Reactive Attachment Disorder
Your child doesn't like to be touched or hugged. He doesn't seem to mind hitting you, though, or pushing or wrestling or bonking heads. Is this a case of reactive attachment disorder (RAD), the frightening diagnosis that describes children who are unable to bond with their parents? Or could sensory integration disorder be responsible for his standoffishness and aggression? It depends on whether your child is reacting to the physical sensations caused by touching and hitting or the emotional ones.
Making a RAD Diagnosis
To make a diagnosis of RAD, a mental health professional will talk to the child and the parents and use DSM guidelines to identify certain patterns of behavior. RAD is indicated when a child exhibits the following:
Relationships that are not developmentally appropriate
Resistance to close family relationships
Excessive watchfulness and lack of trust that her needs will be met
Excessive desire for control in relationships
A mix of different responses to affection
Indiscriminate affection or attachments to people outside the family
The mental health professional will want to make sure that the child does not have any developmental delay or disorder that might account for the behavior and will also look into the child's background to see whether, at some time, the child was abused, neglected, or cared for by so many different people that attachments did not form.
Children from Eastern European orphanages are often diagnosed with attachment problems for these reasons. Since the benign neglect of orphanage life can also be a factor in sensory integration disorder, it's not surprising that the two can become confused. In reality, both diagnoses may be appropriate for some of these children.
The Sensory Integration Difference
You may be confused by the fact that your child seems to love you, enjoy your company, and engage you in conversation or play and yet withdraws so determinedly from your touch or embrace. This is actually a good sign. Children with attachment disorder are overwhelmed by the emotion involved in hugs and caresses, and they can't allow themselves to trust that the emotion is honest and reliable. Children with sensory integration disorder, on the other hand, have no trouble with the emotion part of the equation — they love and trust and want very much to please their parents. It's the tactile sensations they have trouble with.
A child who is overly sensitive to touch may process your tender pat on the head or touch on the shoulder as painful or an attack. Even a gentle hug may provide too much sensory information and feel as overwhelming to your child as a smothering bear hug does to you. If your child is undersensitive to touch, on the other hand, he may not feel your gentle touch at all, and he may not realize that when he hits or pushes or shoves or leaps on top of you, he appears aggressive. To him, wrestling feels like good, affectionate contact.
It's possible for sensory integration disorder to coexist with one of these similar disorders. With neurological impairments, the lines between diagnoses are often very blurry, and it may be that more than one will fit. If a dual diagnosis is suspected, make sure therapy for sensory integration doesn't get lost in the rush to medicate or treat the other problem.
Many adopted children experience attachment as a process rather than a given. If your child seems to be open and friendly toward you emotionally, meet her at a place where she feels comfortable and work from there. If your child seems emotionally guarded or manipulative, that may be a sign that serious attachment work needs to be done. That work often involves therapy that may be difficult and disruptive for a child with sensory integration disorder, so it's worth making a distinction as early as possible.