By Julie DeVore

I. Definition:

The Reactive Attachment Disorder (RADs) is characterized by a difficulty in forming healthy attachment in relationships.

II. Biblical Perspective

The Reactive Attachment Disorder is marked by a lack of attachment and trust which leads to destructive behavior. Children who struggle with RADs must learn to trust God. They must be comforted as sufferers and held accountable as sinners.

Scripture speaks to the child who has experienced great neglect and emotional pain. Scripture comforts the sufferer through the attributes of God. The pain children experience from neglect is not their own fault. However, when pain from neglect leads a child to not trust God, be self-autonomous and disobedient, they must be called to repentance.

The counselor must distinguish suffering from sin, and counsel each accordingly. One suffers because he struggles to attach due to neglect; however, one sins when he allows this detachment to cause him to disobey.

Scripture that comforts the sufferer:

1. Psalm 139 – Promises that their birth was purposeful and planned by God.
2. Genesis 1:27 – Created valuable in the image of God.
3. 3 Corinthians 1:3 – God Comforts us
4. Psalm 10:14, 17-19 – God defends the Fatherless; God is the Perfect Father.
5. Romans 8:27-29 – God works all things for good.
6. Romans 8:31-39 – Nothing can separate us from God’s unconditional love.
7. Hebrews 4:14-16 – God grieves and sympathizes with our weakness.
8. Philippians 4:6 – God is our peace.

Scripture that challenges the sinner:

1. Romans 3:23 – Everyone has sinned in some manner.
2. Proverbs 3:5-6 – God is to be trusted.
3. Psalm 37: 3-7 – Confess sin of self-reliance.
   1. Trust in the Lord
   2. Delight yourself in the Lord
   3. Commit your way to the Lord
   4. Be still before the Lord and wait patiently
4. 1 John 1:9 – Confess sin, God forgives.

III. Secular perspective

Definition: Reactive Attachment Disorder is defined in the DSM-V as “[1]a consistent pattern of inhibited, emotionally withdrawn behavior toward adult caregivers…” A child diagnosed with RADs “[2]minimally seeks comfort” and “Minimally responds to comfort.” The DSM explains that they have “[3]Persistent social and emotional disturbance…” The lack of relationship and attachment forms because a “[4]child has experienced a pattern of extremes of insufficient care…” This is insufficient care from neglect, and lack of basic needs such as food, comfort and stimulation. RADs may be [5]described as “persistent” if it has been present longer than 12 months. The [6]DSM describes this condition as uncommon, occurring in less than 10% of neglected children. Therefore, not every neglected child has RADs, but neglect is the definitive factor of someone who may be diagnosed with RADs.

In 1994, the DSM divided Reactive Attachment Disorder into two specific phenotypes:

1. Inhibited – “[7]persistent failure to initiate and to respond to most social interactions in a developmentally appropriate way.”
2. Disinhibited – “[8]Predominant disturbance in social relatedness is indiscriminate sociability or lack of selectivity in the choice of attachment figures.”

There are [9]three criteria that distinguish RADs from other disorders: Attachment, Timing & Cause.

1. Attachment – “[10]There is a lack of attachment, exhibited by disturbed social relatedness.”
2. Timing – The “[11]onset of symptoms of abnormal behavior begins prior to age five.” RADS is distinctive because it stems from abuse and neglect that occurred before the age of 5 years old.
3. Cause – The cause of RADs is rooted in neglect.

Secular Therapy Methods: 

Because the problem with RADs is attachment, the therapy goal is relearned attachment. Catherin Cain, author of Attachment Disorders: Treatment strategies for traumatized children teaches that “[12]children with RAD need to go through these developmental stages [Trust and Autonomy] a second time in order to experience them in a healthy way…”

1. Dependence and Love Therapy: The American Psychiatric Association teaches that “[13]Children with RAD need to become as dependent upon the adult as a newborn infant is, in order to rebuild the bonds of trust … ” Linda Rice explains that “[14]the child with RAD needs to return to this state of dependency and rely on the caregiver for everything. The caregiver should decide what the child will eat and what the child will wear … ask permission to eat, sleep, use bathroom, or play.”
2. [15]Holding Method – In this method, therapists encourage forced attachment by encouraging the caregiver to hold the child until child resists. They encourage pressure which creates discomfort in the infant. They are seeking to force a response from the child.
3. Re-Birthing Method – Reenact giving birth for an adoptive child to promote attachment with the foster mom. However, Candace a [16]10-year old girl died by suffocation in the “rebirthing” method.

IV. History

The Reactive Attachment Disorder is a newly recognized Psychological Label. It was first described in 1980 in DSM-III as “pathogenic care.” In 1994 the DSM-IV Subdivided RADs into inhibited & disinhibited phenotypes. Then in 2013 the DSM-V broke the category into two different Disorders: Reactive Attachment Disorder of Infancy and Early Childhood and Disinhibited Social Engagement Disorder.

V. Evidence of the Problem

Linda Rice, author of Parenting the Difficult child explains that RADs children are some of the hardest people to counsel. Rice synthesizes some of the common [17]characteristics of RADs:

1. Lack of eye contact
2. Lack of ability to give and receive affection on parents’ terms
3. Demanding, clingy
4. Indiscriminately affectionate
5. Superficially engaging and charming
6. Lying
7. Poor friendships
8. Abnormal eating
9. Theft
10. Destructive to self or others
11. Learning delays
12. Cruel to animals
13. Poor impulse control
14. Intense control battles
15. Hypervigilance/hyperactivity

VI. Etiology

            The main spiritual problem that must be addressed is the child’s lack of trust in God. Then the counselor can begin moving the child to put off his old habits and put on new as their life is being renewed (Colossians 3). However, trust in God must be first. Otherwise, we are encouraging behavior modification instead of internal heart change (James 1:16).

While there are some physical causes that affect RADs, they do not excuse the spiritual need of trust for God. Neglect has caused it to be difficult for a RADs child to trust God and others. However, this does not excuse their lack of trust in God.  

Studies have shown that the neurons also play a quintessential role in the development of a child. Catherine Cain, author of Attachment Disorders: Treatment Strategies for Traumatized Children explains that, “[18]the more the child is exposed to during the early years of life, the more the brain structure the child will have to work with in later years. This is why early childhood experiences are so important. If not used, the neurons are eventually depleted. By the time the child is ten, half of the original one thousand trillion neurons are gone. It is as if the brain is preprogramed with more neurons than we could ever possibly use so that the brain has the ability to adapt to whatever environment it is born into and then discard what it does not need.” Cain further explains that learning is accomplished through patterns in the brain. However, “[19]a chaotic environment, or one that is not predictable, makes it difficult for the brain to figure out patterns it needs in order for these behavioral patterns to form.” Because of this, “[20]a young child left in a poor environment with minimal stimulus during the first two years of life does not stand a chance against a child raised in a rich environment with lots of experiences and sensory input.” Therefore, neglect and neurons do in fact play a major role in the physical causes of RAD.  However, while they should be considered, they should never be the sole resource. A counselor must take in both the physical and spiritual elements of an individual.

VII. Examining the Heart

Possible Heart Themes:

1. Lack of Trust
2. Self-Preservation
3. Autonomy
4. Fear
5. Disobedience
6. Anger
7. Bitterness

Possible Heart Idols:

1. Control
2. Self – Reliance

VIII. Biblical Solutions

The core of counseling must be rooted in Scripture. As Biblical counselors we believe that Scripture is sufficient to counsel every need (1 Timothy 3:16-17). Linda Rice, in her book Parenting the Difficult Child describes five common factors in Reactive Attachment Disorder. Using these 5 labels can help inform our biblical counseling (see Appendix 1).

She recognizes that RADs stems from Neglect. When a child suffers from neglect, Biblical counselors must emphasize the comfort and love of God. The counselor teaches identity in Christ (Psalm 139 & Genesis 1:27) and God’s sovereignty. He is Comforter (1 Corinthians 1:3), Perfect Father and Defender (Psalm 10); He works all for good (Romans 8:27-29), and nothing can separate us from his love (Romans 8:31-39). God comforts the sufferer.

The next stages are Lack of Trust and Self Preservation/Autonomy. The child has “learned” from their neglect experience that people are not trustworthy. Therefore, they trust themselves. We must lead them to the perfect, trustworthy God. He will not fail them. We are commanded to trust Him (Proverbs 3:5-8). Failure to trust God is a sin that must be addressed.

The final stages are Emotions and Habituation. The RADs child lives off emotions and forms destructive habits. Change must take root from within the desires of one’s heart (James 1:16). Old habits must be put off, they must be renewed, and new habits must be put on. (See Colossians 3:5-17).

This cycle of Neglect to Lack of Trust/Autonomy to Emotions to Habituation forms habits that are hard to break. Rice explains that it is [21]difficult to change because:

1. If desire doesn’t change, we don’t change
2. Because its hard/uncomfortable
3. Habits are hard to break

But we believe that hope for change is possible through the power of Christ and Scripture.  (Ephesians 5:8 and Jude 1:24-27).

 

 

 

 

 

 

 

 

 

 

 

 

 

[22]Appendix 1:

 

 

 

 

 

Recommended Resources:

Asher, Marshal and Mary. The Christian’s Guide to Psychological Terms. USA, 2014.

“Biblical Answers for Attachment.” n.d. Faith Therapy. https://www.faiththerapy.org/answers-by-topic/attachment/. 19 February 2019.

Cain, Catherin Swanson. Attachment Disorders: Treatment Strategies for Traumatized Children. Lanhand : Jason Aronson Publishing, 2006.

Emlet, Michael R. “Loving Others as Saints, Sufferers and Sinners (Part 2).” The Journal of Biblical Counseling (2018): 40-65.

Hollinger, Kevin. Rative Attachment Disorder: Helping Adoptive Parents Think Biblically About Attachment. Westminster Thological Seminary, 2007. Thesis.

Rice, Linda J. Parenting the Difficult Child. USA: SeedSown Press, 2012.

Works Cited

American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. Washington: American Psychiatric Association, 1994. Fourth edition.

—. DSM-V. Washington, DC: American Psychiatric Publishing, 2013.

Cain, Catherin Swanson. Attachment Disorders: Treatment Strategies for Traumatized Children. Lanhand : Jason Aronson Publishing, 2006.

Hollinger, Kevin. Rative Attachment Disorder: Helping Adoptive Parents Think Biblically About Attachment. Westminster Thological Seminary, 2007. Thesis.

Rice, Linda J. Parenting the Difficult Child. USA: SeedSown Press, 2012.

The Holy Bible – ESV. Illinois: CrossWay, 2011.

Wilson, Samantha. “Attachment Disorders: Review and Current Status.” Journal of Psychology (2001): 37-.

 

[1] (American Psychiatric Association) 265

[2] (American Psychiatric Association) 265

[3] (American Psychiatric Association) 265

[4] (American Psychiatric Association) 265

[5] (American Psychiatric Association) 266

[6] (American Psychiatric Association) 265

[7] (American Psychiatric Association) 116

[8] (American Psychiatric Association)116

[9] (Rice) 15

[10] (Rice) 15

[11] (Rice)15

[12] (Cain) 151

[13] (Cain)151

[14] (Rice) 151

[15] (Wilson) 11

[16] (Hollinger) 40

[17] (Rice) 51

[18] (Cain) 27-28

[19] (Cain) 31

[20] (Cain) 34

[21] (Rice) 51

[22] (DeVore, 2019) & (Rice) – This figure I created while reading Parenting the Difficult Child.