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Reactive Attachment Disorder and ASD

Autism Spectrum Disorders - Schizophrenia and Autism Spectrum Disorders: Reactive Attachment Disorder (RAD) used to be associated with orphans in Romanian orphanages, the battered, neglected and abused children of ...

 

  1. Reactive Attachment Disorder and ASD

    Reactive Attachment Disorder (RAD) used to be associated with orphans in Romanian orphanages, the battered, neglected and abused children of some disturbed or addict mothers or children given up for adoption. But what if, like autism, RAD is actually a spectrum? Today, the causes of RAD are far more diverse, even thought to potentially effect some (perhaps inherently less resilient) infants born to mothers with untreated prenatal and postnatal depression, ill and immune compromised infants experiencing chronic pain and prem babies experiencing early removal and limited bonding contact.

    But if RAD in infancy can cause severe chronic stress which can result in progressive sleep, gut and immune problems as well as cause real neurological differences, effecting real altered development in emotion regulation, interaction, language development, sensory integration and behavior management, could we have a whole new revamped, almost unrecognisable version of’the refrigerator mother‘?

    RAD is believed to cause:

    * low self-esteem
    * needy, clingy or pseudo-independent behavior
    * inability to deal with stress and adversity
    * lack of self-control
    * inability to develop and maintain friendships
    * alienation from and opposition to parents, caregivers, and other authority figures
    * anti-social attitudes and behaviors
    * aggression and violence
    * difficulty with genuine trust, intimacy, and affection
    * negative, hopeless, pessimistic view of self, family and society
    * lack of empathy, compassion and remorse
    * behavioral and academic problems at school
    * speech and language problems
    * incessant chatter and questions
    * difficulty learning
    * depression
    * apathy
    * susceptibility to chronic illness
    * obsession with food: hordes, gorges, refuses to eat, eats strange things, hides food
    * repetition of cycle of maltreatment and attachment disorder in their own children when they reach adulthood.

    cited here

    We know that chronic stress can lead to sleep, gut and immune problems, that depression and rapid cycling bipolar, social anxiety and compulsive disorders can all be now diagnosed in infancy and can also be found as co-morbid (co-occurring), compounding conditions in those with autism.

    It’s believed that Reactive Attachment Disorder in infancy may inhibit or alter relationship to and processing of emotion and relationships, underpinning a relationship to cognitive and language development and that it gets passed down to future generations but can also be passed on environmentally to those one is not related to.

    If RAD is something then passed on to one’s own children (that a parent with RAD will cause RAD in their child) and that, without therapy and intervention, some of those will grow up to do the same, then this raises many questions.

    Therapists have always been perplexed by the similarities of effects found in infants with RAD who were ‘autistic like’ and had ‘autistic traits’ and children with autism.

    As diagnosis of autism has expanded dramatically since the publication and international success of number one bestsellers like Nobody Nowhere and Somebody Somewhere brought awareness of it’s diversity into the mainstream, those who’d once have been labeled psychotic or disturbed in infancy or with autistic traits, now became diagnosed with autism.

    Whilst these works also expressed implications of RAD for someone with autism (and people with autism are born into all manner of environments including some very challenged ones), it became undeniable that the expansion of autism diagnosis after these books (sometimes as a direct result of people who’d read them and identified their own, later diagnosed children, from similarities to these accounts) had to suggest we’d ultimately have to take another look at possible connections or interactions between RAD and autism in a new and very different, hopefully less judgmental and socially damning light.

    Prolific accounts emerged of the mourning of parents for their child’s autism. The autistic pride movement rose up against the damaging impact this open mourning of these ‘walking wounded’, claiming its damaging impact on the psyche, development and potential of autistic children.

    This also begged the question whether carers, who already sensed their child was ‘autistically detached’, then self protected, sensing they may potentially have to one day have to separate from that ‘damaged’ child. There carers have even been so emotionally disturbed by lack of services promising the salvation of hope and dread over the potential of future separation that they murdered their child. For every carer in that situation there will be many who don’t go that far and live in shame and silence, unable to talk about THEIR emotional entanglement, distress or even detachment.

    Some carers, finding they couldn’t cope and needed to give their children up to adoption, fostering or institutionalized care, have been unable to stop steeling themselves against the ‘daily grind’ and damning predictions ahead. Some have claimed their emotional state couldn’t effect their autistic child because the child’s autism, ironically, ‘protected’ them from such impact. Others have been able to see past involuntary avoidance and diversion responses to realise that autistic children, like any human, are still effected by events even if they don’t cognitively or consciously register them or openly and interactively communicate or express that effect. These are natural human emotional dynamics in ALL people, not limited to families of those with autism.

    The relationship between RAD dynamics and autism has become even harder to avoid with books like Exposure Anxiety; The Invisible Cage of Involuntary Self Protection Responses which looks at involuntary, instinctual and compulsive avoidance, diversion and retaliation responses in those with autism.

    Casting aside the idea that children with autism didn’t sense, Autism and Sensing; The Unlost Instinct then explored the sensitivity of the sensing infant with autism, casting aside the presumption that those who haven’t entered the interpretive phase of cognition, aren’t still deeply affected by events they can’t cognitively process.

    Holistic models like The Jumbled Jigsaw then demonstrating how ASD is actually more of a fruit salad of compounding conditions which result in the developmental impact that gets labeled ‘autism’, the potential contributing role of RAD in at least a subset of cases of even intergenerational autism becomes a no brainer.

    Selective Mutism used to be neatly preserved for non-autistic children until recently where its now recognised as more common in children with developmental disabilities, including a PERCENTAGE autism (other language disorders including Semantic Pragmatic Disorder, Oral Dyspraxia and auditory and language processing disorders are also common) .

    Similarly, Autism used to be a word assigned to 1 in 10,000 children, which today has a vastly expanded presentation and is diagnosed in 1 in 166. Will Reactive Attachment Disorder go the same way? Where’s the cut off? Do we dare ask the hard questions?

    Is possible that we’re living in an age where some pregnant mothers being so busy with cerebral, passive interactions with technology and its related increase in time use that they don’t have the range of movements, emotional experience, that it’d be conceivable some don’t develop the same full prenatal bonding with their child that may have been more common before the 80s and 90s?

    Is it possible that parental reactions to the diagnosis of autism in their infant, reactions of depression, mourning and emotional self protection, may entrench an already established predisposition to RAD? Could some infants inherit particular personality traits and sensitivities that predispose them to RAD more than others? If so, then we wouldn’t find the same response in ALL children.

    If we inherit not just genetics but behavioral patterns of the ‘normality’ of our environment, then “improve” upon it, what if society is improving upon detachment, passivity, being more cerebral than emotional and physical, and progressively then mistrusting and fearing unexercised real interaction with ’strangers out there’?

    We are all, already, becoming more ‘autistic’ and the ‘geek syndrome’ generally associated with Asperger’s Syndrome is so widespread that mild cases are not even worth diagnosing lest we end up losing sight of any measuring stick of ‘normality’ (which is all relative anyway).

    If, as it is now believed, unborn infants are attuned to the emotional/hormonal experiences of their mothers, what are they experiencing in this brave new world? That they aren’t significant (or at least not till the computer is turned off)? That they don’t REALLY ‘exist’ yet until they’re actually ‘here’ and born? That passivity is the trusted norm of the world they’re headed for? That emotion and face to face physical interactions are, by contrast with logic, is uncomfortable, clumsy and inconvenient? That stopping and just ‘being‘ is futile, that being in nature is unfamiliar but interactions with machines isn’t. That filling all space with something physically inactive and passive interaction is the preferred, most socially rewarding ‘normality’?

    With progressive computer addiction, children are now born to pregnant mothers who may barely leave an office chair not only day, but in their own ‘entertainment time’ at night. It is a percentage of these ‘geek’ mothers who are identifying with and being diagnosed now with Aspergers, the same types who were previously in the highest IQ groups and the ‘gifted‘ range in pre-internet days.

    What happens to the prenatal bonding of a gifted kid born in the internet age to a computer addicted conscientious, even concerned and responsible, mother who spent her pregnancy at a soulless keyboard? Do we dare want to know?

    And what of the use of computers to help children with autism? There’s no doubt they help many, but others have been just as hindered by exactly the same ‘medicine’. Does any ‘medicine’ not have its side-effects? And do the side-effects need to be considered when deciding the dose and nature of any medicine or therapy? Even further, do we ask an addict what is best for their addicted child? And if not, what if a majority in society are becoming such addicts? Who do we ask?

    What if a form of RAD were possible through this detachment via distraction, this chronic preoccupation with the non-physical and non-human, this emotional and physical unavailability’?

    What if, because it didn’t effect men, nobody considered the prenatal impact of this on an unborn child?

    What if a pregnant mother was so busy she rarely had time/chance to think of the upcoming relationship with such a child?
    Could such a child handle this first developmental ‘insult’ yet be more vulnerable to depression, bipolar or anxiety or compulsive disorders in infancy and not cope with a second ‘insult’?

    If this happened before age 3, could this lead to a range of compounding developmental complications we call ASD including the health effects?

    If autism and Asperger’s, by contrast, is considered genetic but RAD is passed down intergenerationally could we be living in an age where our 1 in 166 population of children with autism is not an autism ‘epidemic’ at all, is a ‘mutation’ caused by a proliferation in previously unknown, subtler causes of RAD?

    If so, if today’s generation benefit from, enjoy or are addicted to those causes, and if voracious consumer economy feeds, encourages and entrenches those addictions through increasingly consumed media, will we ever wake up? Will we be ‘allowed’ to? And in a dog-eat dog society of stone throwing tabloid press, witch hunts and bitching public forums, can we ever calmly look at even hints of the refrigerator mother yet empathically envision ourselves in their shoes?

    If we can’t, then who can blame anyone for preferring any potentially detrimental status quo to real change? When your blame finger gets the itch to point, start by pointing it at yourself.

    NOTE: this article does NOT intend in any way to imply that RAD may be relevant to all families of those with autism.

    … Donna Williams, Dip Ed BA Hons
    autistic author of 9 books in the field of autism
    Donna Williams *)
    www.donnawilliams.net

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  3. #2

    Re: Reactive Attachment Disorder and ASD

    Whilst attachment disorder gets fairly widespread recognition and attention for children, I'm not sure why there is little research or recognition for adults with this problem, as if attachment issues miraculously disappear when children reach puberty.

    I struggled for years with depression, anxiety, isolation, getting into abusive relationships, a low self esteem and frequent despair. It was only when a psychiatrist told me that I had attachment issues that I did my own research, visited forums (this and others) and did a whole lot of soul searching. Whilst it was refreshing in a way to be able to identify what was wrong, I was also exacerbated with how little this very widespread problem is recognised, identified and how little research and effective help there is for adults.

    The classic description of RAD gives only only very tiny part of the whole spectrum of attachment disorders, this is largely based on the avoidant type, People with RAD are not all lacking in empathy, self centred, unable to love. Its quite insulting to the many millions of people who have attachment disorders who are not like this and read this description of themselves all the time. I am certainly able to love, have empathy and care for others!

    This is the nature of my attachment disorder:

    I have been able to parent my own children lovingly and successfully, They are now young adults that are well rounded and happy young people. I am good at caring and loving others but I cope with this because I am then in control. I am either excessively needy (like a child) in a relationship with an exagerate sense of abandonment and rejection that leaves me emotionally in pieces should I allow someone to love and care for me OR the safer kind for me, in a relationship where I am in control - the person doing the looking after who people depend on. I am the one that people come to, I always have affection, understanding and all the answers. I need desparately to have someone like this for me but I cant seem to allow that ever to happen

    I was married to an alcoholic for over 20 years, I think now because the emotional abuse was what I was comfortable with and because I knew I could never depend on him so was again a kind of carer and was ultimately safe. I dont know how to 'be' in a relationship that has love and support in it for me, even though I crave affection and love almost constantly, I get obsessively attached to anyone who is remotely nurturing, although I have learned to "sit" on those emotions in later years. At the same time I cut myself off (unintentionally or unconsciously) from letting anyone get close and so I come home and close my door and isolate myself. I am friendly and have reasonable social skills, I think I am even quite popular at work, but thats superficial and about survival. No one gets really close to me and yet I am incredibly lonely.

    I am only just beginning to understand this, learning to peep my head out of the door by degrees and test the waters of trust, but its long and difficult.

    When I was told I had an attachment disorder, it all made sense, taking in my early experiences of a mother with post natal depression, frequent absences and being farmed out to different people before I was 5. My father abused us and my 'family' disintegrated totally when I was 12. I was alone in London at 15. Still I know my difficulties are not set in stone and I can (and am) working through them.

    I think attachment disorder is often wrongly diagnosed as depression, anxiety, eating disorders, even BPD. But I believe it is far more widespread than is currently realised.

    I believe the very limited and narrow diagnostic criteria (listed above) actually perpetuates this lack of recognition and diagnosis.
    Last edited by Halo; March 9th, 2008 at 03:24 PM. Reason: deleted double post

  4. #3

    Re: Reactive Attachment Disorder and ASD

    In adults we tend to get diagnosed with Borderline, Dependent or Avoidant personality disorder - or a combination of all 3. As well as depression, anxiety, and so forth, and possibly Complex PTSD.
    It's unfortunate that the diagnostic criteria mostly focus on the symptoms rather than the aetiology [causes] of an illness, where that is relevant. That's my opinion, anyway.

    I suffered early attachment trauma, and also later trauma in relationships too. I have never had a romantic relationship, never dated. I have traits similar to autism, but I am not autistic.

    Molly, I posted the above whilst you were posting the addition!

  5. #4

    Re: Reactive Attachment Disorder and ASD

    I think competent clinicians will recognize the symptoms of adult attachment disorder, although that may not be the primary diagnosis.

  6. #5

    Re: Reactive Attachment Disorder and ASD

    Perhaps it is more recognised in the USA and Canada David but that wasnt my experience. I have seen numerous psychiatrists, therapists and counsellors over a period spanning nearly 30 years (since I was 13!), at general hospitals where I saw consultant psychiatrists for depression, clinics I was referred to and had assessments and counselling practices. It was only about 5 years ago when I got a clear diagnosis. I still have really bad patches but I do now have hope at last that I can change things

    I've not found much information to read up on either and what I have found on the internet isnt always accurate or only gives a partial picture. Much more info about kids with RAD and the origins of it though. So I've read all I could on that

    I think you are right Braveheart .. I was once told that I presented very much like a Borderline, I hadnt heard of it then so went home and read up on it and was convinced that I didnt have it .. I dont! I suppose there is a lot of cross-over and spin off difficulties like depression and eating disorders which makes it doubly difficult to identify maybe.

    I think things are changing slowly though .. I hope so

    Actually guys ... this is a really good article about attachment and therapy. Cant copy and paste for some reason, but here's the link

    Attachment and attachment based therapy
    Attached Files Attached Files
    Last edited by MollyK; March 9th, 2008 at 06:45 PM. Reason: Automerged Double Post

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