RAD

Collaborative Problem Solving and Reactive Attachment Disorder

From time to time, I work with a family, caregiver, or child-focused professional who asks me about whether CPS can work for kiddo with this or that diagnosis. Will CPS work with kids with FASD? Will CPS work with kids on the spectrum? How about kids who have ADHD?

The answer is, invariably, yes! CPS works independent of diagnosis because CPS is a technology that we as caregivers and professionals use to address challenging behavior, solve problems, and build skills. 

Today we'll take a look at Reactive Attachment Disorder (RAD), and whether CPS is a good fit for kids who experience attachment challenges. 

RAD in a Nutshell

Reactive Attachment Disorder is a disorder that is diagnosed early in a child's life, and is marked by disturbed social relationships, a history of disruptions to caregiver relationships, and either a persistent inability to respond appropriately to caregivers, or indiscriminate acceptance of comfort and support from adults. It's a popular diagnosis, especially among kids who are involved with the foster and adoptive systems.

Kids who have attachment issues are often observed to struggle to give up control over their environments, connect with caregivers, react poorly to reasonable limits, consistently regulate their bodies and emotions, build healthy social relationships, and engage adaptively in family traditions (like holidays, vacations, etc).

What Doesn't Work

First, let's talk about conventional wisdom - what it is and how it's commonly used to respond to behaviors associated with attachment concerns.

Conventional wisdom is organized around the idea that kids do well if they want to. Under the umbrella of conventional wisdom, kids who have trouble meeting expectations are seen as unmotivated, and the solutions we as adults with are intended to produce motivation to change. 

Evidence, however, teaches us that kids already want to do well, and when things get hard, it's usually because kids are lagging behind in some aspect of their "thinking skills."

Kids who have lots of skills can actually respond pretty well to conventional wisdom approaches to challenging behavior - things like sticker charts, paychecks, groundings, etc. Kids who don't already have lots of skills usually have a really hard time responding successfully and sustainably to these types of approaches. 

There are lots of reasons kids might have lagging skills. Disruptions to caregiver relationships and subsequent attachment issues are certainly things that interrupt typical skill development. 

Conventional approaches don't work well for kids with attachment issues for a couple reasons. Kids with attachment challenges have learned over time that caregivers are simply not reliable. When caregivers are unreliable, they're unsafe, and systems of consequences and rewards designed by unsafe caregivers are also unsafe. When the consequence and rewards system is unsafe, kids are going to be less inclined to participate in it. 

Disruptions to caregiver relationships also impact a child's ability to develop their thinking skills - skills like emotional regulation, being able to communicate their needs appropriately, adapting to changing environments, and being able to understand and correctly interpret social cues. As caregivers, we do a lot to model these skills and help kids practice them as they move closer to mastery. When caregiver relationships are disrupted, often it means that kids don't get a chance to practice these skills - these kids aren't lost to the wilderness, they're just farther behind. 

Why Collaborative Problem Solving Does Work

Let's take a look at the three main ingredients of Collaborative Problem Solving that are baked in to every Plan B conversation:

  1. Empathize. The first step in a Plan B conversation is to empathize with the child's concern. Remember that empathy isn't endorsement, it's understanding. In this first ingredient, we're trying really hard as adults to drill down into the problem and really get a good picture of the issue from the kid's perspective. Empathy, it turns out, is really really good for kids who have attachment issues. It also, it turns out is good for everyone else in the world, but it's also great for kids who have attachment concerns.
  2. Share the adult concern. The second step of a Plan B conversation is to share the adult concern about the problem. In this step, we're inviting the child to appreciate the perspective of another person and develop their own empathy skills. Do kids with attachment issues struggle to take the perspective of other people, especially caregivers? You bet they do. Ingredient two is great practice.
  3. Collaborate. The final ingredient of a Plan B conversation is an invitation to the child to collaborate on a solution to the problem that incorporates both the child's concern and the adult's concern. In this last phase we're engaging the child's problem solving skills, but we're also asking them to again practice their empathy, to practice their perspective taking, and to practice their emotional regulation. But we're also doing more than just practicing skills - we're demonstrating to the child that we as caregivers are just as invested in the child's concern as we are in our own, and are committed to understanding and creating a solution that works for everyone. 

Look, nothing solves attachment issues overnight. Healing from disrupted relationships with caregivers can take years - parents who are taking care of kids with attachment struggles are invested in the long game. The invitation here, though, is to see kids with attachment issues not as a separate species of kid who are entirely dissimilar to their peers who have developed secure attachment with their caregivers, but as kids who are farther behind in their skill development. 

Kids with attachment issues tend to struggle similar things: giving up control, accepting limits, expressing their concerns, interpreting social cues, etc. A lot of parents with RAD kids would say, "yeah, that sounds like my kid!"

But here's the thing: a lot of parents who have kids who don't have attachment issues would look at that list of things RAD kids struggle with and say, "oh yeah, that's my kid, too."

A RAD diagnosis can help build a narrative of a kid's early childhood experience, and for many parents, getting that diagnosis for their kids can really validate the struggle of parenting. Collaborative Problem Solving doesn't ask us to abandon that narrative - it asks us instead to really focus in on the specific skills our kids with RAD are struggling with, and work with them to develop solutions to problems that work for the whole family. It can be a long process, but it's a process that is focused on empathy, relationship, and skill development - three things which kids with RAD often missed out on big time. 

Ed Morales, LICSW, is a clinician and educational consultant based in MinneapolisFor more information about Collaborative Problem Solving and it's application in schools or families, connect with us.