Reactive Attachment Disorder and Brain Architecture

By June Naureckas, CEI Intern & Suzan Mullane, CEI Faculty

Some children have difficulties bonding with others. In extreme cases, these children may appear sad, listless, and withdrawn. They may show little or no interest in toys, playing, or interacting with peers. Normally, young children will respond when an adult picks them up to comfort them; however, in cases of Reactive Attachment Disorder (RAD) children may not quiet—the yelling and distress may continue. What role do early classroom teachers have when young children show such distress?

The Brain and Early Attachment

Mirror neurons are essential for healthy child development; they are a small circuit of cells that fire when we observe someone performing the same task as us, such as smiling or laughing. In other words, “they collapse the distinction between seeing and doing” (Scientific American, 2019).

Harvard University’s Center for the Developing Child (HUCDC) illustrates mirror neurons graphically through the “serve and return” process with short, informative videos. Imitation, stimulation games, and responding to infants’ physical/emotional needs are all part of “serve and return.” The feedback loop of positive human interaction is key for the vulnerable early childhood brain, because a sense of safety is essential for healthy brain development.

In cases of extreme neglect, brain architecture and the bonding process become disjointed, even high-jacked. Multiple foster homes, chaotic neglectful families, orphanages, or transitional care situations, where the child has an insecure attachment, can increase the likelihood of Reactive Attachment Disorder. RAD is defined as a lack of responsiveness to comfort. Tragically, lack of empathy, and in older children a complete lack of perspective taking for other individuals, are symptomatic of RAD; this makes caring and working with these children difficult. Worse still, it makes a young life lonely when human relationships are needed to thrive, but difficult or impossible to establish.

Understanding Reactive Attachment Disorder

Not every child who experiences a trauma will develop RAD, even when living conditions are horrific. RAD is rare, but “unfortunately it is often misused and misunderstood to describe a wide range of misbehaviors” (Perry, 2006). The Diagnostic and Statistical Manual of Mental Disorders (DSM–V) defines Reactive Attachment Disorder as the “absence of attachment behaviors and emotional dysregulation” (Lehmann et. al., 2018).

Although RAD can look very similar to autism spectrum disorders (ASD) in children under 5, a child cannot be diagnosed with RAD if they have a pre-existing diagnosis of ASD (Mayo Clinic, 2017). Unlike ASD, which are congenital conditions, RAD is a response to pathogenic early care (Walter and Petr, 2004) and is not the same thing as insecure attachment. Many children who meet RAD criteria are securely attached (Pritchett et. al., 2013), while many children have an insecure attachment style without an attachment disorder (Walter and Petr, 2004).

The Importance of Early Intervention

A child with RAD neither seeks nor responds to comfort and has at least two of the following three emotional symptoms (Lehmann et al, 2018):

  • reduced social responsiveness
  • reduced positive affect
  • sudden/unexplained outbursts of irritation, sadness, or fear

Children with RAD are often perceived as angry and unpredictable by peers, which makes forming the relationships they need to experience a secure attachment very challenging. If these symptoms persist without intervention, RAD manifests in older children and adolescents as a lack of trust in or affection for caregivers. Symptoms of RAD were present even in foster children who had been with their foster family for six years or longer (Lehmann et. al., 2018). In fact, children’s symptoms did not decrease in intensity the longer they spent with a family. This highlights the need for early intervention when RAD is detected.

When an educator suspects a child in their room might have RAD, there are several things they can do to help that child heal:

  • Foster a positive relationship with that child to show the child what healthy interaction with adults looks like.
  • Create a safe and welcoming environment so the child has a space where the child can feel secure among people.
  • React to behavior difficulties with compassion, instead of punishment, by asking about the feelings that are the root of the behavior.
  • Help the child practice emotional regulation using mindfulness techniques like breathwork, body scans, and yoga. (Note that some children who have experienced a trauma have emotional difficulty with traditional meditation.)
  • Provide the child’s caregivers with information about therapeutic interventions designed to help children who have experienced a trauma. (See articles in this month’s WowEd! newsletter to learn more about Dr. Bruce Perry’s Neurosequential Model of Therapeutics and the Cognitive Behavioral Intervention for Trauma in Schools.)

Bonding and attachment increase empathy—the cornerstone of healthy relationships. When the “serve and return process” is broken, there is little safety and little brain growth. 

References

Lehmann, S., Monette, S., Egger, H., Breivik, K., Young, D., Davidson, C., & Minnis, H. (2018). Development and examination of the Reactive Attachment Disorder and Disinhibited Social Engagement Disorder Assessment Interview. Assessment. DOI:10.1177/1073191118797422

Mirza, K., Mwimba, G., Pritchett, R., & Davidson, C. (2016). Association between reactive attachment disorder/disinhibited social engagement disorder and emerging personality disorder: A feasibility study. The Scientific World Journal,2016, 1-8. DOI:10.1155/2016/5730104

Perry, B. & Szalavitz, M. (2006). The Boy who was raised as a dog. Philadelphia, PA: Basic Books.

Pritchett, R., Pritchett, J., Marshall, E., Davidson, C., & Minnis, H. (2013). Reactive attachment disorder in the general population: A hidden essence disorder. The Scientific World Journal, 2013, 1-6. DOI: 10.1155/2013/818157

Mayo Clinc. (2017, July 13). Reactive attachment disorder.

Scientific American. (2019). The mirror neuron revolution: Explaining what makes humans social.

Walter, U. M., & Petr, C. (2004). Reactive attachment disorder: Concepts, treatment and research. Best Practices in Children’s Mental Health,1(11).

Zimmermann, P., & Soares, I. (2018). Recent contributions for understanding inhibited reactive attachment disorder. Attachment & Human Development,21(2), 87-94. DOI:10.1080/14616734.2018.1499207

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