UNDER CONSTRUCTION
RAD Training Course for Health Care Providers
COURSE OVERVIEW:
The purpose of this intermediate course is to provide an overview of Reactive Attachment Disorder. Help professionals to better understand the disorder including symptoms, causality, and best evidence-based Interventions.
THIS COURSE EXPLORES:
● The Neurobiology of Attachment● Understanding of Adverse Childhood Experiences (ACE) and RAD● Symptoms/Causes/Prevention of RAD/DSED● Diagnosis and Tests● Brain Development and Reactive Attachment Disorder● Understanding symptoms of RAD vs. ADHD (and other diagnoses)● Nutrition and RAD (Gut-Brain Axis)● Parenting children with Reactive Attachment Disorder● Treatment (Examine current scientific findings regarding the effectiveness of different Therapies in treating RAD)● Discuss the development and implication of RAD knowledge and practical skills in clinical practice working with RAD children and caregivers● Trauma-informed care and RAD● Case Studies
SUGGESTED SETTING: Open to Primary Care, Pediatric,Health Care and Behavioral Health Providers and Staff
DEPARTMENT: Online
TIME:
Helpful Tips for working with RAD children and Caregivers
1. Get educated about Reactive Attachment Disorder
Get trained to enhance your understanding of RAD and how you can reduce the negative impacts of RAD. You can also do the following:
● Read up on Attachment Theory and Reactive Attachment Disorder (RAD).● Know the different types of attachment.● Understand the causes of attachment disorders.● RAD vs. ADHD (diagnosis and overlapping).● Learn how you can help RAD children and their caregivers through a Trauma-Informed Care lens.● Incorporate RAD knowledge at your practice.
Knowledge is the key. It is necessary to get to the root of the problem. "Trained treatment providers base the progress of the therapy on the child’s behavior at home, not the façade the child shows in the office. A mental health professional working with this population should be skilled at breaking through that façade and getting to the ‘real’ child so that they can express their feelings and embrace honesty". Nancy Thomas [87]2. Always use a Trauma-Informed Care (TIC) Approach
The concept of trauma-informed care (TIC) is a framework in which service and care providers understand the complex, multi-dimensional impacts of trauma, and they then work to incorporate that knowledge while providing treatment (Huckshorn & LeBel, 2013). Children in foster care need healthcare providers, therapists, social workers, teachers, and foster parents who understand the complex and varying impacts of trauma on their daily lives. By having a TIC approach across disciplines, the child is more likely to have the comprehensive care that they need.
3. Beware of "Victim Triangle"!
● Be advised that a child with Reactive Attachment Disorder can often "triangulate" people around, pitting them against each other. Karpman's Drama Triangle (also known as "Victim Triangle") describes dysfunctional relationships where the people in the relationship shift between three roles, Persecutor, Rescuer, and Victim, all held in place by guilt and blame.
By understanding the roles of the victim, rescuer, and perpetrator, individuals can recognize when they are caught in this cycle and work to break it. RAD children are very skilled in using this method and it is recommended that educators understand and be able to recognize the signs of it.4. Be Prepared for unexpected behaviors during a hospital visit
The Health Care Providers need to be ready for the unexpected when the child with RAD is in a professional setting. The child's behavior can become unexpectedly out of control. Expect the unexpected with these children when they are in stressful or unfamiliar situations.
5. How do you help a child with Reactive Attachment Disorder?
The best way to help the child and not to make it worse. And the only way not to do it is to be informed, trained, and prepared to see the situation behind the facade. When communicating with a RAD child remember:
● It is very important to direct the child back to the primary caregiver as a trusted source of support and love. ● Providing firm boundaries and a high level of supervision are also necessary. ● Beware of manipulation. "They" can manipulate much easier than other adults who are not prepared to face a RAD child and each time a child “gets away” with manipulating adults, he becomes more deeply entrenched in unhealthy behaviors.6. It is not a good idea to talk to a RAD child in the first place if you are not trained or educated on RAD
Reason # 1 "Children with RAD lie, manipulate, and con. If they are taken behind closed doors with an adult who doesn’t live with the child, the child will use that opportunity to fine-tune their skills in manipulating, conning, and lying to the therapist! This causes tremendous regression in the child’s behavior"Nancy Thomas Attachment.orgRecommendation: Consider implementing standardized assessment tools for RAD.
7. Use proper and effective communication
● Maintaining a calm voice tone and facial expression is probably the most important communication tip if you want to keep the visit with the RAD child effective. ● Try to avoid emotional overstimulation of the child. ● Please, stay professional and keep the subordination. ● Do not let the RAD child "take the stage". ● When talking with a RAD child, try to position your face slightly above the eye level of the child. ● When "meeting and greeting" a caregiver and a RAD child, acknowledge a caregiver first. ● Abstain from offering any treats, toys, coloring books, etc. without obtaining the previous consent of a caregiver first. ● Try to find a moment to discuss before the meeting in private what should and should NOT be discussed in front of the children (personal topics, questions, etc.)● Consider implementation of a semi-structured interview with caregivers, observation of the child in the waiting room, and teacher report of RAD symptoms. [121]
8. Do not take the child to another room
1. Providers are taught to take the child to another room and leave the parent in the waiting area. The blatant messages to the child are; “Your parent is not important. Your parent can’t help you. You don’t need them.” That is the opposite message for healing to begin. Parents are essential!
2. Traditional therapy has the child alone in a room with the therapist. Children with RAD con, lie and manipulate. It is part of their diagnosis. Alone in a room, with an adult who does not know the truth, they will test the adult by lying, conning, or manipulating to see if they can trust that adult. An adult who believes their fables fails the trust test and no help from them will ever be accepted by the child with RAD. With the parent not present there is no one accessible to do a fact check. When an adult is fooled they flunk the child’s test for trust-ability and thus become completely ineffective. Game over!Source: Nancy Thomas [121]
Better Understand the Caregivers
While raising a child with RAD, primary caregivers often:
● Must remain calm yet vigilant about the physical and mental wellness of the whole family amid incessant arguing and bouts of rage from the child● Attempts to attach emotionally to the child are repeatedly rejected● Are falsely accused of abuse, neglect, etc. by the child due to the nature of the disorder (to reject attachment)● Are blamed by and ostracized from their community, friends, and family due to the confusing and deceiving nature of RAD, including false allegations● Lack of personal and professional support due to an overall lack of accurate education and training about RAD● Notice negative changes within self and family outside of their control● RAD is a serious mental health disorder that inhibits a child's ability to trust primary caregivers and leads to maladaptive self-protective behaviors. Those raising children with RAD often develop post-traumatic stress disorder (PTSD)*
Source: *[200]
The following Letters will help you to understand the real-life challenges of caregivers of RAD children.
Dear Teacher Of My Reactive Attachment Disorder (RAD) Child/TeenOpen Letter to a Therapist from a mom of a child with Reactive Attachment Disorder.
Here's what you can do to support parents of kids with RAD:
1. Don't Judge
It's easy to look at a parent who is struggling with their child and assume they need to try different parenting approaches. However, know that RAD is a serious mental health affliction, not a parenting issue. Rather than judge a parent of a child with RAD, remind yourself that you’ve likely never walked in their shoes. Parenting is not a “one size fits all” experience. All kids are different
2. Be there for them emotionally, even from afar
The best thing you can do to support a partner with attachment disorder is to be there for them emotionally, even if you don't always understand what they're going through.
Raising a child with RAD is difficult and lonely. Even friends and family, usually, don’t understand the disorder and many people unfairly place blame on parents for their child’s struggles. Let parents know regularly that you’re thinking of them. They're dealing with a lot.
Encourage them to express themselves freely, ask questions when you don't understand something they say, and validate their emotions [233]3. Talk about your "normal life" (without boasting)
To raise kids with RAD often means regular chaos. Many parents long to hear about “normal” things such as your new puppy or a sale you found on your favorite food at the grocery store. Just try not to boast about your own child. As much as they’d be happy for you, they may feel embarrassed or inferior that they and their child are merely getting by.
4. Do some research.
Get online and find resources written by caregivers of kids with RAD. You will gain a much better insight into what parents go through daily. After you learn more, you can ask parents informed questions and perhaps offer help where you can.
5. Listen to and believe the parents.
The most important thing you can do is to listen to parents of kids with RAD. Give them a safe place to share their experiences. A symptom of RAD is manipulation.
So, while parents often experience their child’s extreme behavior dis-regulation, you may only see a well-mannered and charismatic child. Honor the parent's trust in you, believe what they tell you, and respect their parenting choices. [102]
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