RAD

This past week I was assigned to read an article for class entitled “Reactive Attachment Disorder: What We Know About the Disorder and Implications for Treatment” from a professional journal titled simply Child Maltreatment. Reactive Attachment Disorder is a nebulous “disorder” applied broadly to children who, primarily, have suffered abuse and neglect from their primary caregivers before the age of 5, who then have difficulty forming close bonds with any other caregivers, and which presumably carries into later life, making it difficult for the child to form close bonds with anyone. Their relationships are generally marked by anxiety, distrust, fear, heightened arousal, hostility, etc. This can also, paradoxically, especially in young children, lead to indiscriminate affection, generally to strangers, which, in later life, can manifest in highly dependent or co-dependent relationships when the person with “reactive attachment disorder” hasn’t learned effective coping skills or age-appropriate self-care skills.

There is a lot of controversy surrounding the diagnosis in general (like, whether or not it even actually exists, for starters), but that’s not what I wanted to write about. Particularly when studying treatments for children, in the past there have many, many ill-conceived therapies and treatment methods with absolutely zero emperical basis in effectiveness, and in this article, the authors extensively review some of the more discounted and troubling treatments people in the past have used to treat RAD. Sometimes when you read these things you just slap your forehead and wonder what on Earth these “professionals” and “doctors” could possibly be thinking. And I quote:

One of the more controversial and more well known of these treatments is the coercive technique, also known as holding, attachment, or rage reduction therapy. As critiqued by James (1994), these types of techniques involve three primary components: prolonged restraint for purposes other than protection, prolonged noxious stimulation (e.g., tickling, poking in the ribs), and interference with bodily functions. More specifically, treatment appointments are scheduled in which several adults hold the child immobile for a prolonged time period. This restraining is not related to the child’s immediate behavior, and the procedure may be repeated daily. During the restraining period, the clinician actively attempts to provoke and arouse the child by providing noxious stimulation such as yelling repeatedly in the child’s face, poking or tapping the child, tickling, or pulling on limbs. The child may try to resist by screaming, fighting, or crying, but eventually breaks down. When the child reaches the point of surrender, he is then given to his caregiver(s), to whom he reportedly instantly attaches…the child is theorized to have repressed rage, which is interfering with his ability to form an attachment. The prolonged restraint, noxious stimulation, and interference with bodily functions are theorized to release the rage and teach the child that adults can and will control him. He is then thought to be capable of forming a healthy attachment. Parents may be told that this is the only way to keep their child from becoming a serial killer, murderer, or psychopath, and that alternative conventional treatments will not work for their child.

As someone who works with kids who could probably every single one be described as having some sort of reactive attachment whatever, I feel like I at least partially understand the desperation some parents, foster parents, or adoptive parents must feel when trying to deal with their kids. And as someone who does have to engage in “non-violent physical crisis intervention” holds on children who are getting violent, I can tell you that it’s awful, and makes you feel a little bit like a monster every time you have to do it. But in that case, the kids are displaying an imminent threat to themselves or someone else, and that’s what you have to do to keep everyone safe.

I don’t even know where to begin with what’s been described above.

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