from John Wick to The Revenant. I felt safer in a movie theater in a strange city with friends, watching a man being mauled by a bear, than I did in my own home. I was once awakened by the sounds of a gunfight, annoyed that the hero had the nerve to gun people down during my nap. I put my head back down until the end of the movie. It was the most peaceful I’d been in a long time.
8. Comorbidities are common and complicate treatment for children with reactive attachment disorder.
Severely traumatized children are more likely to have other mental health disorders like bipolar disorder. This makes treating a child with reactive attachment disorder more complicated. Attachment to a caregiver and effective therapy can only be achieved if the child's brain can receive it. This is where medications can help.
9. Outsiders rarely see the truth of the disorder.
At its core, reactive attachment disorder is a disorder centered around vulnerable relationships. Because children with RAD don’t demonstrate behaviors in benign, surface-level relationships, most adults don’t experience the same child that the primary caregiver or others who live in the home do.
Children with RAD aren’t vulnerable when alone with strangers, such as professionals they only see once a week. They’re calm in settings with multiple, rotating caregivers like hospitals and boarding schools. And family members who visit occasionally don’t trigger them.
Because kids with RAD feel a false sense of safety when in control, they’ll maintain control at all times. Again, the primary caregiver is often the only one close enough to the child to recognize it.
A few days before we began in-home wraparound services, my son and I were grocery shopping. I picked up oatmeal cream pies because my other children enjoyed them. My son spent the entire rest of the shopping trip fixated on complaining about me buying oatmeal cream pies. He didn’t like them. Therefore, I should not be buying them.
While love, patience, and consistency could indeed help the child, it is these very same things that reactive attachment disorder repels out of an innate survival mode. It is the entire crux of the very serious brain disorder.
The day the new caseworker came to meet us, my son asked for an oatmeal cream pie. “I thought you didn’t like them,” I replied. He reassured me that they were his favorite snack. Trying to keep the peace, my husband suggested that I just give him one. So I did. My son then opened the oatmeal cream pie, broke off a tiny piece, rolled it between his fingers, licked it, put it down, and said, “I don’t think I care for it.”
No one unfamiliar with the dynamics of RAD would have ever picked up on the amount of triangulation and manipulation that happened in that short oatmeal cream pie exchange. If I’d withheld the pie, I would’ve looked unreasonable to the other adults. When I said yes, he successfully triangulated me, my husband, and the new caseworker. Either way, he was in control.
10. Other children in the home feel the brunt of reactive attachment disorder.
Siblings of special needs children, otherwise known as glass children, often develop their own post-traumatic stress disorder (PTSD) from living in a chaotic family environment. They sacrifice their needs for those of their special-needs sibling. And they often suffer from parental neglect, appear to be hyper-responsible. Older siblings may even take on a parental role for younger siblings. No matter the role, the entire family feels the impact of living in a home with a child with untreated RAD.
A year after our son with RAD no longer lived with us, my eldest son started to exhibit concerning behaviors. He had nightmares about seeing his brother at school. His therapist and I, through probing, learned he was reading a book about an abusive relationship at school. I called the teacher and she said my son demonstrated unusual insight for a child his age. I told her about what our home was like while living with his brother with RAD. It made sense to his teacher that our son understood the dynamics of abuse.
Trauma-informed care makes things worse for kids with RAD, even though most professionals pointed us in that direction. The more that caregivers pour out empathy and compassion onto children who cannot handle it, the more the child feels triggered and the further they escalate.
My son’s therapist and I helped our son understand that the book triggered his own PTSD from living with his RAD-afflicted brother. This calmed his trauma responses and enabled him to process his experience safely. To this day, he uses his skills to process his emotions with help from myself, my husband, and his therapist when PTSD events trigger him.
11. Safety becomes the only concern.
If a child with reactive attachment disorder feels unsafe in a nurturing environment, the entire family environment becomes chaotic and unsafe. When RAD behaviors are severe and persistent, healing is not an option.
Safety within a home may include installing cameras or alarms. The child with RAD may do better in a non-family environment, like a residential treatment center or therapeutic boarding school, where there is no threat of intimacy.
As a parent, I have an obligation to ensure that all of my children are safe, including those without reactive attachment disorder. Everyone deserves to feel safe in their own home. Therefore, in our severe case, we needed to find an alternative living situation for our child with reactive attachment disorder.
12. Healing must come from within the child with reactive attachment disorder.
Caregivers can’t force healing on their children. This may be the hardest thing to accept about kids with reactive attachment disorder. Many people believe that all people want to heal, can heal, and can succeed and do well in life.
If a child with RAD doesn’t realize that healing is their choice and responsibility, it won’t happen. Sadly, there is a limit to a parent’s influence. That was difficult for me to accept.
13. Everything short of actual death is manageable.
This is a bold claim. But, as they say in poker, all you need is a chip and a chair. Our family tried many therapies, parenting styles, and living arrangements to attempt to navigate this disorder.
When I worried that my job might be jeopardized due to my child’s potential false allegations, we split our family. My other kids and I lived apart from my husband and our child with RAD. In the interim, I contemplated other ways to earn a living.
If I had known about and agreed to become a special needs parent from the beginning, my heart may not have broken as badly. I would’ve understood that my child couldn’t accept my love. My expectations would’ve been different.
During our dealings with the state, there was a time when going to jail was a real possibility for me. We discussed sending our other children to live with family out of state for a while.
We always did everything we had to do to keep our family as safe as possible. And we are all safe now. That is, ultimately, all we could do and all that matters.
There is a way through reactive attachment disorder.
The things we did and the decisions we made along our RAD journey are inconceivable to most people. Yes, it was excruciating at times. But recoverable nonetheless.
That thought sustained me during the hardest times in our reactive attachment disorder journey. I learned that there is always a way through. If you're walking the path now, find your people. Find your path.
Photo by Kyle Johnson on Unsplash