The DSM-IV indicates that Reactive Attachment Disorder (RAD) may arises from the “repeated changes of primary caregiver that prevent formation of stable attachments (e.g. frequent change in foster care.)”
The Role of the Mental Health Professional
To bridge the emptiness
in search of psychic pain
with grace to reach inside a troubled soul
To heal the mind and heart
and bridge the loneliness of discontent
That is my grace and gift
A mental health professional (psychologist, psychiatrist, or social worker) can play three important roles on the foster child's road to bonding and permanence. A correct diagnosis is necessary to get started. Then treatment may be necessary to address one of the many psychiatric disorders to which foster children are particularly vulnerable. Finally, the mental health professional can attest to the presence or absence of bonding by performing a bonding evaluation.
Obtaining the correct diagnosis through a Childhood Mental Status Exam is the first step. The most common disorders include Reactive Attachment Disorder (RAD), Oppositional Defiant Disorder (ODD), Attention Deficit/Hyperactivity Disorder (AD/HD), various Learning Disorders, and Adjustment Disorders. More serious are Conduct Disorders, Major Depression, and Autism. If medications appear appropriate, then a physician or psychiatrist will be needed.
At most, a therapist is likely to spend one or two hours per week with the child. Parents spend 24 hours in a day. What parents do or do not do will have considerably more influence on the child’s well-being than what happens in the therapist’s office. A wise child therapist will help the parents to become the primary healers.
Children suffering from Reactive Attachment Disorder make parenting exceptionally difficult. Ordinary parent-child communication can be misinterpreted by the child and backfire. The RAD child may shut down emotionally and seem unreachable, not understanding love nor trusting it. For this reason, we will use the following disorder as an example to show how a therapist can help the child by working with and through the parents.