Bonding and Attachment: Part II

ATTACHMENT SYMPTOMS

INFANT ATTACHMENT CHECKLIST

In the last article, I wrote about some of the causes of Reactive Attachment Disorder (RAD) and discussed the internal dynamics of the RAD child. In this article, I want to give you an understanding of the characteristics of RAD in infants and in children. Parents are in the best position to see the true nature of their child. If they are educated about RAD, they can help detect the condition early. With this information, parents can seek help from a professional who can confirm the diagnosis and provide treatment.

Reactive Attachment Disorder (RAD) is a relative condition ranging in severity from mild to severe. The level of severity is directly related to the extent and duration of the child’s early trauma. Abandonment is usually part of the history of RAD. If neglect and abuse are added to the child’s early history, the resulting condition is generally worse. Usually, the earlier the trauma begins and the longer it lasts, the more severe the RAD condition will be. Diagnosis is best made by assessing the current symptoms of the child and is confirmed by the child’s history. Information taken from the parents is usually more valid than a clinician’s perception of the child. This is true because the child with RAD has the capacity to manipulate and fake “looking good.”

CHILDREN

When I worked at Evergreen Consultants from 1990-1995, it was standard practice to use information from the parents in making a RAD diagnosis. See Checklist.

When more symptoms are present, your child has a greater chance of having RAD. Similarly, when more items are listed as severe versus mild, the condition is more serious. Children with RAD usually display their symptoms more intensely with their mother than their father. Consequently, the parents are asked to describe their child as he relates to them individually and their answers are scored separately. The following are general comments about RAD and its diagnosis and symptoms.

  • All RAD children display difficulty in giving and receiving love. Many parents struggle with the question, “Does your child love you?” Even though a child may have lived in a family for several years, parents often are uncertain of their child’s genuine loving feelings for them. Children with milder forms of RAD usually can express genuine love for their parents. Parents of children with severe RAD will often describe their child as lacking genuine loving feelings for them.
  • At all levels of severity, RAD children will have difficulty accepting or seeking out physical affection and touch. If you touch a child with RAD, often he will recoil or flinch and say, “Ouch,” even though your touch is gentle and should produce no pain. “What would life be like if all touch either tickled or hurt?” I believe this is how many unattached children experience physical closeness or touch.
  • All children with RAD have control issues. The key question is, “How extreme or intense is their need to be in control?” These control issues are captured in a number of the 28 symptoms listed in the checklist. The child with RAD is oppositional, argumentative, disobedient or often defiant. They are exceedingly strong-willed and will go to great extremes to be in charge. Their need to control comes from their intense fear that further harm will occur if they are once again as helpless as they were as babies.
  • Most children with RAD have problems with anger. Many will express their anger overtly, having frequent temper tantrums and a short frustration tolerance. A smaller percentage of the children will be passive-aggressive and engage in annoying, frustrating, and aggravating behavior. Often this is disguised by a facade of innocence or hidden in socially acceptable behavior. For example, a child with RAD can hug a parent so hard it physically hurts. To a casual observer, it would seem the child’s hug was a loving act. In reality, the child inflicted pain, a hurtful act, within a hug, which is a loving act. This is the hallmark of passive-aggressive behavior or indirect anger.
  • Children with RAD have problems developing a conscience. In the most severe children, their conscience is entirely absent. They have no remorse, regret, or guilt when they violate their parents’ or other people’s rights. In the milder condition of RAD, the conscience is underdeveloped. A number of the items on the checklist are related to the child having little or no conscience.
  • All unattached children have trust issues. They do not trust their parents and the parents cannot trust their children. The severity of trust issues is directly related to the severity of the RAD condition. A number of the 28 symptoms assess the child’s desire and willingness to live outside their parent’s circle of control by being deceptive and disobedient. This failure to develop a bond of love, trust, and cooperation must be present in order for a child to be accurately diagnosed with RAD.

    INFANTS

    In the last eight years, I have worked with the parents of babies and toddlers who had problems bonding. Through this work, I developed a 27 item Infant Attachment Checklist. A diagnosis of RAD can be made in an infant with only several items checked in a positive direction.

    There are two major groups of unattached babies. The first group consists of babies who are fussy and unhappy. They are visibly disconnected and cry extensively. They are often inconsolable and reject nurturance and comforting from their parents. The parents are unable to appease or alter the infant’s unhappy condition.

    The second group consists of babies who are overly good. They are calm, quiet, and appear independent. Usually, they have a flat affect and calm appearance. They make few demands upon their parents. For example, if the parents place them on the floor, they can happily entertain themselves for an hour or more. They rarely cry or are fussy. In one instance, I gave a three-hour talk to a group of adoptive parents. One of the mothers present was holding a six or seven month-old infant. The infant sat on the mother’s lap with her back to the mother. She did not make eye contact, smile, or make a sound. The baby did not fuss or make a single demand of the mother during the entire three-hour lecture. The mother saw her baby as a “well-behaved” baby because she sat so quietly and cooperatively for three hours. It is understandable that parents and professionals can mistake this apparent “good behavior” as healthy. Rather than being genuinely content, happy, and emotionally connected, as her outward appearance might suggest, the baby was, in reality, sad, resigned and emotionally disconnected. The Infant Attachment Checklist determines whether the infant is in the unhappy and fussy group or the excessively good group.

    RAD is detectable early in infancy. Originally, my work with RAD was with older children, not infants. As I worked with the parents of these older children, many reported thinking something was wrong with their child as an infant. Usually, the adoptive mothers were the first to recognize “problems” in their infants, but they could not adequately describe what was wrong. Often they sought help from numerous professionals who were unsuccessful in recognizing the RAD symptoms in their babies.

    There is another scenario that is prevalent with RAD. Babies can appear bonded in infancy only to develop symptoms of RAD as they become toddlers. Over the years, many parents stated their babies appeared bonded during infancy. Either RAD was not present in infancy and developed later, or the parents did not recognize the RAD symptoms in their baby. As their baby grew older, he either developed RAD or the condition then manifested itself in ways the parents could easily recognize.

    Early detection and intervention leads to the most complete healing of children with RAD, with the least financial cost and emotional trauma to the child and his family. The following general statements will help you to answer the checklist items and develop an understanding of RAD in an infant.

    • Early in infancy, most babies with RAD reject at least some of their parents’ love. This dynamic is apparent in many small ways. Ask yourself these questions: “Does your child accept your affection or love? Does he accept your touch when you hold or cuddle him? Does he enjoy your physical closeness?”
    • Does your baby let you nurture him when he is upset, hungry, frightened, or uncomfortable? When you care for him, does it help him feel better? When you love him, does it make a difference to him? Often when the parents give love and affection to their baby with RAD, he does not receive or accept it. Many mothers say, “No matter what I do with my baby, it doesn’t seem to help or affect him.”
    • Try to determine if there is a growing emotional connection between you and your baby. Is there a relationship of love, trust, and reciprocity developing? This is evidenced by eye contact and imitative or reciprocal behavior. Does your baby look at you, notice you, and respond to you? After working with one mother and baby for a week, the mother stated, “I notice my baby staring at me. She watches me like she hasn’t seen me before.” Remarkably, the baby had lived in this home for seven months, but the mother reported, “It is as though she is seeing me for the first time.”
    • Does your baby prefer being close to you rather than being alone? The overly good baby is disarming because he appears to be easy, cooperative, and content. He can appear bonded because he seems to accept whatever you give him and makes little or no demands. Overtly, he acts happy and problem free but internally he is unbonded.

    With a medical illness, the patient is often the first person to recognize that a problem may exist. Adequate medical information helps these individuals know whether to seek professional assistance. The same is true with RAD. As parents, you are in a position to see the early signs of problems in your baby. Even if the condition is mild, RAD is serious and should not be ignored. A mild attachment problem in infancy that is manageable or undetected can lead to significant emotional and behavioral problems in toddlers and older children.

    If you have questions or concerns about your infant, consult with an attachment clinician in your area. If you cannot locate a specialist in this field, I would be glad to consult with you professionally.

    • Credits: Walter D. Buenning, Ph.D.
    1773 S. 8th Street, Ste. 202
    Colorado Springs, CO 80906
    (719) 477-9033

    Dr. Buenning has had a private practice in Colorado Springs for the past five years. Prior to working with adoptive families, he worked for twenty years in mental health centers in several Western states.