Fatal Misunderstandings About Reactive Attachment Disorder

[Alison J Stevens]

Fatal Misunderstandings About Reactive Attachment Disorder

Dangerous misunderstandings harm foster children and others.

Published on February 6, 2010

When I began this blog, I chose the name "child myths" because of my concern about misunderstandings that are potentially harmful to children. As
some readers know, my interest in this issue began some years ago with
a study of so-called Attachment Therapy
and its role in the death of Candace Newmaker in 2000 (described in
Mercer, J., Sarner,L., & Rosa, L. [2003], "Attachment Therapy On
Trial". Westport, CT: Praeger). The fact that other children have also
died at the hands of parents acting on the instructions of unconventional therapists has also motivated me to pursue the correction of "child myths".

A number of myths about children are part of mistaken beliefs about the childhood mental health problem called Reactive Attachment Disorder and given the code 313.89 in DSM-IV-Tr. The criteria for Reactive Attachment Disorder
involve children's age-inappropriate relationships with adults, with
behaviors that are either less engaged and dependent than is typical
for the child's developmental stage, or, alternatively, excessively
dependent and "clingy" compared to other children of the same age.
Regrettably, these criteria are little understood by the general
public, but are replaced by myths and misunderstandings that are
reinforced by careless journalists. For example, the newsletter of a
middle-western foster and adoption group (http://www.mfcaa.org/img/files/newsletters/2010/Feb%202010%20News...
) claims that Reactive Attachment Disorder is characterized by the
following symptoms: superficially charming behavior, refusal to make
eye contact on parents' terms, "crazy lying",
and false allegations of abuse, among other things. This misinformation
is repeated by print and television journalists until "everybody knows"
it's true-- even though it's obvious that this set of behaviors has
little or nothing to do with Reactive Attachment Disorder as defined
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The spread of misinformation is a problem for more reasons than one, and is especially problematic because misinformed people can easily make misinformed decisions. Such decisions have resulted in death and
injury of children who have been mistreated systematically by
caregivers, often with the encouragement of caseworkers. Michael
Shermer, writing in "Scientific American" several years ago, referred
to these adverse events as "death by theory", and indeed it is hard to
see how such things could have occurred if the adults had not been
blinded to the obvious by their beliefs about child development.

There have been quite a few reports of harm to children resulting from misinformed beliefs about Reactive Attachment Disorder. One account of an investigation of a foster home following the death of a
child gives examples of these beliefs and their impact. Relevant
correspondence and investigation reports may be seen at http://www.dleg.state.mi.us/fhs/brs/reports/CP140201012_SIR_2008C...,
but I will refer to some of the important statements referring to
beliefs held by the caseworkers in this situation. (I will omit some of
the material dealing with carelessness in the original acceptance of
these foster parents into the system.)

1. One child in the family had a tantrum in the car, and following the foster mother's actions to deal with this, complained that she had broken his leg. He was found to have a "linear displaced fracture of
the proximal tibial epiphysis" [the growth plate area at the end of an
immature bone] and a cast was applied. The caseworker said, however,
"DHS believes it is possible that [he] never really felt any pain in
his leg, that he was just using this as another control mechanism, and
he is bewildered by the fact that he now has a cast on an injury that
he was ‘inventing' in order to get the foster parent into trouble."
2. An anonymous referral said that a child had been locked out of the
house on several occasions and had screamed and cried for close to an
hour, begging to be let in (this was in December in Michigan). The
caseworker, however, said the complaint was "consistent with her
knowledge of [his] classic Reactive Attachment Disorder (RAD)
behaviors, as he frequently yells and screams out toward foster mom,
accusing her of mistreating him", and that he might have gone outside
of his own accord and then taken the opportunity to accuse the caregiver.
3. One child was found locked naked in an abandoned outdoor shed. He was
taken to the emergency room, where doctors expressed concern about
bruises and bite marks on him. Two caseworkers stated their opinions
that these marks were self-inflicted.
4. Another of the foster children stated that a foster parent had made her run barefoot in the snow for "discipline", made her run up and down the stairs in the middle of the night, dragged her through the mud as punishment, and sometimes withheld food. No investigation followed these disclosures.

Do these examples of mistreatment show anything other than the fact that human beings can be unbelievably cruel to children? I believe they do show something else: that the caseworkers who were supposed to
advocate for the children believed that their treatment was
appropriate. They had accepted some ideas current among unconventional
therapists and frequently repeated by unwary journalists. These
included the belief that complaints of pain or sickness by children
said to have Reactive Attachment Disorder are all lies and attempts to
manipulate and exploit other people. Also included was the belief that
allegations of abuse by "RAD children" are always lies and attempts to
cause trouble to their caregivers, even when there is physical evidence
of injury. In addition, not only the individual caseworkers, but one or
more of their supervisors apparently believed that pain, hunger, fear, and humiliation were appropriate treatments for children who were less than satisfactory to their caregivers.

Until we can correct these myths, and until we educate caseworkers, foster and adoptive parents, teachers, and the general public, about them, the most vulnerable of our children remain in real danger from
those who are supposed to care for them. Please, journalists, take
note, and do not exacerbate this problem by circulating dangerous
mistaken beliefs!