This chapter contains a case study of a child with Reactive Attachment Disorder (RAD), which includes a description of trauma that may be distressing to some readers.
As I said previously, I don’t believe that professionals know how to best deal with RAD traits. Reactive Attachment Disorder (RAD) presents unique challenges, both for the children who live with it and the caregivers or professionals striving to help them. Over the years, various approaches have been tried, some of which now seem profoundly misguided. In the past, for instance, “experts” thought it best to facilitate a rebirthing process, which involved having the child reenact birth by going through blankets with staff holding them and easing them through. This was done with the hope of replicating a symbolic rebirth and fostering a new attachment bond between the child and caregiver. Unfortunately, several children actually died using this technique, so it is thankfully no longer used.
The abandonment of such harmful practices has led to a shift in how professionals address RAD. Now, experts emphasize strength and positivity, encouraging caregivers to focus on building the child’s resilience and fostering nurturing relationships. However, while this shift is undoubtedly safer and more hopeful, I believe it still falls short in addressing the core issues of RAD. There is still little mention of “control,” which I believe is the key. Without a focus on helping children regain a sense of internal and external control over their world, we risk overlooking a crucial aspect of their healing journey.
Another professional, widely considered to be an expert on RAD, had a different approach. I interviewed foster/adoptive parents who spent a large sum of money for a single session in the early 2000s. It amounts to the child being in a room with a therapist while the parent/caregiver stands behind a one-way mirror. The primary conceit is for the therapist to traumatize the child, and at the right moment, the caregiver rushes in to rescue the child, thereby creating trust. Eventually, this particular therapist moved away from this method; however, this earlier approach may be still circulating today. In general, I do believe that experts understand it's about control but in the past have emphasized making the parent have control and not the child.
Yet another individual who understands the disorder well and has published resources has a completely different approach. This person is a capable foster and adoptive mom, and initially began her treatments with no licensure although she may have been granted one in more recent years, she has aligned herself with several licensed professionals. A very accurate description of RAD is given but it’s an oppositive technique from my own. Sadly, I believe she has developed a treatment that is contrary to healing and growth. She holds weeklong camps around the country and charges a significant amount of money for families to attend together. Having read her book, I was interested in the exact process she used.
Thirteen years ago, I had begun seeing a family who had adopted two boys from South America. The oldest, an early teenager, was on the severe end of the RAD-spectrum and I was concerned about the safety of the adoptive parents. After introducing them to the book (mentioned in the paragraph above) so they could understand the disorder better, they decided to attend one of the camps. Afterwards, I met with them to learn some of the tactics used there. As an overall glimpse, it entails them arriving at the camp where staff greet them “Hello awesome mom! Hello awesome dad!” and then proceed to completely ignore the child(ren). Children were required to walk subserviently behind and to sit on parents’ feet during circle talks on the floor. During a meal if a child was acting out, the parents would raise their hand and the child(ren) would be whisked away and put in a small room so the parents could enjoy the rest of their meal in peace. The overarching theme was respect for the parents and disrespect for the children in an effort to demonstrate that the parent has total control and the child has none.
In all three of these therapies and/or treatments I maintain that the child is disrespected and re-traumatized. I cannot believe it to be in a child’s best interest to be traumatized further when they have already gone through so much. I also think it’s a lie to tell a child they have no control because in reality they have total control and that is the issue - their inability and unwillingness to give any of that control away because in the past it has proved dangerous.
I am not suggesting that some of the others’ techniques haven’t had some success, or they wouldn’t be considered experts or stand the test of time. They may have made positive changes since I completed my literature review. However, I still think telling a child they are powerless really just puts them back in the situation they came from. They have already been powerless and it’s time to be honest about their power and teach them not how to tamp it down, but how to channel it in productive, successful practices.
This perspective raises critical questions about the balance between providing guidance and fostering independence in children with RAD. While many approaches focus on managing behaviors, there is often a lack of emphasis on empowering the child to take ownership of their actions and decisions. Empowerment doesn’t mean giving unchecked freedom; rather, it involves teaching children to recognize their ability to make choices and understand the consequences of those choices in a supportive environment. This nuanced approach can pave the way for meaningful change, helping children move from a state of perceived powerlessness to one of self-awareness and agency. However, addressing these issues is further complicated by a hallmark quality of RAD: manipulation. The name and identifying information has been changed to protect their identity.
Mary was an adorable seven-year-old when she came into care. She did everything within her power to get and keep attention. As much as we hate to think about it, many children come into foster care with significant trauma and emotional scars. This little girl was sexually assaulted when she was five years old and because of this past trauma would use this to scare other children at school by enlisting their help during recess to capture bad men. As a small child with an imagination that was processing her trauma, she would go down to the nurse to say she was pregnant and cramping and worried about a miscarriage; it was in May, so she was worried they weren’t just “Braxton Hicks” because she wasn’t due until the fourth of July. In her mind, this was her second baby and the first lived with his father in California, but he flew over often to see her.
One Friday afternoon, I received a call from the principal. On the bus, Mary had worried aloud to a fifth-grade boy that on Fridays she was never quite sure that her foster father wasn’t going to rape her. The child protective services case manager and I eventually had to work our way up and down the street to make sure everyone knew that she was safe and no one in the home was hurting her. A week after the worker and I met with everyone at the school including teachers, principal, secretary, nurse, and social worker, we received an email from the social worker with concerns that Mary had come down to say that her foster mom had told her she was too fat and was only feeding her grass and milk. The worker did include the foster parents in on the email, so imagine Mary’s surprise when the foster father arrived at the table that night with a bowl of grass and a glass of milk and said he just wanted to know whether she wanted them separate or the milk poured over! She immediately said, “I haven’t told anyone anything!” She was very creative to say the least, but then again so was he.
Mary’s behavior highlights an essential, albeit difficult, aspect of RAD: manipulation. For children like Mary, manipulation often arises from a combination of deep-seated survival instincts and an overwhelming need to control their environment, shaped by past trauma. While her actions might seem calculated or even malicious at times, they are rooted in her struggle to process pain, fear, and mistrust. Understanding this manipulation as a coping mechanism rather than simply a problem behavior is key to effectively supporting children with RAD.
Seeing a child without a caregiver involved in the treatment or therapy is also dangerous and many misconceptions can happen. Since they work hard to make themselves look great, it becomes necessary for others to not look so good and that means caregivers, siblings, teachers, and classmates bear the brunt. It’s a slippery slope to believe in what the RAD child says because their perception is so often warped by their black and white thinking and their tendency to feel like the victim. There is no sense of personal accountability when everyone else is to blame; that’s one of the many reasons I like the approach I use the best.
Throughout history, treatments for Reactive Attachment Disorder have varied widely, often reflecting the prevailing psychological theories of their time. From the controversial and dangerous rebirthing techniques designed to simulate a new attachment bond to rigid behavioral approaches focused solely on compliance, many early methods prioritized control over understanding. Over time, treatments have evolved to emphasize strength-based strategies and positive reinforcement, though they often fail to fully address the complex interplay of trauma, mistrust, and manipulation that defines RAD. While progress has been made, the history of RAD treatment serves as a reminder of the ongoing need for trauma-informed, compassionate approaches that empower children rather than exacerbate their feelings of powerlessness.
I think the danger of telling a child they are not in control is that it becomes a challenge of sorts. They either know it’s not the truth and then need to challenge it or they believe it and become more of a victim than they’ve already been. Telling a child that they are powerless could cause them to give up, because what’s the point of even trying when you don’t have any control of...well, anything.
