RAD

2. No matter how insulting the child can be, how many times they say they hate you, wish you were dead, etc., you must rise above it. It can be very tiresome, but remember, we are the adults in this scenario. It is vital for us to set a loving example with firm limits. By reacting to negativity, we are reinforcing negative behaviors.

3. When you are parenting a RAD child, it is extremely easy to fall into the pattern of self-doubt. Parenting a child day after day who consistently fights you every step of the way can be one of the most discouraging times a parent will ever face.

4. Avoid power struggles with your child. Walk away whenever possible. Attempting to redirect the child can be very helpful for both of you. When violent behaviors are present, seek immediate professional help.

5. This is your child...don't be ashamed to ask questions or seek other's opinions. Make a strong commitment by becoming an advocate for your child. In the long run, the education you receive will benefit the entire family.

6. Get on your soapbox and shout from the rooftops. Educate others about RAD and what your child needs. Again, advocacy for our children will benefit them for the rest of their lives.

7. Don't be afraid to ask for help outside your typical family resources. There are many experts in the field of Reactive Attachment Disorders, you can find the help that you need.

8. Don't second guess yourself. Don't listen to the criticism of others who believe that if you love your child enough, RAD will go away.

9. Do take time for yourself. Stress causes many physical ailments. Recharging your batteries will most certainly give you a new attitude. Find respite care and use it.

10. Join a support group. Support among families is a crucial element to successfully parenting RAD children while keeping your sanity intact. Please remember that you are not alone. Families like yours have encountered the very same issues that you are struggling with. Don't be ashamed and don't be afraid to reach out.

An appropriate treatment program for a child with multiple challenges requires the participation of several specialists. Most of the treatment is provided by primary caregivers, such as parents or substitute parents, in their everyday interactions with the child. It is hoped that these caregivers can rely on the expertise and advice of a mental health professional who is aware of the emotional needs of children, the phenomenology of attachment disruptions, and the need to repair and recreate the sense of security in the child. Referral to a mental health professional may be critical.

• Play therapy with a child psychotherapist, particularly in the presence of the primary caregivers, may help the child and the caregivers to express the emotional needs, fears, and anxieties of the child in the context of play. Caregivers may become more sensitive to the issues (eg, anger about having been abandoned, maltreated, left alone, or locked up) faced by their child. Also, children may be able to express their dependency needs (eg, to be a baby, to be looked after, or soothed) through play.

Several therapeutic ingredients seem important in treating inhibited RAD and disinhibited RAD. When caregivers provide the ingredients described below, the child may experience healthy dependency, rely on someone, and trust a new person. That is to say, the child may become attached.

• Security, or a sense of psychological safety, helps promote the development of a new attachment relationship. Constant or intense stress and anxiety do not facilitate a sense of security but, rather, promote guarding behavior. To correct the scars or sequelae of attachment disruption, the clinician, parent, or caregiver must have time and be ready, without judging, to listen to the child. Limits must be set for the child, but these should be set in the context of empathy and compassion. Only when the verbal children feel emotionally secure will they begin talking about what has happened to them and, likely, to their siblings and gradually develop trust in the new caregiver.

• Stability refers to the permanence of the attachment figure. The child needs time to develop trust in a new primary caregiver. After disruption(s), these children need to learn to recognize their needs and to learn that these needs can be met repeatedly by the same person.

  The child might fear that the caregiver will disappear, die, or go away, thus leading to another disruption.

  Some children take a long time (more than a year) to trust a caregiver again; others trust a caregiver after receiving just a few months of sensitive care. This may be a temperamental feature (eg, orientation toward others vs inwardness) or a reflection of the quality of the match between the child and the new caregiver.

  Separations and disruptions may reactivate a defensive isolation on the part of the child.

• Sensitivity, or emotional availability, refers to attentiveness to the child’s needs and is crucial in care taking. Inform substitute caregivers that though the child may or may not be mature cognitively, the child’s emotional development frequently is delayed in areas such as emotional expression, attachment, and age-appropriate independence. Hopefully, during the course of treatment, the child will gradually begin to develop feelings of dependency toward the primary caregiver because the child learns to expect the caregiver will be physically and emotionally available at times of crisis. During this process, caution parents to expect and tolerate occasional regressive behaviors and to view them as signs that the child is psychologically working through earlier phases in development.

For instance, a child who typically is independent and suspicious of others may suddenly express needs for dependency, complain of fears, want to sleep in the parents’ bed, and wish to be mommy’s little boy or girl. Recommend that the parents, in a sensitive way, allow the child to express and experience that dependency. Encourage parents to think of the child as emotionally younger and as having legitimate emotional needs appropriate for his or her emotional age.

Some children are almost frozen emotionally because, with multiple placements and relationships, it has not been safe for them to express age-appropriate emotions. These children might at first appear to be obedient because they do not express anger and are not prone to emotional outbursts. As time goes by, expressing emotions, such as anger, jealousy, and neediness, becomes safe. The caregiver may observe the appearance of temper outbursts, jealousy, and anger toward him or her upon separation. Things that previously did not seem to matter to the child (eg, if the caregiver comes or goes) suddenly may be upsetting. For example, a child who never seemed to mind separations may strongly protest the parent’s leaving by clinging or going to the parent for comfort. Encourage caregivers to see these behaviors as positive signs that a new attachment and a deeper level of trust have formed because it feels safe for the child to express these developmentally appropriate dependency needs.