Understanding Reactive Attachment Disorder

Reactive attachment disorder (RAD) is a rare condition of emotional dysfunction, in which a baby or child cannot form a bond with its parents or caregivers due to early neglect or mistreatment. While the prevalence of RAD across the general population is one percent, between 19-35% of children entering foster care are diagnosed with RAD. Unfortunately, as a result of the opioid epidemic that is plaguing the nation, the number of children placed in foster care is rising. Students with a RAD diagnosis may experience significant, consistent and pronounced symptoms such as aversion to touch, underdeveloped conscience, and anger control issues. RAD is an infrequent diagnosis, but it's vital for school staff to understand the disorder, its symptoms and behaviors, and classroom strategies that can help.

Common Behaviors

Students with RAD engage in similar behaviors, including:

• Experiencing pervasive sadness, fear, or irritability that is unexplained.
• Not seeking comfort from adults - family, friends, or teachers - when sad, hurt, or upset.
• Being unresponsive when comfort is given.
• Not asking for help or support from teachers, caregivers, or friends.
• Not showing interest in interactive games with teachers or caregivers.
• Watching others without engaging in interaction.

Some children with RAD appear accident-prone or are destructive to themselves, others, and material objects. A student with RAD may lie about obvious things, steal from others, exhibit attention deficits or hyperactive behavior, or lack impulse controls. As a result, he or she will often have poor peer relationships. A student with RAD may also experience learning lags, ask persistent nonsense questions, talk excessively, or have abnormal speech patterns. He or she may also seem inappropriately demanding or clingy with teachers, administrators, or staff.

Strategies for School Staff

Students with RAD need:

• A calm, structured classroom that's a safe place for them to enjoy relationships and engage in appropriate activities that stimulate their brains.
• To feel like they can succeed in the tasks presented to them.
• Trusting relationships with appropriate attachment to caring people, such as teachers, administrators, or other school personnel.

Instructional Supports

Some common instructional supports you may already be using can be helpful to students with RAD, including:

• Chunking content into shorter units.
• Giving step-by-step instructions, both verbal and written.
• Using picture schedules for younger students and daily agendas for older students.
• Implementing Positive Behavioral Interventions and Supports systems.
• Engaging in self-talk as a way to model thoughts and feelings.
• Maintaining consistency in both expectations and consequences.

Students with RAD need tight structure and firm limit setting, but they also need empathy for their fears and anxieties. They often feel as if they're struggling just to survive - regardless of whether you think they're in danger. When you combine the best of order and unconditional love in your classroom, you'll provide the best learning environment for students with RAD.

These tips are from the Exceptional Child online PD course, Reactive Attachment Disorder, by Dr. Laura Clarke and Dr. Dusty Columbia Embury.