A Developmental Model of Behavior in Children Diagnosed with Reactive Attachment Disorder

Background and Purpose: One of the least researched and understood children’s mental health disorders in the DSM-IV is reactive attachment disorder (RAD). Children with RAD are commonly exposed to early childhood neglect (ages 0-3), and are identified by their lack of discernment between parental figures and strangers. They are also known to engage in a myriad of other behaviors, such as hoarding, stealing, self-harm, and verbal and physical aggression toward others. Currently, there is little research examining RAD in the context adoption and family environments.

This paper fills this gap by providing an in-depth understanding of how RAD behavior emerged in children who were adopted by families in the United States. Drawing on both retrospective and contemporary accounts, parents and children provided narratives on how RAD behaviors emerged overtime in the adopted child, along with how they coped with stress caused by these behaviors, and the types of interventions/supports that were used.

Methods: The sample included five families, all of whom adopted (domestically or internationally) a child diagnosed with RAD. Participants were recruited via advertisements on local adoption and mental health agency websites and social networking websites (e.g. Facebook). There were a total of 28 participants: parents (10), relatives (1), and children (17; ages 5-17). To obtain rich, descriptive narratives, interviews were conducted in three stages (individuals only, all family members, and parents only) and employed a reflexive interviewing approach adapted from Duneier’s (1999) ethnographic work. The three-stage interview design yielded a total of 38 interviews. The analysis was guided by the principles of grounded theory, and was performed by systematically reading each interview and assessing for common properties that could be developed into broader themes. These themes were then developed into propositions, and eventually combined into a developmental theory to explain RAD behavior. The adopted child’s mental health assessments and individual education plans were also analyzed as a form of data triangulation. Data were collected and analyzed over a 6-month period and ended when new findings ceased to emerge.

Findings: The results of the study revealed that the children with RAD exhibit behavior that aims to exact control over their environment. These behaviors were distinct and found to emerge at similar times in the children’s development. Early behaviors (ages 3-6) included hoarding food and trash, while later behaviors (ages 7-11) were more sophisticated, and included deception and the manipulation of others. Aggressive behaviors were found to be used as a means for the child to regulate heightened levels of anxiety and were directed toward caretakers(s) for whom the child had the strongest relational bond.

Conclusions and Implications: The findings suggest children with RAD may have difficulty with developing a sense of safety and with the emotional regulation of anxiety. Child welfare workers who provide adoptive parents with this information may better prepare them to address for the kinds of behaviors that can emerge. Additionally, clinicians could use this information to develop interventions that serve to enhance coping abilities and sense of personal safety in children with RAD.