Reactive Attachment Disorder Treatment (RAD)
Healing with Love and Limits
Walter D. Buenning, Ph.D. & Assoc.
Palo Alto, CA
Licensed Psychologist, Colorado #1424



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Bonding and Attachment

For the past ten years, I have worked with families who have adopted children. For one reason or another, their child has failed to bond. In this article, I will share with you some of my clinical observations, opinions, and conclusions. They are based upon years of working with literally hundreds of children and their families.

What is attachment? Bonding or attachment refers to the emotional connection or the strength of the relationship between one person and another. Usually it is between a child and his parents. In this article I will refer to attachment as the capacity of an infant or child to form a close, trusting, and loving relationship with his mother and father. In professional circles, when a child or baby has a problem attaching or bonding to his parents, it is called a Reactive Attachment Disorder (RAD). As the name implies, difficulty with bonding is a reaction to something that child has experienced.

["his" throughout is used to indicate both genders. RAD is not gender specific.]

What causes a child to have difficulty attaching to his parents? If a baby is traumatized early in life, it usually affects his ability to bond. The extent of the baby’s difficulty depends on the severity of the trauma.

One major group of children who are traumatized are those who become available for adoption. Every baby who becomes available for adoption has experienced some trauma. The most common trauma they can experience is the loss of their relationship to their birth mother. Over the past ten to twenty years, there has been growing evidence that a strong or significant bond exists at birth between the infant and his birth mother which develops during the nine-month period the child was inside his mother. In my experience, besides food and air, nothing is more important to a baby’s survival than his mother’s love. When the love from his relationship is lost, regardless of the reason, the bond is broken and the baby is adversely affected.

Many babies, who are adopted at birth or shortly thereafter, bond to the adoptive parent or mother without any problems. Others do not. We do not clearly know the reasons why. We also don’t know how frequently this occurs. Based on my clinical experience, I estimate that it occurs in 10-30% of infants adopted at birth. If other harmful experiences, such as neglect, abandonment, abuse, or multiple placements are added to the loss of his birth mother, the resulting damaging affects are compounded. The more severe the problems in the relationship with the birth parents, the more difficult it will be for the child to receive and give love to the new adoptive parents.

Until recently, little was known about bonding. RAD as an emotional disorder was not even identified. Even now, many clinicians and most parents have not heard of RAD. In the past and sometimes today, when adoption agencies placed babies or children, bonding or attachment problems were not taken seriously enough. Too often, parents and agencies believed that if a baby or child were placed with loving parents, all would go well. We all know that babies need and want love. Adoptive parents are motivated to nurture and love their adoptive babies. Consequently, it should be a perfect match. Unfortunately, anyone who works with adoptive families knows that frequently something goes wrong.

What happens when an adoptive child fails to bond? Let me share my perceptions based on my experience. In a few rare instances, I have seen adoptive parents who are not very loving and capable parents. When parents are unable to love well, then it is understandable that a baby is not able to bond. In my clinical experience, however, this has been rare. In most families, what I have observed is that the adoptive parents give the child more than sufficient, high quality love. But sometimes it's not enough.

What I have seen is that bonding is a two step process. First, the parents must give the child love. Secondly, the child must accept it. The problem arises in the second step or phase. Because of past loss, some children are unable to trust. They are unable to accept the new parent’s love and risk losing it as they did with their first parent. It is difficult for most parents and many clinicians to believe that this could happen with children and even infants. In adoptive homes, love is like a gift given to the child. The core problem is that the child does not, indeed cannot, accept the gift. In the end, the result is that the child looks and acts as if he has not been loved.

For some parents and clinicians, it is understandable that a three or four year old child may not accept an adoptive parent’s love. But for many parents and many clinicians, it seems illogical that an infant would resist being loved. There is no doubt in my mind that a percentage of infants adopted at birth actively and spontaneously resist accepting their adoptive parent’s love. Everything in normal experience would tell us that babies want to be loved and if you give it, they will accept it. However, if something has gone wrong with the original parent—child relationship, the baby can be afraid to again risk loving and being abandoned. When this happens, the parents will often try to give even more love. Usually, this does not work. Over time, the parents become more and more frustrated and feel rejected by the infant who resists virtually all their efforts to love him. Many mothers and fathers who began with a heart full of love and hope, end up defeated, discouraged and angry. After years of such rejection, they have a tough time liking their child much less loving them. If they go for help, the child with RAD usually presents to the clinician as a friendly, cooperative and healthy child. On the other hand, the parents, particularly the mother, often appear frustrated, angry and critical toward their child. The clinician frequently concludes that any problem that exists must result from the mother’s anger and criticism toward her child. Consequently, mothers become the focus of therapy and as a result feel even further misunderstood.

What is the solution? Knowledge is power. With knowledge comes understanding, a new perspective and options or choices that previously did not exist. The first task in solving RAD is detection. It is essential for parents who have an unbonded baby or child to discover it early and seek help. As with most, if not all medical conditions, early detection and intervention is best. The sooner you can recognize a bonding problem with a baby or child, the more quickly you can get help. For several years I have thought that all babies who are adopted should have routine attachment check-ups, just as there are well baby medical check-ups. After the child has been placed with a family for several months, bonding should have begun. Evaluations could be done four to six months after the placement, and every four to six months thereafter. The evaluations could stop after two or three “problem-free” check-ups.

While parents should not be making a final diagnosis, they are the most likely persons to know if a problem exists. Often the child with RAD hides his problems from the outside world. Consequently, adults such as teachers and relatives often see the child as normal or as a “great kid.” Meanwhile, the child is very symptomatic at home, especially with his mother. In some extreme cases, the child even hides his symptoms from the father, displaying them only to his mother when the two of them are alone. In these families, even the father doubts the mother’s report of how disturbed the child is.

In order for early detection to occur, it is essential that parents know the core symptoms. This will give the parent warning signs that their child is having trouble bonding to them and may have developed RAD. There is a growing body of knowledge about RAD in children who are three or four years old or older. However, RAD often develops in infants. If it is detected in infancy, it can be healed very quickly and effectively. Even with children who are five or six years old, treatment may be very successful in a brief time. With older children the task is harder, but doable.

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Copyright © 2018 Walter D. Buenning, Ph.D. & Assoc.
Reactive Attachment Disorder Treatment