What Is Reactive Attachment Disorder?

What Is Reactive Attachment Disorder?

Reactive attachment disorder, also known as RAD, is a mood or behavioral disorder that affects babies and children. It involves difficulties with bonding and forming relationships, as well as having social patterns that are not appropriate, but without an intellectual disability or pervasive developmental disorder (such as autism ) to explain these characteristics.1

Additionally, reactive attachment disorder is caused by some type of issue with care, such as caregivers being unable to fully provide for the needs of the child, not fulfilling physical and emotional needs, inconsistency, or too many primary caregiver changes.

The term “reactive attachment disorder” is sometimes shortened to “attachment disorder,” but reactive attachment disorder is actually a type of attachment disorder, aquaARTS studio / Getty Images Reactive Attachment Disorder vs. Disinhibited Social Engagement Disorder

Attachment disorders are sometimes described as being inhibited or disinhibited. These terms are used to describe the behaviors of babies and young children.

Children who fall into the category of inhibited struggle to regulate their emotions, do not prefer any specific adult or caregiver, do not seek caregiver comfort, or do not show much affection, or they display a combination of these behaviors.2 On the other hand, children who fall into the category of disinhibited may engage or overly engage with all adults evenly, including strangers, and they do not prefer primary caregivers.

Reactive attachment disorder is the inhibited type of attachment disorder. There used to be only one diagnosis for both inhibited and disinhibited attachment, but that has changed with more recent research. The disinhibited type of attachment disorder is called disinhibited social engagement disorder, or DSED.1 Characteristics

The characteristics of reactive attachment disorder are the inhibited type, meaning that the child behaves in ways that show little or no attachment to parents or other caregivers. This is seen in babies and young children. They are not able to bond with their parents or primary caregivers in a way that is healthy and secure.3 Reactive Attachment Disorder Symptoms

Symptoms of RAD include:

  • Avoidance of comfort when distressed
  • Avoidance of physical touch
  • Difficulty managing emotions
  • Not being affected when left alone
  • Not making eye contact, smiling, or engaging
  • Emotional detachment
  • Excessive rocking or self-comforting Inability to show guilt, remorse, or regret
  • Inconsolable crying Little or no interest in interaction with others
  • Need to be in control
  • Tantrums, anger, sadness

Diagnosis Reactive attachment disorder can be diagnosed by a mental health professional such as a psychiatrist or psychologist specializing in children. They do this by assessing the child based on the fifth edition of the “Diagnostic and Statistical Manual of Mental Disorders” ( DSM-5 ) diagnostic criteria. Then they assess the child in terms of how the symptoms affect their ability to function.4 […]

What Is Family Therapy?

What Is Family Therapy?

Family therapy is a type of psychotherapy, or talk therapy, that looks at the entire family, including the relationships between the individual members of the family.1 This is a treatment used to address the mental health challenges of one or more family members, address relationship challenges between two or more family members, and improve family dynamics as a whole.

Family therapy is sometimes known as marriage and family therapy, couples and family therapy, and family counseling.

Family therapy is used to treat a wide variety of mental health conditions of one or more members of the family. It can also be used to support the emotional side of physical health conditions, relationship and bonding challenges, and overall family well-being.

Sometimes this is used to help support one member of the family who is struggling with a mental health diagnosis by addressing their interactions and relationships with other members of the family. Other times, there is more of a focus on the family as a whole.

For example, a family struggling with frequent disagreements may seek support through family therapy, even without a specific diagnosis, to improve communication, strengthen their connection, and navigate stressful situations.2

Conditions Treated With Family Therapy

Family therapists can address a variety of situations and conditions, including:

  • Addiction
  • Adoption
  • Anger
  • Attachment disorders
  • Behavioral challenges
  • Blended family
  • Communication challenges
  • Conflict
  • Death
  • Disability
  • Divorce or separation
  • Domestic violence
  • Eating disorders
  • Emotional challenges
  • Grief
  • Infertility
  • Marital conflict
  • LGBTQ challenges
  • Physical health concerns
  • Race, ethnic, or cultural challenges
  • Relationship difficulties
  • Religious challenges
  • Self-harm
  • Transitions
  • Unemployment

The process of family therapy depends on the situation, why the family is seeking support, and the family members involved. It also may depend on the ages of the children and the abilities and willingness of each family member.

Typically, the process begins with an evaluation or assessment. The provider may speak with the family as a group, members individually, or both individually and as a group. Children could take part in play therapy, which is a form of therapy that involves playing together to learn about the thoughts and feelings of the child.

Objectives of Family Therapy

Some of the objectives of family therapy sessions include determining how well the family expresses thoughts and emotions and solves problems, looking at the rules, roles, and behavior patterns of the family that lead to problems, and evaluate the strengths and weaknesses of the family.2

From there, the therapy sessions can focus on how to work through issues, strengthen relationships, and function better together. This happens with conversations between the provider and the family members, either one-on-one or in a group.

10 Evidence-backed Tips to Teach Kids Focus and Concentration

10 Evidence-backed Tips to Teach Kids Focus and Concentration

Teaching kids to listen, focus, follow instructions, keep rules in mind and practice self-control

Adele Diamond, a well-known Professor whose studies have focused on self-regulation, argues that children should be taught to:

1. Develop self-control, i.e., they should learn to do what is appropriate rather than what they want to do.

2. Develop the working memory, i.e., they should be helped to hold information in memory while mentally incorporating new information.

3. Develop cognitive flexibility, i.e., they should learn to think outside the box.

Diamond believes that teaching self-regulation skills can help improve children’s concentration and focus. These skills can help your child learn to follow instructions and persist even when they encounter enormous challenges. Other studies have found that self-regulated children are able to listen, pay attention, think, then act.

Everything you need to know to help your child focus and concentrate better

“My child won’t concentrate on anything” is a rather common parenting complaint. While a child’s inability to focus is usually a common cause of concern, all children are easily distracted and generally have shorter attention spans than adults. They are more curious and more easily distracted when they feel little interest for the tasks and activities they are asked to do.

Children’s concentration tends to improve as they grow older and develop their self-control skills. That said, some children struggle more with focusing and resisting distractions. The problem with children’s lack of attention is that it contributes to their learning and to their day to day lives.

So first let’s look at what may be behind your child’s inability to pay attention.

Some of the common causes of children’s lack of focus and concentration

1) Anxiety may be the reason your child can’t concentrate

Anxiety is a common but often ignored cause of inattention among children described as “unfocused”, and this actually makes perfect sense. It is not uncommon for anxiety to “block” your child, meaning that listening to and following instructions may be more complicated for such a child. Your child’s separation anxiety or worry about doing something wrong at school or even embarrassing or humiliating themselves may mean that they are more likely to have difficulty paying attention.

2) Insufficient sleep has an impact on your child’s ability to concentrate

It is a well-known fact that poor sleeping habits have a negative impact on children’s focus and concentration. If you think that your child’s lack of sleep may be behind their inability to focus, ensure that they are getting the appropriate number of hours of sleep every night or taking a mid-day rest if they need to.

DESR: “Does ADHD Emotional Dysregulation Ever Fade?”

DESR: “Does ADHD Emotional Dysregulation Ever Fade?”

Emotional dysregulation is a core facet of ADHD that is excluded from official diagnostic criteria and most symptom tests — a contradiction that is pushing researchers and clinicians to further investigate the connection. One such ADHD expert is Russell Barkley, Ph.D., who has coined the term deficient emotional self-regulation (DESR) to describe this fundamental trait.

Because DESR is a novel concept to many, questions abound. Below, I answer several posed during my recent ADDitude webinar titled “Deficient Emotional Self-Regulation: The Overlooked ADHD Symptom That Impacts Everything.”

Q: Does emotional dysregulation change over time? Does it ever improve?

Emotional dysregulation does change and it can improve, but it depends on the individual and the factors involved. For instance, emotional self-regulation is rarely elevated as an issue in toddlers. We don’t expect 4-year-olds to manage their emotions very well. Parents are typically more concerned with the impulsive aspect of emotion at this stage.

But by the time we get into late adolescence, and especially adulthood, we do expect individuals to have developed that second stage of emotional control: top-down executive management (or moderating emotional reactions to evocative events). However, DESR impairs just that —processes related to emotional self-regulation. And that leads to more disparaging moral judgment about adults with ADHD than it would in much younger individuals.

It’s almost like the two components of this emotion problem in ADHD — emotional impulsivity (EI) and DESR — trade places as individuals age. The former is more problematic in children, while the latter becomes a more compelling deficit for the adult individual.

We also know that ADHD symptoms fluctuate over time for many individuals, which may mean that issues like emotional dysregulation also change in severity or degree of impairment. And keep in mind that ADHD mostly persists to some degree from childhood to adulthood for 90% of people.

But can emotional regulation be “trained?” In children, the chances of that are quite slim because they haven’t yet developed the appropriate self-regulation skills that such training would require. Interventions like medication, parent training, and controlling for environmental triggers may be most helpful for this stage. Adults, however, may benefit from cognitive behavioral therapy (CBT) and mindfulness-based programs especially reformulated for adult ADHD in recent books, both of which help the individual deal with many aspects of emotional dysregulation.

Q: Do men and women with ADHD experience emotional dysregulation differently?

Generally, we know that males are more prone to exhibit aggression and hostility, which are associated with externalizing disorders, while females are more prone to anxiety and mood disorders. Both, however, do struggle with impatience and frustration, and the emotional dysregulation component in ADHD will only exacerbate that.

Q: When might DESR symptoms start to appear in children?

DESR usually appears between ages 3 and 5, though it may be quite obvious in a younger child who is significantly hyperactive and impulsive. Still, many families write off this behavior, believing it to be developmentally normal (i.e. the terrible twos), only realizing later on that the child is quite hot-headed and emotional compared to peers. Some of these children will go on to develop oppositional defiant disorder (ODD). If we accept DESR as a core feature of ADHD, we can see why the disorder poses such a significant risk for ODD and related disorders.

DESR: Why Deficient Emotional Self-Regulation is Central to ADHD (and Largely Overlooked)

DESR: Why Deficient Emotional Self-Regulation is Central to ADHD (and Largely Overlooked)

Deficient emotional self-regulation (DESR) is a relatively new term used to describe the problem of impulsive emotion coupled with emotional self-regulation difficulties long associated with attention deficit hyperactivity disorder (ADHD or ADD). DESR may be new to the ADHD lexicon, however I argue that it is a core and commonly overlooked component of the disorder — and one that can help predict a patient’s impairments, and even improve diagnostic and treatment practices.1

Emotional dysregulation is noticeably missing from diagnostic criteria for ADHD. However, most patients and experts recognize that it is central to the disorder2. DESR, a manifestation of emotional dysregulation, specifically refers to deficiencies with these four components of emotional self-regulation3:

  • Ability to inhibit inappropriate behavior triggered by strong emotions. I argue that this emotional impulsiveness (EI) is an aspect of poor inhibition associated with ADHD that is illustrated by low frustration tolerance, impatience, being quick to anger, aggression, greater emotional excitability, and other negative reactions, all of which are related to the impulsivity dimension of the disorder
  • Ability to self-soothe and down-regulate a strong emotion to reduce its severity
  • Ability to refocus attention from emotionally provocative events
  • Ability to organize or substitute more moderate, healthier emotional responses in the service of goals and long-term welfare

To understand the role of EI and DESR in ADHD is to acknowledge the prominent role of emotional control difficulties in the disorder’s appearance and outlook, including understanding the following:

  • Why these issues are prevalent in individuals with ADHD
  • Why major comorbid disorders often develop as a result of these challenges
  • The major life impairments not adequately explained by traditional symptoms of ADHD

A wealth of compelling evidence — from ADHD’s clinical conceptualization over time to neuroanatomical and psychological research — clearly shows that EI and DESR are key components of ADHD and should be incorporated into the disorder’s diagnostic criteria and treatment practices.

EI and DESR: Evidence of Its ADHD Ties

1. EI and DESR in Historical Concepts of ADHD

Conceptualizations of ADHD have included emotional control problems for centuries. One of the earliest references to attention disorder in western medical literature4, a textbook written by German physician Melchior Adam Weikard in 1770, characterizes those who have a “lack of attention” as “unwary,” “flighty,” “careless,” mercurial,” and “bacchanal.”

EI and DESR through history4:

What Is Parentification?

What Is Parentification?

Do you feel like you were pushed into taking care of your parents or siblings when you were only a child yourself? That you became an adult before you were ready for the role?

If you’re nodding, you may have been parentified. Being a “little parent” involves excessive responsibility or emotional burden that can impact a child’s development.

That said, it’s important to remember that some responsibility is a good thing. Helping out a parent on occasion and at the right level helps a child believe in themselves and their ability to one day also be an adult.

Let’s take a closer look at how and when the line into parentification is crossed.

In the typical order of things, parents give and children receive. Yes, sometimes — especially in the early morning hours when your baby is teething — the giving can seem never-ending.

But in general, parents are expected to give their children unconditional love and to take care of their physical needs (food, shelter, daily structure). Emotionally secure children whose physical needs are taken care of are then free to focus their energy on growing, learning, and maturing.

Sometimes, though, this gets reversed.

Instead of giving to their child, the parent takes from them. In this role reversal, the parent may relegate duties to the child. At other times, the child voluntarily takes them on.

Either way, the child learns that taking over the duties of the parent is the way to maintain closeness to them.

Children are pretty resilient. We’ve already said that some level of responsibility can help a child’s development — but 2020 research takes things further. The researchers suggest that sometimes, parentification can actually give a child feelings of self-efficacy, competence, and other positive benefits.

It seems that when a child feels positively about the person they’re caring for and the responsibilities that come with the role of caregiver, the child develops a positive self-image and feelings of self-worth. (Note that this isn’t a reason to pursue or justify parentification.)

Not all parents are able to take care of their children’s physical and emotional needs. In some families, the child takes over the role of caregiver in order to keep the family functioning as a whole.

Parentification can happen when a parent has a physical or emotional impairment, such as the following:

  • The parent was neglected or abused as a child.
  • The parent has a mental health condition.
  • The parent has an alcohol or substance use disorder.
  • The parent or a sibling is disabled or has a serious medical condition.

Parentification can also happen when life throws curveballs, like:

  • The parents are divorced or one parent has died.
  • The parents are immigrants and have difficulty integrating into society.
  • The family experiences financial hardship.

There are two types of parentification: instrumental and emotional.