Sometimes called Reactive Attachment Disorder (RAD), Disinhibited Social Engagement Disorder (DSED) is a serious condition in which an infant or child doesn’t establish a healthy attachment with a parent or primary caregiver. RAD and DSED originate during the early development period prior to the age of five. Healthy parent/child relationships are formed by the time we are three years of age. Infants and young children who have spent time in foster care, orphanages, or are adopted are at high risk of developing attachment disorders as well as children that have experienced abuse, neglect, trauma, breaks from the primary caregiver, and unresolved ongoing pain.

Attachment Disorder can happen when a child experiences discomfort or has a need, cries out, and the cries are not met with a nurturing response from the primary caregiver. When an infant’s basic and emotional needs are not met with affection, comforting and nurturing continuously by the primary caregiver, healthy bonds are not established. Attachment disorders are not as common with children who have lived and are raised by their biological parents; however, there are reasons where this disorder can manifest in a child raised with their biological family, usually when the primary caregiver is not emotionally available to meet the infant’s needs due to severe depression, divorce issues, drug or alcohol use, mental illness, or deployment.

Symptoms of Attachment Disorders

The ramifications for a child that has not learned to form a healthy attachment to their primary caretaker can result with behaviors listed below:

• Refusal to accept comfort or affection(on parents’ terms).
• Cruelty to animals or people.
• Avoidance of eye contact (mostly on parents’ terms).
• Impulsivity/lack of self-control.
• Inappropriate sexual behaviors.
• Destruction of property, stealing, lying.
• Unusual eating patterns, gorging or hiding food.
• Lack of conscience, empathy or remorse.
• Problems with learning and learning lags.
• Inappropriate clinginess or indiscriminate affection with relatives or strangers.
• Controlling behavior.
• Lack of cause and effect thinking.
• Withdrawn or overly talkative or chatty nonsense questions, fake, phony, not sincere, superficially engaging and charming.
• Lack of an awareness of others’ personal space.
• States the obvious.
• Blame shifting – doesn’t take responsibility for actions.
• Trouble with peers, ADD/ADHD.
• False allegations of abuse.

Children with attachment disorder may experience some of these symptoms or many.

DSM-5

Recently the DSM-5 divides this disorder into two sub-types:

• Inhibited – known now as Reactive Attachment Disorder.
• Disinhibited – known now as Disinhibited Social Engagement Disorder.

RAD and DSED are part of a new category group of diagnoses in the DSM-5 which are found in trauma and stressor-related disorders. Post-traumatic Stress Disorder (PTSD) is part of this group; however, PSTD can happen at any age and is usually related to a single trauma incident.

The DSM-5 explains the differences between the two sub-types:

• Reactive Attachment Disorder (inhibited). The child rarely or minimally seeks comfort when distressed. Minimal social and emotional responsiveness to others, limited positive effects, episodes of unexplained irritability, sadness or fearfulness are evident even during a non-threatening interaction with the caregiver.
• Disinhibited Social Engagement Disorder (DSED). The child that is not reserved or reluctant to approaching unfamiliar adults. A child that is overly familiar verbal or physical behavior, isn’t checking with adult caregiver or parent after venturing away, even in an unfamiliar setting, and is willing to go off with an unfamiliar adult with little to no hesitation.

Attachment Disorders are misdiagnosed frequently with Bi-polar, OCD, ADHD, Mood Disorders, etc.

Living with a child that suffers from early childhood trauma can be exhausting and extremely hard to deal with for the whole family. Parent’s may experience triangulation, manipulation among a slew of other problems. Children with this disorder can have a mom living in crisis mode and extremely exhausted on a daily bases. This child can constantly be seeking negative attention from mom while creating havoc at home and school. Most of the time the Mom is the target and she will be dealing with the brunt of this child’s acting out.

Normally a child with RAD targets the primary caregiver due to the first hurts the child experienced with the birth mother. This child can be “paying back” the new mom for old wounds from their past. Children with this disorder do not trust that the new mother is truly going to be their forever mom, they live in fear that history will repeat itself. From the child’s perceptive, when the birth mom “abandoned” or has given them up for adoption, they can be left with feelings of unworthiness and shame. Neglect, abandonment, and abuse are painful to experience for anyone, much less an infant or young child.

It is hard for a young child to make sense of these experiences and for some, inner rage develops and grows into controlling behaviors. As an infant is left to his own devices, he can start to internalize the early trauma and the child can start placing blame on themselves for past events. Shame and feelings of inadequacy can also start to develop. So these children tend to reject the new mom’s love and may continually be testing or pushing away the love she gives. Children with this disorder tend to have ambivalent feelings, on one hand they are comfortable being distance but on the other they feel jealous watching others enjoying relationships. These ambivalent feelings can lend to some of their acting out behavior’s. When a young child or infant does not find relief from stress or discomfort on a consistent basis, this creates a sense of distrust and the child begins to fend for himself. This child hasn’t learned to rely or depend on the caregiver.

The cycle of attachment becomes blocked as the child is living in survival mode. As the infant or young child is relying on themselves he can view the new parent’s love and caring as intrusive. Normal parenting ways can feel threatening to a child that had to fend for itself. These children or infant can be seen by their new parent’s and some unknowing professional’s as being self-reliant or independent. It is important to know that Attachment Disorders do not present the same in all children. Some are ambivalent while others are passive aggressive and some present as failure to thrive to name a few. Taking a child back to stages where their needs were not meet and giving them the gift of learning how to rely and depend on a parents is vital when working on establishing healthy bonds between mother and child. When a child learns that their needs can be meet and their world is safe, they can begin to receive the nurture given. The cycle of attachment can begin and a healthy bond between caretake and child starts to blossom.

Recommendations for therapy

Finding a therapist that specializes in these disorders is highly recommended. Therapy for this child should be done mostly with the parent in the session so the therapist can help to facilitate the bonding experience between mother and child. It is important that the primary caretaker be present. Children with RAD/DESD need to feel safe. Left alone in therapy, a child can lead even the best of therapists astray. It is important that this child doesn’t have opportunities to lie and manipulate as this can strengthen the disorder and grow the controlling behaviors.

Results of this can make the child feel very powerful and unsafe as he will feel smarter than the adults caring for him. Helping a child become aware of their feelings and learn to express and reach out to have needs meet in a safe nurturing environment is key. A child with this disorder can be very toxic to the entire family. A therapist specializing in this disorder would know the importance of working to heal the whole family.