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.

What too of autistic face blind infants unable to recognise their carer’s from others, those with tactile and body agnosias unable to process touch and being held, those with verbal agnosias unable to understand a carer’s speech or social-emotional agnosia who are unable to process facial expression, body language or intonation? Could they too be more susceptible to naturally developing elements of Reactive Attachment Disorder even in the ‘best of’ families?  In fact literature is now beginning to acknowlege that mental retardation can affect attachment behaviour so if a significant percentage of children with autism are considered mentally retarded would this make them more prone to attachment disorders?  Further, how much of what we presume to be mental retardation effecting bonding is actually significant agnosias common in those with autism?

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, even physiologically so mimicking what is seen in ASD that it can be indistinguishable from it.

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 Reactive Attachment Disorder 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. Are there any possible connections? Could the two mimic each other or even sometimes occur together in the same child? Children with ASD are born into all kinds of families, wonderful, helpful, well adjusted ones, wonderful, challenged, less adjusted ones and plain full on imbalanced ones, so kids with both ASD and RAD are eventually bound to pop up. If a child had both RAD and ASD would we be able to tell how much was autism and how much was RAD?
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 less 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.
A current autism approach of RDI (Relationship Development Intervention) is sweeping the world and taking over from the costly approach of ABA. Unlike ABA which focuses on the presumed ‘cognitive pathology’ of autism, RDI recognises these ‘pathologies’ as significant information processing differences and addresses the bonding issues which can complicate autism if the carers are using an approach ill suited to the child’s perceptual, cognitive or social-communication reality. In other words the challenges of autism itself may present a block to bonding processes requiring tuition of some carers in how to overcome those blocks in order to have a happier child with autism more capable of reaching their potential.
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. This is certainly not representative of the families of all people on the spectrum but it will be of some.

There is no ALL.
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 and I’m certainly not implying RAD will be relevant to all families of people with ASD, not even the majority.

The potential relationship between RAD dynamics and autism may be 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. If nothing else Exposure Anxiety is something relevant to a subset of people with ASD and it may be worth exploring any potential role of RAD in such a subset.
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?
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’?  How much more might significantly agnosic children be effected by this factor than usual children?

With progressive computer addiction, children are now born to often intelligent, caring pregnant mothers who, nevertheless, may barely leave an office chair not only day, but in their own ‘entertainment time’ at night without having any idea this may impact on an unborn child. 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. Is this co-incidence?  Alternatively if one has social emotional agnosia and misses facial expression, body language and intonation, then computer addiction may feel more rewarding, but at what cost to those already potentially more prone than usual children to attachment disorders?
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?
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’? Certainly no mother can be blamed for the potential effects of something they have not understood. But perhaps we might at least try and understand it and give people choice.
What if, because it didn’t effect men, nobody considered the prenatal impact of this on an unborn child?

What if a caring, conscientious, loving 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’? We don’t know but at least studies could explore it and let us know.
If this happened before age 3, could this exacerbate 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 a subset of the 1 in 166 population of children with autism may not necessarily be part of an autism ‘epidemic’ at all, but possibly a ‘mutation’ exacerbated 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 especially when studies have ignored clarifying the possibilities?
NOTE: this article does NOT intend in any way to imply that RAD may be relevant to all or even the majority families of those with autism.

… Donna Williams, Dip Ed BA Hons
autistic author of 9 books in the field of autism

http://www.donnawilliams.net