Special needs adoption from a Jewish perspective.

Special needs adoption from a Jewish perspective.

Saturday, April 27, 2013

What about RAD?

The scariest aspect of adoption is the possibility of Reactive Attachment Disorder (RAD). Now, all children going through a change in caregivers will have attachment issues - whether it is acquiring a new step-parent or being placed for foster care/adoption.  In most cases, however, these issues will gradually subside with parental consistency and love.  Parents can certainly make the normal process of attachment easier or harder by their actions, behaviors and expectations, but on rare occasions, the "normal process" simply fails to present itself.  A child will appear to go through the motions of bonding, but then either lash out at other family members, clam up into his/her own world, or show indiscriminate affection.

Really, not enough is known yet about RAD and what constitutes effective treatment for it.  Consistency - above and beyond that needed for all children - is foremost.  I suspect that unrealistic expectations play a big role in triggering RAD.  Parents who report inadequate preparation and support from the placement agency are more likely to struggle with it.  Also, it seems that many adoptive parents assume RAD is to blame when the normal process of attachment is longer or more difficult than they bargained for.   But research suggests that there is at least a genetic component to the predisposition to RAD.  This is the scary part!  You can do everything right and still end up with a nightmare situation.  Success stories are few, and one out of every five adoptions is disrupted.

The Mayo Clinic recommends parental preparation, therapy, and possibly drugs to help children with attachment issues.  They warn against radical, unproven and coercive "therapies".  For example, in the context of proper attachment therapy, the adoptive parents are the only source of anything during the initial bonding period: Food, drink, affection, assistance with daily tasks, etc.  On the other hand, some take this to an extreme of "holding therapy", where the child is forced into submission by coerced physical contact.

Seems to me like this is just another one of the ways that hurt children are hurting.  Some are malnourished.  Some are long-term non-verbal.  And some resist attachment.  As in all aspects of child-rearing, I think it is paramount to consider the child's needs first.  What does this behavior mean?  Just that the child is hurting. S/he needs that hurt validated, and the need behind it fulfilled.  This may take longer, and may require more professional assistance, but I think that a child-based approach has the best chance of producing positive results.

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