Alaska Attachment & Bonding Associates


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Definition 1


Reactive Attachment Disorder (RAD) is a mental disorder listed in the DSM (Diagnostic and Statistical Manual of Mental Disorders) with onset starting in infancy or early childhood.  Although the DSM establishes clear diagnostic criteria for RAD, it is important to understand that children who experience attachment issues have symptoms that range from mild to severe.  Like other mental illnesses, it is biologically based; research has shown neurological abnormalities in children who have been diagnosed with the disorder.

Attachment disorder occurs when bonding is interrupted between the infant child and the parent (or primary care giver).  The most common cause of disruption is emotional or physical neglect of the child.  The infant who is repeatedly left for hours crying with hunger or a dirty diaper is a likely candidate for developing attachment disorder.  Severe mental illness or drug addiction may sometimes result in neglectful parenting.  Other causes of disrupted attachment include: physical and sexual abuse, or abrupt transfer of the primary care giver (Many adopted children or foster children have attachment disorder).

As a result of this poor bonding with parent/primary caregiver, the child learns that adults are at best inconsistent or undependable, and at worst, dangerous.  These children learn that adults canít be trusted and these children develop behaviors they believe are essential to their survival but in reality are destructive and negatively impact their ability to develop an intimate relationship with any adult.  Children with these issues believe they must control everything for their basic survival.  Kids with attachment issues internalize the belief that they are not lovable and often have a deep-rooted sense of shame.

Symptoms of attachment disorder include: oppositional behavior, poor eye contact, defiance, pathological lying, inability/refusal to be comforted, sabotaging, constant talking, manipulative behavior, and fear of intimacy.  Children who have attachment disorder may also have concurrent depression, anxiety, trauma/PTSD and attention deficits (ADD/ADHD) or other mental illnesses.  Children with attachment disorder are sometimes misdiagnosed as having Oppositional Defiant disorder (ODD).

In all but the most severe cases, the symptoms of attachment disorder occur mostly at home with the primary care givers.  Typically the mother figure is the recipient of the most hostile and aggressive behavior.  The rest of the word (school, neighbors, family) often see a charming, talkative, engaging child.  This can leave the parents/primary care givers feeling isolated or worse, criticized or second guessed by other people in the childís support system.

It is important for parents dealing with a child with attachment issues to get professional help as soon as possible.  Most standard parenting techniques do not work with children with attachment issues; in fact successful interventions are often counterintuitive.

Definition 2

Reactive Attachment Disorder

 RAD is a condition in which individuals have difficulty forming loving lasting relationships.  They often have a nearly complete lack of ability to be genuinely affectionate with others.  They typically fail to develop a conscience and do not learn to trust.  They do not allow people to be in control of them due to this trust issue.  They can be surface compliant for weeks if there is no loving relationship involved.  With strangers they can be extremely charming and appear loving.

Uneducated adults misinterpret this as the child trusting or caring for them.  They do not think and feel like a normal person.  Some famous people with RAD that did not get help in time: Hitler, Saddam Hussein, Edgar Allen Poe, Jeffrey Dahmer, and Ted Bundy.


Any of the following occurring to a child under 36 months of age puts a child at high risk for developing RAD:

Abuse (physical, emotional, sexual)


Sudden separation from primary caretaker (i.e. illness or death of mother or severe illness or hospitalization of child)

Undiagnosed or painful illness such as colic or ear infections

Inconsistent or inadequate day care

Chronic maternal depression

Several moves or placements (foster care, failed adoptions)

Unprepared mothers with poor parenting skills

In-utero trauma, drugs, alcohol exposure


Respite care is short term care that helps a family take a break from the daily routine and stress. It can be provided in the client’s home or in a variety of out of home settings.

Respite care is an essential part of the overall support that families may need to keep their child with a disability or chronic illness at home.

Since not all families have the same needs, respite care should always be geared to individual family needs by identifying the type of respite needed and matching the need to the services currently available. Once identified, it is also important for families to have ready access to that type of respite, in an affordable form.

In many families, it is common for children to attend day care or after-school care, interact with peers and adults outside the family, and stay with a child care provider while their parents enjoy an evening out. Respite provides these same opportunities for children with special needs.

States and communities are recognizing that respite care also benefits them. On average the costs for respite services are 65 to 70 percent less than the costs of maintaining people in institutions (Salisbury and Intagliata, 1986). The cost effectiveness of respite services allows scarce tax dollars to be used for additional community based services. During the previous decade, over 30 states passed legislation for in-home family support services, including respite care, using either direct services or voucher systems (Agosta and Bradley, 1985).


Tight structure and powerful nurturing from the real parents is the most effective way to get these high risk children back on track.  Respite care providers have been chosen to be entrusted with the healing heart of these children.  It is essential that these children not be given privileges that have not been earned at home. Television, movies, Nintendo etc. are not an option for these children.  Sweets are a vital part of bonding and should only come from real parents (foster, adopted), not earned, just given.  These children are   aware of this.  Feel free to feed the rest of your family goodies so the respite child can see how other moms love their families.  It will not harm these children.  Do not deprive your family of their special things in front of these children.  It makes RAD kids feel powerful and perpetuates the belief that adults are stupid suckers, easily manipulated.  This keeps them from feeling safe which slows or halts the healing.