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Reactive Attachment Disorder

Q. I am a foster parent who needs more info on reactive attachment disorder (RAD). We have a 7-year-old foster son, who in a previous home, was diagnosed with RAD. His case worker did not feel this was accurate because he can show some affection. We have had him for eight months. In this time, he has been aggressive towards our youngest daughter. It's always our youngest and never our older daughter who is older than him.

He has urinated in his bedroom (on the bed, the carpet, the walls). He lies constantly, even when confronted with proof. We are to the point now where we feel he needs to be placed in a home with no younger siblings. Do you have any info I can find on symptoms of this disorder?

A. This syndrome of Reactive Attachment Disorder of Infancy (RADI) is among the most controversial in all of psychiatry--and that's saying something! I can imagine how frustrating this is for you as a foster parent. RADI is a disorder that begins before age 5, and is defined as "markedly disturbed and developmentally inappropriate social relatedness in most contexts... [due to] grossly pathological care [as an infant]."

RADI is usually due to severe emotional and/or physical neglect--not just being in foster care or being adopted. RADI shows up either as failure to initiate and respond to most social interactions, or as indiscriminate social attachment. In other words, kids with RADI either find it very hard to get emotionally close to anyone, or tend to get "too close" to almost everybody. (So, depending on how much affection your foster son shows, and how often, the diagnosis might or might not apply).

By definition, RADI is not diagnosed if the symptoms are due to some other mental disorder, such as a conduct disorder, attention deficit hyperactivity disorder (ADHD), bipolar disorder, etc. So, the first thing I would consider is obtaining a second opinion regarding your foster son's diagnosis. Seeing a child psychiatrist would be a good start, since non-RADI conditions might respond to appropriate medications, and perhaps make it possible for you to manage your foster son more effectively, if you choose to have him remain with you.

Keep in mind that the treatment of RADI is controversial, and some of the treatments recommended by so-called therapists--such as forcible holding of the child--may actually cause further harm. You may also find useful information at the website of the American Academy of Child and Adolescent Psychiatry (www.aacap.org). Also, though NOT a professional site, the website http://www.attachmentdisorder.net/ may provide you with some useful personal perspectives. I hope things work out with this very difficult situation.

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December 2002

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