By Kristen O’Neill
There is a quiet war raging in the mental health and social services communities, and it all has to do with a relatively rare disease, reactive attachment disorder, which only affects 1% of the world’s children under five years old (Balasingham). Of course, by those numbers that is still about 6 million children (“World Midyear Population”), and it disproportionately affects children in the foster care system (Balasingham). And really what this war boils down to is simple: the numbers versus the damage the kids face. On one side you have people who believe focusing on such a rare disorder, even within the context of the foster care system, distracts from other prevalent and equally damaging diseases. On the other side, some argue that because RAD is so damaging and more prevalent in foster children, it deserves focus.
But let’s back up for a second and figure out what exactly reactive attachment disorder really is.
RAD is thought to develop when children fail to form significant bonds with their primary caregivers. The placement instability of children in the foster care system may lead to them not having enough time to bond with their caregiver. Despite mental health criteria being updated in 2013, much of the research on this subject still used the previous standards. The old standards listed two subsets of reactive attachment disorder, inhibited and disinhibited. Children diagnosed with inhibited RAD find themselves aloof and distant, possibly to the point of avoiding their caregiver altogether. Disinhibited reactive attachment disorder is quite the opposite, and describes children who form bonds much too easily, even with complete strangers (Balasingham). With the new standards, these subsets have been split into reactive attachment disorder, which describes the inhibited subtype, and disinhibited social engagement disorder, which describes the disinhibited subtype (“Highlights of Changes”). Because most research used the previous standards, all statistics used here describe RAD as including the two subtypes.
It is definitely true that there are other as or more prevalent disorders affecting foster children that are arguably as or more damaging. A study by in 2013 found the prevalence of RAD to be about the same as ADHD disorders and behavioral disorders, and only a little less than emotional disorders. It is worth noting, however, that RAD was the only singular disorder that made it into the most common disorders of the study (Lehmann, Stine, et al.). However another study, done by Matt Woolgar and Emma Baldock found that while there was evidence RAD was over diagnosed in foster children, this problem did not inherently cause other disorders to be ignored, a fact backed up by Lehmann’s study, which also found that RAD had a comorbidity rate of 70% with other mental disorders.
The fact is, as rare or common RAD is believed to be in foster children, it can present a very real issue for parents in an already difficult situation. RAD has been linked with learning difficulties in adopted children (Raaska, H., et al.). These children also have difficulty processing their emotions and controlling their behaviors (Schwartz, Eric, and Andrew S. Davis). This has led to damaging misconceptions being spread to parents and guardians of children diagnosed with reactive attachment disorder, like their tendency to be violent, destructive and manipulative. Damaging and unsubstantiated therapies and treatments have been spread such as “rebirthing” and “holding therapy” (Mercer). Holding therapy involves forcibly “hugging” the child for extended periods of time, often against their will (Hunt). In a particularly well known rebirthing case, therapists wrapped a 10-year-old girl in blankets and pillows, pressing down on her to simulate uterine contractions, while encouraging her to find her way out of the makeshift womb. When the 70 minute session finally ended, the girl was not breathing and was rushed to the hospital, only to die the following day (Josefson). These cures can lead to well-meaning but grossly undereducated parents ending up in court for abuse, or even cause the child’s death (Mercer). The trouble for children diagnosed, and the dangerous misconceptions many are exposed to, make awareness for this disorder a definite priority.
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Lehmann, Stine, et al. “Mental Disorders In Foster Children: A Study Of Prevalence, Comorbidity And Risk Factors.” Child & Adolescent Psychiatry & Mental Health 7.1 (2013): 1-23. Academic Search Complete. Web. 26 May 2015.
“World Midyear Population by Age and Sex for 2012.” US Census Bureau. International Database. Web. 26 May 2015. <http://www.census.gov/cgi-bin/broker>.
“Highlights of Changes from DSM-IV-TR to DSM-5.” American Psychiatric Publishing, 2013. Web. 7 Mar. 2015. <http://www.dsm5.org/Documents/changes%20from%20dsm-iv-tr%20to%20dsm-5.pdf>.
Balasingham, Shawnna. “An Uncommon Disorder That Is Fairly Common among Institutionalized Children.” Colombia Social Work Review 3 (2012). Colombia University Academic Commons. Web. 27 May 2015. .
Schwartz, Eric, and Andrew S. Davis. “Reactive Attachment Disorder: Implications For School Readiness And School Functioning.” Psychology In The Schools 43.4 (2006): 471-479. Academic Search Complete. Web. 28 May 2015.
Raaska, H., et al. “Internationally Adopted Children In Finland: Parental Evaluations Of Symptoms Of Reactive Attachment Disorder And Learning Difficulties – FINADO Study.” Child: Care, Health & Development 38.5 (2012): 697-705. Academic Search Complete. Web. 28 May 2015.
Mercer, Jean. “Giving Parents Information About Reactive Attachment Disorder: Some Problems.” Brown University Child & Adolescent Behavior Letter 29.8 (2013): 1-7. Academic Search Complete. Web. 28 May 2015.
Hunt, Jan. “The Dangers of Holding Therapy.” The Natural Child Project. Web. 31 May 2015. <http://www.naturalchild.org/jan_hunt/holding_therapy.html>.
Josefson, Deborah. “Rebirthing Therapy Banned after Girl Died in 70 Minute Struggle.” British Medical Journal 322 (2001). Web. 30 May 2015. <http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1174742/#__ffn_sectitle>.