An
Overview of Reactive
Attachment Disorder for Teachers
If a parent has given you this to read, you are teaching a child
with Reactive Attachment Disorder. The family of this child has
apparently decided to share this information with you. That sharing
is a big step for this family and one you have to treat gently and
with the respect it deserves.
Reactive Attachment Disorder (RAD) is most common in foster and
adopted children but can be found in many other so-called "normal"
families as well due to divorce, illness or separations. Reactive
Attachment Disorder (RAD) develops when a child is not properly
nurtured in the first few months and years of life. It is causes
by early chronic maltreatment such as neglect, abuse, or institutional
care. The child, left to cry in hunger, pain or need for cuddling,
learns that adults will not help. The child whose parent(s) are
more involved in getting their next drug fix than they are in nurturing
the developing child learns that the child’s needs are not
primary to the caregivers. Children born of drug or alcohol addicted
parents learn even in the womb that things do not feel good and
are not safe for them. In severe cases, where the child was an abuse
or violence victim, the child learns adults are hurtful and cannot
be trusted. The child with RAD may develop approaches or “working
models” of the world to keep the child safe. The child may
try to control a world the child experiences as dangerous if not
controlled by the child. Without therapy child with RAD may not
develop the attachments to other human beings which allow them to
trust, accept discipline, develop cause and effect thinking, self-control
and responsibility.
Children with RAD are often involved in the Juvenile Justice System,
as they get older. They feel no remorse, have no conscience and
see no relation between their actions and what happens as a result
because they never connected with or relied upon another human being
in trust their entire lives.
What you may see as a teacher is a child who is, initially, surprisingly
charming to you, even seeking to hold your hand, climbing into your
lap, smiling a lot, you're delighted you are getting on so well
with such a child. At the onset of your contact with the child who
has been reported from prior grades as "impossible" you
will wonder what those previous teachers did to provoke the behaviors
you have not (yet) seen but which are reflected in the prior grade
reports. A few months into what you thought was a working relationship
the child is suddenly openly defiant, moody, angry and difficult
to handle; there is no way to predict what will happen from day
to the next; the child eats as if he hasn't been properly fed and
is suspected of stealing other children's snacks or lunch items;
the child does not seem to make or keep friends; the child seems
able to play one-on-one for short periods, but cannot really function
well in groups; the child is often a bully on the playground; although
child with RAD may have above average intelligence they often do
not perform well in school due to lack of problem solving and analytical
thinking skills; they often test poorly because they have not learned
cause-effect thinking. In addition, having experienced at an early
age that nothing they do matters, they do not “try”
or put in effort; why try when what you do has not effect?
A child with RAD may climb into your lap and pretend to be affection
starved. Children with RAD may talk out loud in classrooms, do not
contribute fairly to group work or conversely argue to dominate
and control the group. Organizational abilities are limited and
monitoring is resented. There may be a sense of hypervigilance about
them that you initially perceive as no sense of personal space and
general "nosiness". They seem to want to know everyone
else's business but never tell you anything about their own. There
is no sense of conscience, even if someone else is hurt. They may
express an offhand or even seemingly sincere "sorry,”
but will likely do the same thing again tomorrow. They are not motivated
by self or parental pride, normal reward and punishment systems
simply do not work.
They may omit parts of assignments even when writing their names
just so that they are in control of the assignment, not you. This
stems from a deep feeling that adults are not to be trusted, so
the best strategy when you don’t trust someone may be to not
do what that person asks you to do. When assigned a seat they may
choose an indirect, self- selected path to reach the seat. When
given a certain number of things to repeat or do, they often do
more, or less than directed. They destroy toys, clothing, bedding,
pillows, and family memorabilia. They may blame parents, siblings,
or others for missing or incomplete homework, missing items of clothing,
lost lunch bags, etc. They may destroy school bags, lose supplies,
steal food, sneak sweets, break zippers on coats, tear clothing,
and eat so as to disgust those around them (open mouth chewing,
food smeared over face).
They may inflict self-injuries, pick at scabs until they bleed,
seek attention for non-existent/miniscule injuries, and yet will
seek to avoid adults when they have real injuries or genuine pain.
These children have not learned how to seek and accept comfort and
care from caregivers because their early experiences have taught
them that adults don’t care. Children with RAD may have multiple
falls and accidents and frequently complain about what other children
have done to them ("he started it!", "Suzy kicked
me first"). Children with RAD can walk around in significant
physical pain from real injuries and may minimize the injury until
it is detected. They may not wipe a running nose or cover a mouth
to sneeze or conversely will overreact or exaggerate a cough or
mild illness. They often have not had experiences of being taught
in a loving responsive manner how to wash, bathe, brush teeth, and
engage in other self-care activities.
They are in a constant battle for control of their environment and
seek that control however they can, even in totally meaningless
situations. If they are in control they feel safe. If they are loved
and protected by an adult they are convinced they are going to be
hurt because they never learned to trust adults, adult judgment
or to develop any of what you know as normal feelings of acceptance,
safety and warmth. Their speech patterns are often unusual and may
involve talking out of turn, talking constantly, talking nonsense,
humming, singsong, asking unanswerable or obvious questions ("Do
I get a drink any time today?"). They have one pace –
theirs. No amount of "hurry up everyone is waiting on you"
will work – they must be in control and you have just told
them they are. Need the child to finish lunch so everyone can go
to the playground. Need the child to dress and line up, the child
may scatter papers, drop clothing, fail to locate gloves, wander
around the room – anything to slow the process and control
it further. Five minutes later the child may be kissing your hand
or stroking your cheek for you with absolutely no sense of having
caused the mayhem that ensues from his actions. Again all these
behavior are NOT intentional. The behaviors are the result of having
experienced significant early chronic maltreatment. These early
experiences have created an internal working model of the world
and relationship that mirror those early experiences and which are
projected onto current relationships.
You can begin to understand what this child's parents must face
on a daily basis. The parents are often tense; involved in control
battles for their parental role every minute they are with the child,
they adopted the child thinking love would cure anything that had
happened to her before the adoption. They have only recently learned
that normal parenting will not work with this child; that much of
what they have tried to do for years simply fed into the child's
dysfunction. They are frightened, sad, stressed and lonely. Many
feel unmerited guilt for their perceived "failure" with
this child. The mothers often bear the brunt of the child's actions.
It takes a tremendous amount of work and therapy to turn these kids
around so that they can experience real feelings and learn to trust.
Parents who have embarked on this healing journey for their child
need support and consistency from other adults who interact with
the child.
What can you do as a teacher? CALL THE PARENTS. Have them in to
talk with you about this issue. Call them and talk about what you
see in the classroom and ask if they have any other strategies for
managing things. Parents who are in counseling and therapy with
this child will eventually open up to you and you'll all be able
to help the child get healthy or at least not contribute to his
dysfunction.
Parents will tell you if time is precious on a particular occasion
due to ongoing therapy, or whatever, don't feel put off or shut
out. They will talk to you when they have time and time is one of
the things parents often run out of as they work desperately to
save their child's future. The therapy and home parenting techniques
are exhausting and time consumptive. Try to respect that if it seems
they are not focusing on your goal of home or class work. Do not
trust schoolbag communication or expect things sent in a "communication
envelope" to be as complete as when they left the school with
the child. Use the phone, e-mail, and regular mail – it works.
Don't feel you need to apologize if you have believed this child
and blamed the parents. If they have given you this information
they already trust you and do not blame you for not having the information
you needed – likely they only just recently got it themselves.
Make it perfectly clear in your interactions with the child that
you will take care of the child and the classroom or activity. Remind
the child, unemotionally but firmly, that you are the teacher, you
make the rules. You can even smile when you say it if you can get
the "smile all the way up to the eyes", just remember
to get the child to verbally acknowledge your position. Do it every
day for a while, and then use periodic reminders. Insist upon use
of titles or prefixes (Miss Jane, Teacher Sarah, Ms. Philips), they
establish position and rank. Structure choices so that you remain
in control ("do you want to wear your coat or carry it to the
playground?” "you may complete that paper sitting or
standing", "you may complete that assignment during this
period or during recess"). Remember to keep the anger and frustration
the child is seeking out of your voice. Try to "smile all the
way to your eyes" if you can, otherwise simply stay as neutral
as you can. Structure and control without threat.
YOU ARE NOT THE PRIMARY CAREGIVER for this child. You cannot parent
this child. You are the child’s teacher, not therapist, nor
parent. Teachers are left behind each year, its normal. These children
need to learn that lesson.
Establish EYE CONTACT with this child. Be firm, be consistent, and
be specific.
Try to remember to ACKNOWLEDGE GOOD DECISIONS AND GOOD BEHAVIOR
CONSEQUENCE POOR DECISIONS AND BAD BEHAVIOR. Poor decisions and
choices like incomplete homework, wrong weight jacket for the weather,
also need to be acknowledged ("I see you didn’t complete
work from this activity period. You may finish it at recess while
the other children who chose to finish their work go outside and
play.") Nothing mean or angry or spiteful – it's just
the facts. Remember they have difficulty with cause and effect thinking
and have to be taught consequences. Normal reward systems like treats
and stickers simply do not work with these children. Standard behavior
modification techniques do not work with this child.
Consequencing is a good teaching technique– there is a consequence
associated with each good behavior, each poor behavior – teach
them what those consequences are – they will not think of
or recognize them without your direction.
BE CONSISTENT, BE SPECIFIC. The child with RAD may be "good"
for you one or two days or even weeks and then fall apart. This
is normal. No general compliments like "you're a good boy!"
or "You know better.” Be specific and consistent –
confront each misbehavior and support each good behavior with direct
language. "You scribbled on the desk – you clean it up",
"You hit Timmy, you sit here next to me until I decide you
may play again without hitting." "You did well on the
playground today, good for you!” "You completed that
assignment, that's a good choice!” Be positive when you can.
This NATURAL CONSEQUENCES thing is important. Do not permit this
child to control your behavior by threatening to throw a tantrum
(let him, out in the hallway or in another room -"You can have
your tantrum here if you choose to"), "I see you've wet
the rug, here is a rag and bucket to clean it up", or puttering
around doing his own thing when it delays the class' departure for
a planned activity ("I see you've not gotten ready to go, you
can wait here in the supervisor's office until we get back").
Time-outs do not work for these children – they want to isolate
themselves from others. Bring the child near the activity he has
had to be removed from and have them stand with or sit in a chair
along side you. It's called a "TIME-IN.” If you can take
the time, speak quietly about how much fun the other children are
having and how sad it is that she cannot join in right now. No raised
voices, no anger. Don't lose your temper if you can avoid it; remember
he is manipulating you to do just that. If you are going to lose
it, seek assistance from another adult until you are back in control
of yourself.
RESPONSIVE, ATTUNED, EMOTIONALLY ENGAGED INTERACTIONS with this
child. It is very important that this child experience positive
regard and that the child is good, even is the behavior is not acceptable.
This helps the child move from feeling overwhelming shame to experiencing
guilt.
SUPPORT THE PARENTS. The child who is losing control at home and
in the classroom because folks are "on to him" will get
a whole lot worse before he gets better. Listen appropriately. Absolutely
redirect this child to parents for choices, hugs, decision-making
and sharing of information you believe is either not true or is
designed to shock or manipulate you. Follow up with the parents.
REMAIN CALM AND IN CONTROL OF YOURSELF. No matter what the child
does today. If the child manages to upset you, the child is in control,
not you. Remove yourself or the child from the situation until you
are able to cope. The child may push your “buttons.”
But remember, these are YOUR buttons and it is your job as a professional
to disconnect the buttons so that pressing them has no negative
effect.
If your classroom is out of control because of this child, get help.
Many school counselors and administrators have not had exposure
to the RAD diagnosis or how to handle it in schools. There are many
resources available. Don't give up. These children are inventive,
manipulative and very much in need of everything you can offer to
help them get healthy. Remind the child you will be speaking with
her parents on a regular basis.
Report to the child's home as often as you can without feeling burdened
by the effort. Expect notes to be destroyed. Use the phone. If you
do not get a response to written communication and the parents seem
to be out of touch with general information, do not blame them.
Chances are they never got the message, never saw the right number
of papers and have no clue what is going on because that is just
how the child likes it. It takes control from the parent. Give it
back by communicating directly whenever possible.
This child can and will be helped to get healthy and you can be
a part of that process with the right tools. Keep in touch with
the family. Remember that what you see in school is only the tip
of the iceberg – family life is terribly threatening to these
children and what the parents have to deal with every day is nearly
unimaginable to other uninformed adults. Blaming the family or failing
to communicate with them adds to the dysfunction and puts the child
at greater risk of never getting healthy. This child is learning
in therapy to be respectful, responsible and fun to be around. It
will take time, it will be an effort, if in the end it is successful
it will be because the adults in her life were consistent and the
child decided to work in therapy. Your contribution as his teacher
cannot be underestimated or undervalued – his parents will
be grateful for the support and the therapist will have fewer inconsistent
venues to sort out while helping the child to heal.
Edited
by Dr. Arthur Becker-Weidman 2006
Remember
to purchase:
Captive
in the Classroom - This three hour video set by Nancy Thomas, presents
powerful techniques for teaching and surviving disruptive, defiant,
and Reactive Attachment disorder students.
Clear concise tools to identify emotionally disturbed children and
youth who have the potential for violence are included. Effective
classroom interventions for emotionally disturbed students are clearly
explained.
Many parents have purchased this tape to share with their children’s
teachers to save their sanity while making them a vital part of
the healing team.
Parents,
do you need help with parenting
your child with attachment disorder?
Professionals,
do you need help teaching parenting
techniques that help a child with attachment disorder heal?
Clear,
concise help is here in
Dr. Arthur Becker-Weidman's
Attachment Facilitating Videos