The first time I knew I was in the presence of a developmental trauma/reactive attachment disorder-informed therapist was when she asked, “Where are you at in your ability to continue trying all of this with your child?”
It was a stark difference from our encounters with trauma-informed therapists who had suggested I was the problem. I needed to love more, do more, and be more, they suggested. But I had done all of the “more” I could. There was nothing left to give and my son was only getting more sick. Our family had fallen apart.
So when the therapist checked on me, I was taken aback. Someone finally understood what our family was experiencing. Although it was a relief to hear, it turned out to be too late for us.
Reactive attachment disorder (RAD), also known as developmental trauma disorder (DTD), is a serious brain disorder that affects children who have endured early life trauma, neglect, or separation from their caregivers. It affects their ability to trust, learn empathy, and develop healthy relationships with the people in their lives, especially their caregivers. Most people, including those who work with children professionally, do not understand the intricate dynamics of the disorder.
We knew something was different with our child, but that’s all we knew.
My husband and I knew our son Joe* was different the day we met him, although we didn’t know exactly why or how. At the time, we explained away his behavior as that of a merely traumatized toddler. He was uninterested in interacting with us. He self-isolated. He didn’t sleep. He raged. He was extremely aggressive with his younger brother. He could not accept no as an answer.
I needed to love more, do more, and be more, they suggested. But I had done all of the “more” I could. There was nothing left to give and my son was only getting more sick. Our family had fallen apart.
We did what any other “good” parent would do — we did everything we possibly could. We tried to show him more love and sought all of the help and advice we could find. We began seeking help from therapists when Joe was four years old.
At the time, we had no idea what reactive attachment disorder/developmental trauma was. Because we knew enough to realize he suffered from some form of early trauma, we sought the help of trauma-informed therapists. We didn’t know how the modality was any different from a therapist who specializes in the serious brain impacts of developmental trauma/reactive attachment disorder. We didn’t understand the harm that difference would cause. And neither did the therapists themselves.
The trouble with trauma-informed therapy for children with developmental trauma/reactive attachment disorder
The critical difference between trauma-informed therapists and qualified RAD/DTD-specific therapists is in how they understand trauma and the brain. A trauma-informed therapist thinks about how early trauma impacts a child's experiences and life. A RAD/DTD-specific therapist approaches therapy from the knowledge that the child's brain is wired by trauma and fear. The difference may seem slight but the outcome is drastic.
“Many aspiring clinicians learn about healthy child development in graduate school and how to support people throughout life from that framework,” says Forrest Lien, developmental trauma expert, licensed clinical social worker, and NavRAD keynote speaker. “Few learn about what happens and what to do, however, when a brain develops abnormally from trauma.”
Children with developmental trauma/reactive attachment disorder neurologically cannot receive trauma-informed therapy in the same way as children with healthy brains can. A child with trauma issues might experience some success with the modality, but not a child with the more serious implications of a brain wired in fear. It’s akin to handing a child with dyslexia a book and expecting them to simply read. They aren’t ready for it.
When the therapist checked on me, I was taken aback. Someone finally understood what our family was experiencing. Although it was a relief to hear, it turned out to be too late for us.
The Centers for Disease Control and Prevention and the Substance Abuse and Mental Health Services Administration (www.samhsa.gov) outline the six pillars of trauma-informed care as:
1. Safety
2. Trustworthiness and transparency
3. Peer support
4. Collaboration and mutuality
5. Empowerment voice and choice
6. Cultural, historical, and gender issues.
While the pillars of trauma-informed care may seem sound in theory, the foundation presumes that the child can feel safe with and trust others. When placed upon a child with a trauma-wired, fearful, survival-based brain, the modality backfires and poses more harm to the child and the entire family.
7 things a qualified developmental trauma/reactive attachment disorder-specific therapist understands compared to other therapists:
1. The child’s brain is wired in fear.
A child with RAD/DTD does not feel safe, no matter their physical location. The impact of trauma is left on the brain, not at the place or in the family where the trauma originally occurred. The felt sense of threat goes with them wherever they go.
Removing a child from an abusive home and placing them in a safe one isn’t the cure for early trauma. If it were, RAD/DTD would not be disproportionately represented in the foster care system and adoptive families like it is. Parents wouldn’t be desperately seeking help for their child’s behaviors if all a child needed to feel safe was a safe environment. If that were the case, traditional parenting techniques and other trauma-informed interventions would help in healthy families.
2. Children with the disorder reject healthy parenting, no matter how “good” it is.
In healthy families, the parents lead the family with scheduling, meals, activities, and most importantly, emotional regulation. Ideally, parents are their children’s first therapist of sorts. They help their children make sense of their lives and big emotions. Parents can do so because the children can follow the parents’ lead without an abnormal amount of resistance.
Children with reactive attachment disorder/developmental trauma do not trust and therefore do not follow their parents’ lead. They maintain a false sense of control and invulnerability within relationships and keep others, especially caregivers, at an emotional arm’s length. The primary nurturing parent is the greatest trigger.
The closer the primary caregiver attempts to get to the child emotionally and parent them, the more the child will push away. The child resorts to maladaptive coping mechanisms like lying, manipulation, or even violence as a means of escape. The more the child fears attachment, the bigger the behaviors become.
The parent-child dynamic almost always turns upside down with developmental trauma. The child, through their intense and frequent disruptive moods and behaviors, dysregulate every member of the family. The child with the disorder eventually controls the overall dynamics of the home.
3. Developmental trauma/reactive attachment disorder impacts the entire family.
Living with a child with DTD/RAD who displays severe behaviors inevitably leads to post-traumatic stress disorder (PTSD) in every other family member to some degree. My other children suffered from nightmares, anxiety-induced asthma, and bedwetting. My husband had anxiety. And, I had nightmares, social anxiety, and panic attacks.
When the impact of the child’s trauma creates trauma and triggers in the other family members, the whole family is in crisis. No healthy parenting or healing can come from a situation where everyone is displaying trauma responses.
4. The rest of the family, especially the primary caregiver/nurturing enemy, must have the capacity to continue caring for the child.
No one on Joe’s therapeutic team had ever considered that I was burnt out, experiencing compassion fatigue, or suffering from my own post-traumatic stress disorder until after nearly a decade of my parenting a child with severe behaviors.
Because trauma-informed care focuses solely on how the child is coping with their early trauma, many clinicians fail to consider the impact the child’s behavior has on family members. Such therapists miss the critical component of whether the parents can continue to care for the child and if the family as a whole is safe enough to do so.
A child with trauma issues might experience some success with trauma-informed therapy, but not a child with the more serious implications of a brain wired in fear. It’s akin to handing a child with dyslexia a book and expecting them to simply read. They aren’t ready for it.
I lost track of the number of times I was told to simply be a better parent by trauma-informed therapists when I was literally at my wit’s end trying to keep my family safe from Joe’s more severe behaviors.
5. A child with developmental trauma/reactive attachment disorder cannot authentically trust anyone, including trained professionals.
A therapist focused on building trust with a child who cannot trust only provides the child with a greater ability to control and manipulate them. Yet, to build rapport is often what the therapist is most focused on. “Based on traditional therapy modalities, trauma-informed care typically starts with the therapist attempting to establish trust and rapport with their client,” says Lien. “Since a child with a trauma-wired brain cannot trust, however, this effort only enables the disorder to ultimately cause more trauma within the family environment.” A child with the disorder often triangulates their clinician and parents.
When Joe was nine years old, he had a new trauma-informed case manager who fully believed she had earned his trust and had established a rapport with him after months of one-on-one work. She often told me that Joe was having breakthrough after breakthrough. She said he clearly labeled his emotions and used his coping skills.
I, his primary caregiver, never saw these therapeutic breakthroughs or voluntary use of coping skills outside of her presence. It wasn’t until many months later, after a physical altercation Joe had at school, did the case manager understand how Joe had been manipulating her. Once she realized that they had no real rapport or trust and brought up the lying, their dynamic imploded quickly.
A DTD/RAD-specific therapist understands that RAD/DTD is a disorder that manifests in a family environment. They also understand that every member of the family is affected by the disorder. They place the health of the family at the forefront of their work, not on their own relationship with the child.
6. Healing is ultimately a choice.
All children have little control over their lives. The difference for a child with RAD/DTD, however, is that this lack of control terrifies them. They exert whatever control they have to remain emotionally distant and feel safe. If the child does not want to heal, they will manipulate the therapist and the therapeutic interactions by lying and telling the therapist what they want to hear.
A seasoned RAD-informed therapist understands the difference between manipulative behaviors and when the child truly has buy-in to learn to trust. They understand that the child can slowly heal, but not until they make that choice. As Lien tells children with developmental trauma/reactive attachment disorder in his practice, “You have to make a choice to make a change.”
7. Sometimes out-of-home placement is in the best interest of a child with developmental trauma/reactive attachment disorder.
If the child does not want to do the work to heal, the family is too traumatized from living with the child’s severe behaviors for years, and/or physical safety is a concern, out-of-home placement can be the most appropriate option for the child with the disorder.
Because RAD/DTD is a disorder provoked by relationships, living in a residential or boarding school-type setting may help the child learn how to function in society without being continuously triggered by intimate relationships in a family setting. A qualified DTD/RAD-informed therapist will be open to this possibility, whether the out-of-home placement is a temporary or permanent arrangement depending on the severity of the disorder.
Ultimately, we were forced into making this decision for Joe because he did not have buy-in, the entire family was exhibiting signs of PTSD, and our safety was at risk.
Families living with developmental trauma/reactive attachment disorder need a supportive team, not shaming.
Like us, parents of children with developmental trauma/reactive attachment disorder do not always know the extent of their child’s early trauma, especially in adoption situations. Even when a parent does know the extent of their child’s early trauma and understands their struggles early on, they do not have the training or capacity to navigate the disorder on their own — no one has that ability.
No matter how “good” the parenting or initially stable the family, no one can erase the serious impact that early trauma leaves on the brain through love. Since my husband and I didn’t know this critical piece of information early on, we kept pushing. And we, following the advice of trauma-informed therapists, pushed our family past the limits it could withstand.
None of us, including the therapists, understood how our pushing for connection with our son made matters worse for everyone. We didn’t know what we didn’t know. I write these posts, not to add to the despair parents often feel, but to inform and empower them. We wasted precious time and resources going down the wrong path. But other families don’t have to do that too. Find the right path and the right team for your family.
If you need help finding qualified professionals or navigating the way forward for your family, NavRAD24 is right around the corner on April 19-21 in San Antonio, Texas. There is a way. You are not alone.
*name changed to protect identity
About the Author:
After parenting a child with developmental trauma, the author is passionate about furthering advocacy and education for families like hers. She hopes that, one day, other families will receive more support, understanding, and empathy than hers did. For now, she chooses to remain anonymous until that time comes. But she continues to volunteer for RAD Advocates in their mission to educate and advocate to equip families, communities, and professionals to effectively support children with developmental trauma.
Photo by Kelly Sikkema on Unsplash