Reactive Attachment Disorder: A New Understanding


Reactive attachment disorder (RAD) is a mental health diagnosis listed in the Diagnostic and Statistical Manual of Mental Disorders (DSM-IVTR) under disorders usually first diagnosed in infancy, childhood, or adolescence. RAD was initially introduced to the mental health community some 20 years ago. Since that time, much of the information regarding this disorder has painted a dismal and often dangerous picture of these children. 

Books and articles have compared children with RAD to serial killers, rapists, and hardcore criminals. Intensive and often physically aggressive therapies have been developed to treat these children. Additionally, unconventional parenting techniques have been taught to parents in order to control these children—children referred to as "disturbed" or "unattached."

The main premise of RAD is that the child cannot socially connect or attach to others in interpersonal relationships. Behaviors inhibiting attachment to caretakers are often demonstrated by children diagnosed with RAD. Some of the behavioral symptoms published in literature include the following: oppositional; frequent and intense anger outbursts, manipulative or controlling; little or no conscience; destructive to self, others, and property; cruelty to animals or killing animals; gorging or hoarding food; and preoccupation with fire, blood, or violence.

Wow! Read that list again. Many of these behaviors sound downright frightening. It is hard to imagine that a child can do these things. Yet, while these behaviors certainly appear abnormal for anyone, especially a child, they are actually quite reasonable reactions to the experiences these children have endured. Read on….

There are many life events that can cause attachment trauma between the primary caretaker (usually the mother) and the child. These include an unwanted pregnancy, separation from the birthmother due to adoption, death of a parent, premature birth, inconsistent caretakers, abuse, neglect, chronic pain, long-term hospitalizations with separations from the mother, and parental depression. Such life events interrupt a child’s ability to learn to self-regulate through the relationship with the parent.

Typically, when a baby or small child is in a state of stress, he cries and the parent attends to the child’s needs, whether by feeding, rocking, or simply holding him. Each and every one of these interactions with the parent plays a critical part in assisting the development of the child’s neuro-physiological control system—the system that allows the child to return back to a calm state. It is truly through this parent-child relationship that we as humans learn how to self-regulate in order to stay balanced and easily shift from a state of stress back to a state of calm. This regulatory mechanism within us is not "online" at birth, and brain research has shown that it takes up to thirty months before this part of the brain is fully developed. Within this thirty-month timeframe, a well-attuned parent has connected with this child to calm his stress response system thousands, if not millions, of times. How critical these first thirty months are to a baby! It is through the parent-child relationship that a child’s self-regulatory ability becomes engaged. This internal regulatory system then sets the foundation for the child’s neurological, physical, emotional, behavioral, cognitive, and social development.

When a child does not receive loving, nurturing care, the child’s ability to develop a sufficient regulatory system is severely compromised. In cases of severe neglect and abuse, the child’s life is literally at risk. For these children, their internal survival mechanisms become activated, dedicating all the body’s resources to remain alert in "survival mode." These children perceive the world as threatening from a neurological, physical, emotional, cognitive, and social perspective. These children operate from a paradigm of fear to ensure their safety and security. Hence, we see an overly stressed-out child who has difficulty interacting in relationships, who struggles to behave in a loving way, who quite often cannot think clearly, and who swings back and forth in his emotional states due to an underdeveloped regulatory system. While perceived by most professionals as dangerous, a child with RAD is essentially a scared and stressed child living out of a primal survival mode in order to maintain his existence.

With this understanding, the term "attachment-challenged" becomes more appropriate to use with children instead of the traditional label of "RAD child." In times of stress, this child is challenged to connect and his ability to make connection is restricted. In fact, we all become attachment-challenged to some degree when we’re stressed. Reflect for a moment on the last time you were overly stressed: How did you react when someone tried to interact with you? Be honest! Perhaps you had difficulty interacting appropriately. Stress causes confused and distorted thinking, and it constricts us emotionally, leaving little room for relationships. Thus, a child with a traumatic history who is living in a stressful, fear-based state, simply is not capable of nor equipped to be in a relationship. From a behavioral standpoint, a child living in a state of fear simply cannot act in a loving way. The frightening behaviors listed above are only external reflections of the internal fear and chaos within these children. They are simply behaviors that are intended for survival.

Treatment for the attachment-challenged child needs to address this internal fear. When the child’s stress state can be soothed, and the deep wounds driving the fearful behaviors can be acknowledged, the child has an opportunity for healing. Yes, healing is possible, but it takes intense work and many, many repetitions of positive experiences to recondition the body’s reactions. It is also essential that the therapeutic attachment techniques and parenting paradigms enlisted for these children be grounded in neurological research and based in love and compassion. Such techniques can offer ways to create peaceful environments within the home that work to recreate safety and security in the insecure foundations set within these children.

A word of caution from the author: Some therapists specializing in attachment therapy work from a fear-based platform and recommend techniques that are confrontational, aggressive, child-centered instead of family-centered, and fear-based. While these techniques sometimes offer short-term results, families using them are often faced with more severe long-term pain and challenges. Many of these therapies and therapists have separated themselves from dangerous techniques that have resulted in the tragic death of children in the past; however, they continue to lack compassion and are grounded in fear. Some examples of these techniques include instructing parents to force eye contact with their children; have children do excessive chores to feel a part of the family system; send children to respite care out of the home for making poor choices; give up their need to communicate love to their children; and put locks on the outside of children’s doors to keep them "safe." When looking for appropriate interventions for families, be alert to these specific techniques.

Be aware, as well, of techniques that talk in general about gaining control of a child and viewing the child as manipulative. These techniques are child-blaming, parentcontrolling, and devoid of scientific research. It is counterproductive to feed more fear into an already scared child. When seeking help, it is highly recommended that you have a thorough understanding of the basis for each therapy being considered.

When parents first begin realizing that they are dealing with an attachment-challenged child, they have likely already experienced many severe and disruptive behaviors in their homes. In these experiences, they themselves often begin to slip into their own fear and see the child as a threat (at times so threatening that they simply want the child out of their home, forever). Because the behaviors can be so intense, it is easy to lose sight of the child’s reality—that of a young person living in a world of pain, fear, and isolation. Resources are available, and hope for these families is real. Suggested resources on the

Internet include:

1. Beyond Consequences Institute:

2. Child Trauma Academy:

3. Therapeutic Help and Educational Material:

4. Therapeutic Fairy Tales:

As a therapist specializing in working with attachment-challenged children, I am overwhelmed by great sadness every time I initially speak with a parent seeking help for their family. This sadness stems from the realization that all of these wounds and pain could have been avoided. Babies are born in a spirit of love, but it is life’s circumstances that shift them into a spirit of fear. All it takes to maintain this spirit of love is high quality care giving; it takes an emotionally available parent to create a secure and loving base for a child. Attachment Parenting in the formative years, from conception to three years old, sets the foundation for all future relationships, and it gives the child’s body’s own internal regulatory system the opportunity to develop to its fullest. The old adage, "an ounce of prevention is worth a pound of cure" says everything in the context of Attachment Parenting.

If you’re currently struggling with a child(ren) exhibiting symptoms of RAD who’s early beginnings were far from nurturing and secure, I want to encourage you to have hope.  Several years ago, I found myself in the same situation, waking up every morning wondering how I was going to make it through the day. In learning more about my children and understanding that their behaviors were driven from a deeply wounded place, I was able to parent them in a way that allowed healing to begin. Yes, it is hard work and it takes endurance and faith, but creating a peaceful home is possible!

Heather T. Forbes, LCSW

About the author: 

Heather Forbes, LCSW, is the co-founder of the Beyond Consequences Institute, LLC. Ms. Forbes has been training in the field of trauma and attachment with nationally recognized, firstgeneration attachment therapists since 1999. She has been active in the field of adoption with experience ranging from pre-adoption to post-adoption clinical work. Ms. Forbes is an internationally published author, with her most recent book titled, Beyond Consequences, Logic, and Control: A Love-based Approach for Helping Attachment-Challenged Children With Severe Behaviors, endorsed by Sir Richard Bowlby, son of John Bowlby. As a speaker, her passion for families is known throughout the nation. Ms. Forbes consults with and coaches families both nationally and internationally who are struggling with children with severe behaviors. Much of her experience and insight on understanding trauma, disruptive behaviors, and attachment-related issues has come from her direct mothering experience with her two adopted children.


this article

Bryan Post is the asshole who abused my children.... and it is all full of shit



you adopted and foster children are not the damaged trash social services tries to make you out to be...

maybe you are just people; no better or worse than anyone else; maybe we should chuck all this attachment disorder crap, which is not the DSMIV disorder says RAD is anyone... no attachment disorder was made up by people like Bryan Post and Heather Forbes so they could take nice long vacations to Mexico at the hands of the most needy children and rob kids from real families...

maybe we should not listen to social workers telling everyone what trash you all are.. because you are not

why don't you all see what Wayward Radish has to say...

Bryan and Heather have made millions and we have a count of at least 15 kids who lost their homes and are growing up in foster care just since the last 4 years of their program, which got them really rich really quick...

More benighted quackery

"Some of the behavioral symptoms published in literature include the following: oppositional; frequent and intense anger outbursts, manipulative or controlling; little or no conscience; destructive to self, others, and property; cruelty to animals or killing animals; gorging or hoarding food; and preoccupation with fire, blood, or violence."

Published in literature? More like fiction. The true DSM-IV definition of RAD comprises NO symptoms of aggression--indeed, RAD in actuality is characterized by introversion much more than anything approaching violence. Heather Forbes is an uneducated quack; note that none of her credentials list actual degrees or certification, rather anecdotal "experience" with her own adopted children and "training" with other quacks whose background is as dubious as her own.

- Wayward Radish


While I agree "fear, stress and dread" all contribute to anxious feelings towards another person, I do not believe these issues are being properly addressed in the scope of "family therapy".  Thanks to adoption, there has cropped a new "parenting audience".... and a new breed of parenting "specialist".... and I can't help but wonder if these "specialists" getting paid top dollar by AP's really know what they are doing to adopted children.

Before RAD became a vogue diagnosis within adoption communities, twenty-five years ago,  David Kirschner, Ph.D. coined another phrase not so widely accepted by the adopted community.  He called it  Adopted Child Syndrome.   Note the similarities in description....

the adopted child syndrome is characterized by various forms of antisocial acting out, primarily directed against parental and authority figures. Pathologic lying, stealing, fire setting, promiscuity, substance abuse, and running away (or threats to do so) are typical; assaultiveness occurs in severe cases. The child socializes with "streetwise" delinquents, antisocial children or adults, often of a lower socioeconomic class than that of the adoptive  [ ]

In both situational/diagnostic cases, much blame for a child's reactions/behaviors gets placed on the first-parents, making parental neglect and domestic violence the social ills family services are paid to address and attack.  Remove the illness/causing factor (the abusive parent/care-taker) ASAP, and start all over.  Sadly, many children see themselves as the causing factor...the illness... creating a foundation (sense of self) marred with self-doubt and insecurity.

To make matters worse, because foster care is in such a state of disrepair,  there has become a growing push to adopt, as if removal from the foster care system is going to improve foster care, as a service.  Few see how the many upheavals and changing faces during the "child placement phase" can change a child's perspective on adult behavior, child safety and 'the powers that be" (absolute authority).   In addition, a new hidden problem is afoot:  so many want to quickly assume all adoptive homes are great safe places, litte thought is given to the idea that perhaps that non-compliant child... the one who doesn't want to bond to the new mommy and/or daddy... is not bonding "properly" because the child is still being abused.  What happens then?   More drugs (unapproved for small children) and therapy?

Research studies prove the environment of an infant influences future relationships, especially as it relates to future child abuse:

To compare the influence of genes vs. experience, Maestripieri used a cross-fostering technique that involved taking a new-born female monkey from her biological mother and passing her within 48 hours of her birth to a different adult female who would raise the infant as her own. Some monkeys born to abusive mothers were passed to a non-abusive foster mother and vice versa. Other monkeys in the experiment were raised by their abusive or non-abusive biological mother as usual. Later on, Maestripieri observed which infants went on to abuse their own offspring.
Maestripieri found no evidence for abusive behaviour being genetically inherited, rather it appeared to be acquired through experience of being abused. Nine of the 16 monkeys who were reared by abusive mothers went on to be abusive themselves, including four adopted monkeys whose biological mother was not an abuser. In contrast, none of the monkeys raised by non-abusive mothers went on to abuse, including six adopted monkeys whose biological mother was an abuser.
Maestripieri said abused female monkeys might learn to be abusive themselves either based on their own direct experience of being abused, or through observation of their mother abusing their younger siblings, or because of neural changes caused by being abused. That not all abused monkeys went on to be abusive themselves also points to other protective or risk factors. [ ]

I don't have answers... I simply have many questions.  How does "Attachment Parenting" work if a bullied/abused child is put into a situation where he/she feels bullied and abused, AGAIN? I hope people realize compliance is not a cure... it's simply a way of buying more time.    Eventually these unresolved trust and rage issues manifest themselves later in life, in older relationships.  [And yes, it can be VERY scary for all involved.]

Personally, I would like to see more effort going towards the teaching of positive parenting to those who were given very poor examples of "adult behavior", and less bullying done by those parents and therapists seeking compliance and peer-approval.  Last but not least, I would like to see these attachment theories tested-out in a more scientific milieu.  If you want us to buy your theory, show -- prove, with science and study -- how it works.

Meanwhile, if you were to ask me, "What's the best type of therapy being used on those with attachment/trust issues?"  I would say the Prison Pup Programs used in some (not all) of our state prisons seems to work really great.  This model reflects how well man and "wounded animal" can work together in the name of peace and harmony.

I wonder how many "RAD specialists" would agree?

the problem

were the monkeys exposed to drugs while their mom was growing them? Problem number 1 in USA foster care, prebirth drug exposure causing brain damage...

attachment disorder is the new name for adopted child syndrome.....

but I like a lot of your point... why exactly take kids away from one set of people who often are just poor and give them to child abusing RAD cult people and pay some quack $100,000 in a year to help the child abusing RAD cult person find new ways to abuse the children?

sadly, many adoptive parents don't pay for these parenting classes, therapy, whatever... no, most of it comes from you the tax payer... you the tax payers in North Carlina helped pay to kill Candance Newmaker...

and sadly instead of getting real help, or learning that this is your kid, this is what he does, figure out how to live with it... you get parents going into hock trying to help these kids through this con methods...

now remember most of it is holding the kid down or having cuddle time... and then you get the boot camp parents only feeding the kids oats and PB&J

most RAD specialist would not agree to anything unless they could make some money off of it

Documented, scientific proof

Problem number 1 in USA foster care, prebirth drug exposure causing brain damage...

BECAUSE there is proof that alcohol and drug use during pregnancy does indeed cause birth defects, doctors/scientisis should be using  the technology that's available (like fMRI bran scanning) so appropriate treatment plans for "special needs children" can be established.  Treatment should be based on anatomical fact and brain function, NOT just personal opinion or popular published theory.... but that's my own personal opinion.

Problem is, this technology is expensive and it costs a lot of money to do proper studies -- heaven forbid anyone waste time and effort on those who can't pay their bills.


Pound Pup Legacy