Reactive Attachment Disorder (RAD) - II
“Attachment. A secure attachment is the ability to bond; to develop a secure and safe base; an unbreakable or perceivable inability to shatter to bond between primary parental caregiver(s) and child; a quest for familiarity; an unspoken language and knowledge that a caregiver will be a permanent fixture.”
Asa Don Brown,
The effects of childhood trauma on adult perception and worldview.
I vividly recall watching on cable news, U.S. authorities separating the toddlers and kids from their mothers on the southern border. Infants taken from parents, young ones being told lies about seeing mommy soon. Tears uncontrollably ran from my eyes. My emotional brain was outraged. Having received my Ph.D. in Child and Develop-mental Psychology, my cognitive brain shouted out that, “this cannot stand. A solution must be found!” I reflected on the remediative work I have accomplished with our combat-veterans. How might this successful PTSD remediation intervention be applied to infants, toddlers, etc.?
The first piece of the puzzle surfaced in my deep-sleep state. Reactive Attachment Disorder (RAD) and Post-Traumatic Stress Disorder (PTSD) are the same! They symptomatically evidence differently in advancing development stages. With remediation intervention, combat veterans were able to release the emotional aspect of trauma while sustaining the memory/non-emotional aspect of the trauma. Might it be possible to place some sense of early bonding security into the long-term memory system? More specifically, is it possible to introject the sensory experience of unconditional love into an individual who has not had this visceral experience previously?
As an initial answer, take a look at 10-month-old toddler (Michaela)with RESET applied by one of my trained practitioners (Susan Parcell Bindewald, PMHCNS-BC). When toddler Michaela stayed with a relative, she was reportedly “a very active but ‘good’ baby’ who showed no fear of strangers. However, when she slept, day or night, she awakened almost hourly, screaming with her eyes tightly closed. It was difficult if not impossible to comfort her. When encouraged, she made eye contact while drinking a bottle, but she seemed to prefer holding the bottle herself and looking away. She smiled at times when she played or rolled around in her walker, but generally, her affect was flat.
The therapist reported that she applied RESET Therapy-RAD to this 10-month-old child for about 20 minutes using bone conduction headphones. “She wanted to play with the regular headphones, so I used my bone conduction headphones and she had no problem at all with it. She danced a little, and I believe she thought it was music.
“The toddler evidenced flat affect but seemed happy throughout the time we used the binaural sound. Clinically, I believe that Michaela was experiencing a trauma reaction in recent months. The family didn't know where she and her mother were, just that she was ‘living with friends.’ Two weeks ago, Child Protective Services called her great aunt, to come to a specific motel to get the baby. The baby had been living in the motel with the mother and a ‘myriad of ‘friends,’ using meth and heroin. The mother had been stealing Michaela’s formula from stores.
The evening following her treatment, Michaela was put to bed at 9:30 p.m. and she slept, reportedly, until 9:30 a.m., awakening only once, not crying and going back to sleep without a bottle. On the following workday, Child Protective Services gave temporary custody to another great-aunt who is where Michaela will remain until her birth mother completes treatment and can evidence stability. The first night in the new setting, she also slept all night, awakening once for a bottle without the screaming and eyes closed. She was quickly and successfully comforted.
Based on our tentative inquiry as evidenced in the above case, the answer to our earlier question, might it be possible to place some sense of early bonding security into the long-term memory system seems to be a definite yes. To date, in addition to the example, a young adult has been able to transform himself from a person who constantly sought the approval of others to that of one who can establish structure and boundaries with those who interact with him. I’m currently exploring the concept with a 15-year-old RAD adolescent who is deeply involved in self-medicating and negatively engaged with the justice system. Standby for a breakthrough in innovative RAD treatment this year. It appears that ‘memory updating’ of the sense of unconditional love is indeed possible.
In essence, RESET Therapy appears to induce neuronal plasticity for a brief period (five hours) during which trauma reactivity can be altered by dropping out the emotional component of the experience. As noted in my first RAD article, (January 2018) the idea is to simultaneously drop out negative aspects such as distrust of others as well as facilitating a positive emotional experience that was missed earlier in life. Through this means, I believe that it becomes possible to bridge the void created in the first critical psychosocial trust stage as described by Eric Erickson. (Bee & Boyd, 2011)
I’m preparing our first article for submission to a peer-reviewed journal on this topic. Stay tuned for status reports on the progress of said article. I’m optimistic that we may be able to reverse what has turned out to be a man-made induced traumatic experiment that has shattered the trust bond between parent and child. The extension of these principles to adopted children is enormous and profound.
I’ll provide you with a hint (teaser) of what is involved in the development of the new RAD Protocol. Of course, the binaural sound is a critical component. The treatment remains non-verbal. External speakers or bone-conducting headphones replace regular headphones. Sound frequencies are in the Theta range. A surrogate/adoptive/natural parent is engaged in the process of introjecting a sense of unconditional love.
Review of Recent RAD Literature
My final component of this article is to provide the interested reader with recent and pertinent scientific information about the RAD continuum. In general, it remains an understudied, and controversial disorder. Consistent with prior findings, the authors of a 2018 study found a high prevalence of callous-unemotional traits among those with RAD that is supportive of previous research. . . “A point we assume we all agree on is the importance of continued empirical research to advance our knowledge and understanding of RAD. (Waschbusch, Mayes, Calhoun, & Baweja, 2018)”
Exposure to adversity in childhood (Adverse Childhood Experience - ACE) is thought to affect brain development and health negatively.
“This study showed that adolescents who experienced more adversity during childhood also demonstrated poorer global executive functioning. Adolescents with four or more ACEs struggled with inhibition, self-monitoring, shifting, emotional control, task completion, working memory, and planning/organizing more than those with three or fewer ACEs. Adolescents who did not feel safe in their neighborhood or did not believe neighbors could be trusted (adverse neighborhood experience) demonstrated executive function deficits in the areas of shifting, task completion, working memory, and overall emotional regulation. Adolescents who indicated an ACE for bullying were more likely to struggle with task completion. In sum, this study demonstrated several significant correlations between early life adversity and global cognitive, behavioral, and emotional executive dysfunction on self-reports” (Barta, 2018).
Within RAD, aggression remains a topic of continued argument and controversy. Five adoptive family units including adopted children with RAD were chosen for the referenced study. Some prominent themes emerged including the following:
“The adopted children are reported to engage in extreme and prolonged tantrums, known as rages; children were often inconsolable during these rages; these rages are perceived as uncontrollable by children with RAD; these rages are directed toward a discriminate caregiver; and the impetus for these rages appears to be associated with difficulties in adapting to environmental demands” (Vasquez & Miller, 2018).
Pre-natal exposure to alcohol, opiates and illicit drugs, significantly influence a child’s neurodevelopment. Children with the above exposure between the ages of 6 and 14 years were engaged in a Norwegian study. The investigators concluded that:
“Children mainly exposed to substances other than alcohol were found to have an increased level of symptoms associated with ASD and ADHD in the areas of inattention and hyperactivity/impulsivity. A high proportion of the prenatally exposed children lived in adoptive homes or in foster care. . . Further research is needed both on diagnostic investigation of mental health problems and on determining the care and support needs in children prenatally exposed to substances” (Sandtorv, 2018).
From a public health perspective, epidemiologic trauma literature implies that children with one or more traumatic events are at increased risk for PTSD. They are also vulnerable to future interpersonal violence and other health ramifications. “the full mental health impact of trauma exposure on youth has yet to be appreciated, and further research is needed to explore the extent to which trauma-related disorders co-occur with neurodevelopmental disorders in the general population” (Lowe, Walsh, Opthof, & Tineo, 2018)
I end this blog with a brief discussion of a research study focused on being in love and feeling a romantic attachment to a partner.
“Early memories and attachment towards a caregiver, lay the foundation for later attachment behavior. . . Brain regions concerned with reward, emotion and thought processing, such as the reward circuitry network of the brain and the limbic system, are being investigated. . . Research findings suggest that brain areas responsible for affection, emotional control, learning, memory, and social judgment are all involved in the complex processes of being in love and feeling romantically attached. These findings are represented by the involvement of the frontal lobe, cerebral cortex, limbic system, orbitofrontal cortex, and hippocampus, anterior cingulate cortex (ACC), ventral tegmental area (VTA), caudate tail, including the reward pathways of the brain. . . Overlapping evidence confirms the involvement of the reward circuitry network, together with the limbic system as crucial in the formation and maintenance of a romantic relationship” (Junker & Constance, 2018).c
It appears that being able to love is a positive side of the same coin with the other side being the inability to connect to others. All sounds familiar, doesn’t it? The love side is related to openness, exploration, and curiosity. Flip the coin, and you have the ‘protect and defend’ mode. Optimistically, we can reset the involved cortical circuits to connect to the love mode again.
References:
Barta, J. (2018). The Relationship Between Adverse Childhood Experiences And Executive Functions in High School Aged Students. PCOM Psychology Dissertations. https://digitalcommons.pcom.edu/psychology_dissertations/446
Junker, B., & Constance, M. (2018). Neural correlates of romantic love and romantic attachment. http://urn.kb.se/resolve?urn=urn:nbn:se:his:diva-16055
Lowe, S. R., Walsh, K. L., Opthof, E., & Tineo, P. (2018). Trauma and Neurodevelopmental Disorders from a Public Health Perspective. In J. M. Fogler & R. A. Phelps (Eds.), Trauma, Autism, and Neurodevelopmental Disorders: Integrating Research, Practice, and Policy (pp. 205–239). Cham: Springer International Publishing. https://doi.org/10.1007/978-3-030-00503-0_11
Sandtorv, L. B. (2018). Mental Health and care situation in school-aged children prenatally exposed to alcohol and other substances: a hospital based study. The University of Bergen. https://bora.uib.no/handle/1956/18886
Vasquez, M., & Miller, N. (2018). Aggression in Children With Reactive Attachment Disorder: A Sign of Deficits in Emotional Regulatory Processes? Journal of Aggression, Maltreatment & Trauma, 27(4), 347–366. https://doi.org/10.1080/10926771.2017.1322655
Waschbusch, D. A., Mayes, S. D., Calhoun, S. L., & Baweja, R. (2018). Response to Allen (2018): Points of agreement and disagreement on reactive attachment disorder. Research in Developmental Disabilities, 83, 190–193. https://doi.org/10.1016/j.ridd.2018.09.002
