Throughout our parenting journey, my husband and I were often asked why our son Joe* continued to display severe behaviors, even though he was living in our safe and loving home. This common question stems from a widespread misunderstanding about children with reactive attachment disorder (RAD), otherwise known as developmental trauma. Many people assume that once a child finds physical safety after early trauma, they should be able to calm down and begin to heal.
Unfortunately, this isn't the case.
When Joe’s behaviors didn’t improve but instead escalated, people started questioning our parenting. They blamed us for his lack of healing. What we, along with everyone else, didn’t realize at the time was the critical difference between felt safety and actual safety.
The Difference Between Felt and Actual Safety for Kids with Reactive Attachment Disorder
Felt safety is a perception, not a reflection of reality. According to Stephen Porges’ Polyvagal Theory, our nervous system’s ability to adapt to our physical environment is key to achieving felt safety. For example, if we're being chased by a bear, our nervous system kicks into high gear to protect us. Conversely, in a non-threatening space with trusted people, our nervous system calms.
However, traumatic experiences can compromise this system, making it difficult to match our physical environment's reality. As a result, a person can feel unsafe even in safe surroundings.
Many people assume that once a child finds physical safety after early trauma, they should be able to calm down and begin to heal. Unfortunately, this isn't the case.
One of the diagnostic criteria for reactive attachment disorder (RAD), or developmental trauma disorder (DTD), is abuse or neglect within the first few years of life, even in utero. Dr. John Alston calls reactive attachment disorder, “the post-traumatic stress disorder (PTSD) of infancy and toddlerhood.” Unlike adults whose brains are fully developed when they experience trauma, however, children’s brains are still developing. This means their brains were “hard-wired” with trauma, says developmental trauma expert and therapist Forrest Lien. Because of this, a child can feel unsafe throughout their lives.
The impact that early trauma leaves on the nervous system is not simply left at the doorstep of a loving and nurturing home.
How Reactive Attachment Disorder Manifests
Children with the disorder often carry deep-rooted emotional scars that go beyond what can be seen on the surface. Their behaviors are shaped by early experiences of neglect or abuse, leaving them in a constant state of fear and distrust. Even in a safe and loving home, these children often struggle to feel secure, as their nervous system remains stuck in survival mode. This disconnect between actual safety and their perceived sense of danger leads to a range of challenging behaviors.
Children with developmental trauma often:
Act out from fight-or-flight mode: When a child lacks felt safety, their nervous system stays on high alert. They may engage in fight (arguing, refusing to comply, becoming violent) or flight (running away, lying, or engaging in unhealthy behaviors like overeating or substance use) in misguided attempts to regain a sense of control.
Push away primary caregivers: Children with reactive attachment disorder often feel safest when they are left to their own devices, even though this isn't physically safe. They go to great lengths to push away their primary caregivers, leaving those responsible for their well-being in a difficult position. The adults often worry about the physical or mental health of their family members, including themselves, from the chaos the disorder brings into the home. Primary caregivers can develop post-traumatic stress disorder through the experience.
Remain constantly on edge: Hypervigilance is common in children with RAD. They are always on alert for perceived threats and often misinterpret harmless interactions as dangerous. Sleep is often a struggle for them.
Without felt safety, a child with developmental trauma cannot begin to heal. Restoring a felt sense of safety is more challenging for someone who has never felt safe to begin with, which is why the disorder often affects a person for life.
Looking back, it’s clear that Joe never felt safe with us. When he first stayed with us at 18 months old, he self-isolated by obsessively vacuuming with a toy vacuum, telling us, “I no hear you. I vacuum.” Whenever we tried to engage him, he would move away to vacuum a different spot. We assumed this was typical behavior for a traumatized toddler and that he would eventually come to trust us. But he never did.
Sleep is an activity that requires a felt sense of safety. Unlike his siblings, Joe never napped and rarely slept more than a few hours at night. I often found him sitting upright in his bed in the middle of the night, refusing to sleep. As he got older, he wandered the house while we slept. His psychiatrist eventually prescribed sleep medication, but Joe’s hypervigilance was so intense that he could override the medication’s effects through sheer willpower, staying awake despite being groggy.
Attempts to connect with Joe and nurture his felt sense of safety actually made him feel less safe, leading to more dramatic and violent behaviors as he aged. Each moment of safety and vulnerability he allowed himself was followed by an even greater escalation of behaviors.
The Impact of Reactive Attachment Disorder on Our Family
When a child with the disorder doesn’t feel safe in a safe environment, they create an unsafe environment for themselves and everyone around them. As Joe’s behaviors escalated, our entire family’s felt safety was compromised. At that point, restoring physical safety became our only priority.
When Joe’s behaviors didn’t improve but instead escalated, people started questioning our parenting. They blamed us for his lack of healing. What we didn’t realize at the time, along with everyone else, was the critical difference between felt safety and actual safety.
In third grade, Joe moved to a different school, which provided an hour of one-on-one time with me each day. His therapists recommended that I use this time to connect with him through games and play. Unfortunately, this increased his anxiety and his behaviors worsened over the course of the year. Eventually, our home became physically unsafe. Multiple professionals advised out-of-home placement for him.
Clearing Up Misconceptions
Many well-meaning parents and professionals, like we once were, mistakenly believe that connecting, empathizing and building trust will help a child with developmental trauma feel safe. In reality, these efforts often trigger the child further and worsen their sense of insecurity.
Felt safety for a child with reactive attachment disorder must be built slowly, often over years. Traditional parenting and even therapeutic approaches can sometimes make things worse. In our case, out-of-home placement was the best option for Joe. He was able to regain a sense of felt safety, which allowed him to become physically safe. Meanwhile, our family was able to restore our own physical safety and begin the process of healing.
Our story did not end how we ever intended. It was the last resort. We hope that we can help raise awareness so that other families have more options than we did through the support of better educated professionals and communities.
Frontiers in Integrative Neuroscience. 2022 May 10:16:871227. doi: 10.3389/fnint.2022.871227. eCollection 2022.
Early Human Development. 2017 Oct:113:40-48. doi: 10.1016/j.earlhumdev.2017.07.014. Epub 2017 Jul 20.
*names changed to protect identity
This could be my story. The inability to sleep was the worst problem in the beginning. Staying awake all night and fighting sleep was chronic, The wandering at night became very unsafe for everyone. Several times I would waken to his siblings screaming because he was putting a pillow over their face. He would wander the kitchen and turn on the gas stove. He would take knives and stab and cut things. I would have to continually lock more and more things up. It became impossible for me to sleep for fear of what he might do.
No matter how tired he was, he fought sleep. Melatonin did nothing, OTC sleep medication did nothing. Prescribed sleep aids did nothing. This…