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Reactive Attachment Disorder (RAD): Dispelling the Myths

August 24, 2011

Yesterday, adoptive parent Jessica Beagley was found guilty in an Alaskan court of child abuse for punishing her Russian adopted child by giving him hot sauce and forcing him to take cold showers. Although unfortunately this form of abuse is thought to be common, what made this case unusual was the fact that she made a video of this that aired on the Dr. Phil show and that brought her abuse to the attention of authorities who then pressed charges. Beagley did not lose custody of her children.

The punishment of hot saucing and cold showers was not part of any kind of Attachment Therapy treatment, as the mom and children were not in any kind of therapy at the time. However, attachment therapy, along with all its myths, did enter the picture when so-called “experts” testified at the trial that the child was suffering from RAD and that this explained his alleged behavior problems, thus mitigating what the mom did. The problem is, that the behavior problems they attributed to RAD are nowhere in the DSM diagnosis of RAD, nor is there sound evidence that they have anything to do with attachment problems. No doubt, the publicity of this case is now going to be accompanied by more spreading of these myths that children with attachment problems lie, cheat, steal, are violent and will grow up to be sociopaths and the only thing that can stop this from happening is the harsh disciplinary measures associated with so-called “attachment therapy” which is what I consider to be abuse in the name of therapy.

This case is a prime example of why more states need to adopt Daubert, which would require experts to produce actual scientific evidence for that statements. That did not appear to be the case here. Even though Beagley was deservedly convicted, these therapists were allowed in as “experts” to testify to symptoms that have no basis in scientific evidence.

I thought that this would be an appropriate time to cite a table in a recent publication of mine, a systematic review of the literature on RAD and international adoption. The table clarifies the difference between what is in the DSM-IV-TR and the symptoms made up by “attachment therapists” that have no basis. For emphasis, I have placed the latter in red font for this posting (of course, in the actual publication, it is not in red). For even more such symptoms, see Nancy Thomas’ website. Jean Mercer has just coined the term MAD (Misunderstood Attachment Disorder) to describe these symptoms that are repeated far and wide as legitimate when they are not.

From:

Pignotti, M. (2011). Reactive attachment disorder and international adoption: A systematic research synthesis. The Scientific Review of Mental Health Practice, 8, 30-49. (p.33)

Table 1. DSM Definition of RAD vs. Symptoms not in DSM Attributed to Attachment Problems

DSM-IV-TR Criteria 313.89 (American Psychiatric Association, 2000)

Reactive Attachment Disorder of Infancy or Early Childhood

A. Markedly disturbed and developmentally inappropriate social relatedness in most contexts, beginning before age 5 years, as evidenced by either (1) or (2):
(1) persistent failure to initiate or respond in a developmentally appropriate fashion to most social interactions, as manifest by excessively inhibited, hypervigilant, or highly ambivalent and contradictory responses (e.g., the child may respond to caregivers with a mixture of approach, avoidance, and resistance to comforting, or may exhibit frozen watchfulness)
(2) diffuse attachments as manifest by indiscriminate sociability with marked inability to exhibit appropriate selective attachments (e.g., excessive familiarity with relative strangers or lack of selectivity in choice of attachment figures)

B. The disturbance in Criterion A is not accounted for solely by developmental delay (as in Mental Retardation) and does not meet criteria for a Pervasive Developmental Disorder.

C. Pathogenic care as evidenced by at least one of the following:

(1) persistent disregard of the child’s basic emotional needs for comfort, stimulation, and affection
(2) persistent disregard of the child’s basic physical needs
(3) repeated changes of primary caregiver that prevent formation of stable attachments (e.g., frequent changes in foster care)

D. There is a presumption that the care in Criterion C is responsible for the disturbed behavior in Criterion A (e.g., the disturbances in Criterion A began following the pathogenic care in Criterion C).

(American Psychiatric Association, 2000, p. 128).

 Symptoms Outside the DSM-IV Definition Attributed to Attachment Disorders [red emphasis added]

Reference Symptoms
Coleman, 2003 Physical aggression, shallow, emotionally deficient social behavior, tantrums, recklessness, risk taking, bullying, stealing, abuse of pets, hoarding food, deception, emotional insatiability, need to control others, defianceFamily of RAD child symptoms:  loss of executive parental power, decreases in spousal interaction in parents of RAD children, parentification of siblings.
Howe, 2003 Aggression towards mother, crazy lying [lying about the obvious], poor eye contact, obsession with violence and bloody imagery, inability to anticipate consequences of behavior, compulsion to be in control and fear of being controlled, aggressive behaviors.
Hughes, 2003 Aggression, dissociation, affect and behavioral disregulation, impulsivity, alterations in consciousness, loss of meaning, somatization, inability to differentiate facial expressions, lack of eye contact with caregivers, discomfort with touch, shame.

References:

American Psychiatric Association (2000). Diagnostic and statistical manual of mental disorders (4th ed. text rev.)Washington,DC: American Psychiatric Press.

Coleman, P. K.  (2003). Reactive attachment disorder in the context of the family: A review and call for further research. Emotional and Behavioural Difficulties, 8, 205-216.

Howe, D. (2003). Attachment disorders. Disinhibited attachment behaviours and secure base distortions with special reference to adopted children. Attachment and Human Development 5, 265-270.

Hughes, D. A. (2003). Psychological interventions for the spectrum of attachment disorders and interfamilial trauma. Attachment and Human Development, 5, 271-277.

Recently, Pavel Astakhov, Russia’s Commissioner of Children’s Rights, spoke out against this demonization without basis of Russian adoption children. However, thus far it appears that his pleas are falling on deaf ears while these bogus and sometimes highly abusive “therapies” and testimony that lacks scientific basis continues here in the US.

What is particularly disturbing is that there is mounting evidence that misdiagnoses (and bogus ones) of various sorts can become self-fulfilling prophecies. In other words, people so diagnosed can actually take on the symptoms that have been suggested to them. This is a topic deserving of a separate posting, which I will do at sometime in the future, as it encompasses not only RAD, but many other diagnoses.

Once a myth gets out there and is repeated, it strengthens and continues, no matter what others try to do to counteract it. The psychologist Scott Lilienfeld even wrote a book about 50 common myths associated with psychology.  However, I will keep trying.
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7 Comments
  1. You are nuts. You clearly are NOT the parent of a child with RAD. They DO lie, steal and engage in violence. The DO also pee their pants deliberately, while awake and fully dressed and standing there laughing at you. They DO smear poop. And YES, my child was adopted at age 7. Oh, and don’t forget the sexual acting out. That’s part of it too. Engaging in sexual behavior with anyone who’s willing from young ages. Who are you? You need to learn something before you spout off.

    • I am not denying that there are children with serious behavior problems who display the behaviors you describe. I worked with children with serious behavior problems for several years. Some are adopted and some are not. However, the research literature, which I have extensively reviewed indicates that these problems are not attachment disorder related, which is why none of the symptoms you mention are in the DSM definition of RAD. Additionally, there is no good evidence that inflicting controversial, abusive interventions such as the ones I have been criticizing that involve dangerous restraint and holding practices and boot camp tactics are helpful to children with serious behavior problems.

  2. Sara permalink

    I am an adoptive mother to a child from East Europe.

    As mentioned before. You are NOT the parent of the child. You have never experienced raising an adopted child from an orphanage. Nancy Thomas raised these children, she speaks from the bottom of her heart and experience. YOU ARE TOTALLY A STRANGER TO THE CHILD. You see those children in your so called “therapy” room for 1 or 2 hours a week, kind of a snapshot from a movie, while you have never watched the whole movie. Then you write this ridiculous article, based on your so called “observations”, and the whole nation is reading this nonsense.

    Sara, Israel.

    • You’re right about one thing. I do have the freedom to express my views and criticism of Nancy Thomas and others. Here and elsewhere on the internet, rather than reading the uncritical adulation by her followers, “the whole nation” as you put it is able to access challenges to people such as Nancy Thomas, who have no mental health degrees and licensure.

      More and more people are now coming forward who were subjected to this type of approach as children by a number of so-called “attachment” and “holding” therapists and some have had to have therapy as adults for PTSD because of having been subjected to brutal forms of holding and “attachment” therapy as well as so-called therapeutic parenting. I have also spoken to many parents of adopted children who are rightfully horrified by these methods.

      One does not have to experience sitting on a thumb tack to know it is a very bad idea to do so.

      Click here for some quotes from Nancy Thomas’s book. People can read them for themselves and make their own evaluation.

      Valid approaches stand up to critical scrutiny. If her approach is truly valid and well supported, you wouldn’t need to feel so threatened by such criticism.

      • Sara permalink

        I agree with Nancy Thomas about the way she sees things. In my opinion, she analyzes the situation very well and right. I disagree with Nancy Thomas about the holding and other violent methods. These holding and re-birth methods may be very dangerous. I don’t think her physical methods are affective, and I don’t think other therapists’ methods are effective as well. Actually there is no effective therapy today for RAD children.

        I have adopted my child when she was 15 months old from an horrible orphanage. She is now 10 years old.
        I have gone through hell during these years. My child had therapy with games when she was 4 years old for 1 year. The therapy made her behavior worse. Then I decided to drop all “Therapy” approaches forever, because none of them is based on scientific studies, and was not proved as effective. Today she is much better. I believe the best therapy for RAD children is good nutrition in family and environment, and strict education. These children need strict education, because the strict borders supply them confidence, as many of them suffer from anxieties, not just separation anxieties.
        Their anxieties come from the obsessive need to be in control all the time.

        My child still lies a lot, she can manipulate any therapist, but she is no longer violent as before, and she studies in a public school with no medications and no therapy.
        Best therapy for RAD children from my point of view is for instance:
        Go to the sea, smile to them a lot with a wide smile, tell them sweet words, talk about their advantages to a third person while they are listening from the side (third person grammer), stand for your rules, strict borders with no discounts. Punish them when they act bad (disconnect the computer or TV, for example), and hug them when they act good. The punishment (you may use a more gentle word – sanction) is important, because it is a reflection of the reality outside. There is a whole world outside our protective home, and out there if someone breaks the law he gets punished, and the child should know that.

        Sometimes punishment does not work. For example, my child was stealing all the time. She was stealing for nearly 2 years. I have tried many approaches but nothing helped. So I took her to a woman, a psychiatrist that is against drugs. She is known for her approach that frightens children by talking horrible things about them. We had a meeting with my child, and that psychiatrist talked to me while my child was listening from the side. It was kind of a show. She told me that all the children in school should know that she is a thief, and that this should be announced in a loudspeaker at school, and then my child should be put in an institution, where they tie children to their beds and make other horrible things to children. My daughter was so horrified from that woman and her so called “threats” that she stopped stealing at once.

        When it comes to RAD kids, I don’t believe in University degrees and Diplomas. I believe in life experience and common sense.

        Sara, Israel

  3. Sara this so-called psychiatrist and you need to be informed that while you will never be prosecuted, this so called approach is illegal for use against enemy soldiers under the Geneva convention.I think you should cross check references back to the school of record or just leave Dr.Goebbels alone.

  4. In Russia, often make similar shows for children. But do not talk about torture. This can damage the child’s psyche. Unknown woman or a man in the form of talking to each other about the possible consequences and shame for the child. Sometimes a child “accidentally” overhears this conversation. “Actors” suggest a way out. They say it is necessary to return the stolen item and apologize. Sometimes offer to work
    the garden (snatch weed or watered garden, and so on.). The victim usually forgives children and does not disclose the secret. The child himself must return the stolen item owner and apologize. The child should experience shame, but not fear. You can not shame the children in the presence of large numbers of people. The child must return the stolen item one on one. He should experience relief after apologies but not the bitterness of humiliation ..

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