When my husband and I embarked on our foster/adoption journey, we were unprepared to parent a child with severe reactive attachment disorder (RAD), also known as developmental trauma disorder (DTD). We were unaware that children with the disorder would display significant, sometimes dangerous, behaviors — emotional outbursts and dysfunctional relationship dynamics — that would pervade every part of their and our lives.
Our foster care training barely mentioned the disorder, much less prepared us for how a child with severe RAD would interact within a family setting. Parenting children with developmental trauma was presented as being only slightly more difficult than parenting neurotypical or biological children, just with more paperwork. We quickly learned that was far from the reality.
The costs of parenting a child with reactive attachment disorder touches every aspect of life — physical, mental, social, spiritual and financial. While these challenges are overwhelming, I want to share what I’ve learned along the way so other families can avoid some of the most costly pitfalls we encountered.
1. Understand and Plan for Unexpected "Reactive Attachment Disorder Expenses" Early On
We had no idea what we were walking into when we first adopted our sons. The staff assured us that any extra needs the boys had would be financially covered by the minimal monthly stipend we received. It felt reasonable at the time, so we started educational savings accounts for them with that stipend — believing they would one day pursue higher education. Now, that assumption feels laughable. We didn't realize that college would be the last thing on our minds while raising our son Joe*. Mere survival became our goal each day.
Looking back, I wish we had put that money aside for more immediate, practical needs. As Joe’s disorder worsened, our financial needs skyrocketed. That small stipend barely made a dent in co-pays for his medication, let alone $40,000 hospital stays or the thousands we spent repairing damage from his rages.
The costs of parenting a child with reactive attachment disorder touches every aspect of life — physical, mental, social, spiritual and financial. The more you know early on to navigate these obstacles, the better off you'll be.
Nobody warned us about the extent of property destruction that children with reactive attachment disorder could cause. Off the top of my head, Joe damaged or destroyed:
Three windows
Four kitchen light fixtures
Every door in our home
Three bicycles
Three washing machines and two dryers
Nearly every room in the house from holes
Countless pairs of shoes, curtain rods and pieces of clothing
The list goes on, and I’m sure I’ve forgotten some.
No one told us about the cost of therapy multiple times a week or how meetings with specialists would become so demanding that I couldn’t work for years. Acute inpatient stays became part of our reality — and many weren’t covered by insurance. We even had to hire lawyers at one point just to get Joe the support he needed.
No one warned us about disordered eating habits. By the time Joe left our home, our grocery bill dropped by $700 a month.
In the ten years that Joe lived in our home, we estimate that the disorder cost us over $1 million — through lost wages, repairs, medical expenses, and legal fees. That’s the level of chaos and disorder we were trying to manage daily.
2. Save Resources Through Focus on Empathy with Accountability, Not Therapeutic Parenting
In the beginning, my husband and I poured our time and money into learning about therapeutic parenting techniques. But what we didn’t understand was that therapeutic parenting, with its focus on nurturing and empathy, actually triggered Joe and escalated his behaviors.
Children with reactive attachment disorder often need space — rather than constant nurturing — until they feel safe enough to connect. They also need clear accountability. Forcing closeness too early only drove Joe to push us away harder. We became desperate, and he escalated. We burned out.
It was a lesson we learned the hard way: Children with developmental trauma need to choose to buy into a family unit. They need to find their own reasons to trust, relinquish control and build healthy attachments.
3. Skip Spending Time and Money on Reward Systems That Don't Work for Reactive Attachment Disorder
Children with reactive attachment disorder are naturally transactional — they prefer relationships that are no more vulnerable than an exchange at a grocery store. At first, Joe responded well to sticker charts and small rewards. But over time, those rewards stopped working — or he’d demand increasingly extravagant ones.
By the time Joe was seven, he wanted Nike Air Jordans — a $200 pair of shoes — just to learn how to tie his shoes. That kind of reward system wasn’t sustainable for us.
In the ten years that Joe lived in our home, we estimate that the disorder cost us over $1 million — through lost wages, repairs, medical expenses, and legal fees. That’s the level of chaos and disorder we were trying to manage daily.
Every time a new professional joined Joe’s wraparound team, they’d suggest more reward systems. Some even recommended giving Joe 15 minutes of basketball or video game time for every positive behavior. If we had followed that plan, Joe would have spent three hours a day playing games — an impossible expectation in a household with other children, working parents and daily responsibilities.
4. Match Costly Privileges to the Emotional Age of the Child, Not Their Chronological Age
Children with the disorder often experience emotional development delays stemming from early disruptions in attachment. Because they lacked a consistent, nurturing primary caregiver during infancy and early childhood, their brain development was impacted. As a result, their emotional maturity may lag years behind their chronological age, depending on the severity of the disorder.
These developmental gaps can be costly — not only emotionally but also financially.
Parents may invest significant resources into opportunities they believe are age-appropriate, only to discover their child with reactive attachment disorder is unprepared to handle them. The child is often "stuck," emotionally speaking, at the developmental stage where their trauma occurred. This makes it difficult for them to meet the expectations placed on children their age. Like many parents, we initially misunderstood this dynamic and assigned our son Joe privileges and responsibilities appropriate for his age — with costly and frustrating results.
When Joe was five, we purchased V-readers — small electronic learning devices — for him and his siblings. His older and younger siblings used theirs appropriately, but Joe destroyed his within days. When we didn’t replace it, he broke both of his brothers' V-readers in frustration. Determined to give him another chance, we bought a single V-reader for them to share — but Joe destroyed that one too.
As he got older, the pattern continued. Joe had begged to play competitive basketball since he was six, and we finally signed him up, hoping it would provide structure and teach teamwork. Initially, we thought he could handle practices without our supervision. However, within weeks, the coach asked us to attend because Joe was so disruptive. He argued with referees during games and was eventually kicked off the team.
The child is often "stuck," emotionally speaking, at the developmental stage where their trauma occurred. This makes it difficult for them to meet the expectations placed on children their age. Like many parents, we initially misunderstood this dynamic and assigned our son Joe privileges and responsibilities appropriate for his age — with costly and frustrating results.
We tried again with soccer, wrestling, and swimming, hoping each new sport would help him channel his energy and connect with others. But every time, the result was the same — more disappointment, both for Joe and for us. Each attempt represented another financial and emotional investment that didn't pay off, underscoring the challenges of parenting a child with the disorder and the importance of understanding their unique developmental needs.
5. Do Your Best to Secure a Proper Diagnosis Early On
According to Forrest Lien, LCSW, children with the disorder often go undiagnosed until they’re 10 to 12 years old. By then, the child has learned many maladaptive behaviors that have both strengthened the disorder and created collateral damage within the child’s family. In the meantime, the family has typically spent a fortune on co-pays, therapy appointments, medications and more on the wrong diagnosis.
The reasons for misdiagnosis may be that the child never had consistent caregivers to get a proper diagnosis, the child spent time in foster care where the diagnosis was removed to encourage placement of the child, or the child had been misdiagnosed by uneducated professionals and had been receiving ineffective treatment, all of which enable and worsen the disorder.
Because proper interventions for the disorder are intensive and time consuming, the prognosis for healing goes down the older the child is when proper interventions begin. The earlier the child is properly diagnosed, the better the prognosis for the child to eventually thrive within a family environment.
We began searching for answers when Joe was just 3½. His intense rages, inability to accept “no,” and sneaky behaviors were unlike anything we had seen. Initially, he was diagnosed with ADHD. When ADHD treatment didn’t help, I kept digging until Joe was diagnosed with reactive attachment disorder at seven. We were lucky to find a therapist truly experienced in developmental trauma disorder.
Unfortunately for us, it still remained a struggle to build a qualified team who could successfully help us work with the disorder. But while it was still too late for us, some families do secure the right diagnosis, advocacy and intervention. Yet, it all starts with the right diagnosis as early as possible.
6. Vet Professionals Before Investing in Treatment
Families like ours often find that parents with lived experience understand the disorder far better than many professionals. A friend of mine, a sociology professor familiar with our family’s journey, regularly invites me to guest lecture in her classes since the textbook she uses only devotes one paragraph to the disorder.
The reality is that developmental trauma is not part of standard training for therapists, social workers or counselors. Some receive minimal education on the subject, but most receive none at all. This leads to misdiagnosis, ineffective treatment, and often enables the disorder. Yet, families turn to these professionals for help, unaware of the risks involved.
Amy VanTine, CEO and founder of RAD Advocates, explains, “Most well-meaning professionals and programs have no idea how quickly they make the disorder worse.”
Carrie O’Toole — a parent of a child with RAD, coach for parents, and regular presenter at NavRAD — often shares how her experience parenting a child with RAD led her to become a therapist. During her graduate studies and continuing education, even courses marketed as helpful for attachment disorders barely mentioned developmental trauma, confirming her concerns about the lack of professional knowledge.
Since the disorder involves controlling behaviors, manipulation, and triangulation within intimate relationships, traditional talk therapy tends to backfire. Children with developmental trauma learn to say what therapists want to hear, creating the illusion of progress. However, this rarely carries over into real-life behavior. As a result, therapists may assume the child is improving, while parents continue to struggle with severe behaviors at home.
Untrained professionals may unintentionally undermine the parents by offering services or gifts directly to the child. “This trauma-informed approach sends the message that the parents are unable to meet the child’s needs,” VanTine notes. In some cases, therapists even place blame on parents for the child’s behavior, reinforcing the child’s belief that their caregivers are untrustworthy and unnecessary.
When we made the difficult decision to place Joe in a residential treatment center, I knew there was a risk that the disorder would be enabled. My worst fears were confirmed during a visit. Joe proudly entered the room, showing off the new shoes and coat the staff had given him. Nearly a decade of work to build trust was undone in less than two weeks.
7. Prepare for Financial Barriers to Effective Reactive Attachment Disorder Treatment
Many families end up working with well-meaning but uneducated professionals because the most effective treatments for the disorder are usually not covered by insurance. Unfortunately, families dealing with developmental trauma often find their mental health coverage is limited, and third-party payers typically exclude the therapeutic practices that are most effective. Or specialized providers do not take insurance because they are too busy — because there are so few of them — to deal with the logistics of handling insurance. These services include RAD-specific therapists, RAD-specialized residential treatment centers and neurofeedback therapy.
By the time Joe was ten, every provider we consulted recommended out-of-home RAD-specialized residential treatment. However, Joe was rejected by every in-state facility that accepted Medicaid, each citing different reasons. Although a few out-of-state programs accepted him, none accepted his Medicaid coverage. We were advised to take out a second mortgage, use credit cards, ask family members for financial help or even sue the school district to cover his education costs.
The programs we considered ranged from $7,000 to $18,000 per month, with the possibility of requiring a two-year stay — all without any guarantee that Joe would make progress. In the end, the financial barriers were what prevented us from accessing the treatment Joe needed.
Final Thoughts on the Cost of the Reactive Attachment Disorder Journey
If you’re just beginning your journey with a child with reactive attachment disorder, it’s not too late to course-correct. The road ahead will be challenging, but with knowledge, planning, and the right support, you can avoid some of the costly mistakes many families make.
At RAD Advocates, we’re here to help you navigate this journey — wherever you are on the path. You don’t have to do this alone. Reach out to us to learn more about how we can support your family and help you find the resources you need.