Reduce expectations: Developing an attached relationship may take a long time. In some instances, it may take until the child has reached adulthood. She may need that distance from her early trauma in order to look back and realistically evaluate what the adoptive parents are offering. Parents who feel that they cannot possibly wait that long for a child to bond may want to consider a child with an extremely low risk of attachment problems rather than a child who has any of the risk factors. Some parents begin to feel frustrated within a few weeks of living with an unattached child. This can lead to them exerting subtle, or overt pressures on the child. In turn, this can lead to the child pulling farther away.
Get a proper evaluation: of the degree of attachment problem Attachment problems can be thought of as existing on a continuum. Children may have some degree of problem without having full RAD. It is important to understand where the new child is on this continuum so that the intervention is appropriate to the need. As well, be sure to evaluate whether it is an attachment problem, or simply an adjustment problem that does not involve a psychological disorder.
Play feet: Feet involves everyone living in the home taking turns having his or her feet and hands massaged by the others. For example, one child or adult lays on the floor, bed, mat, or whatever feels safest, and the others each take an extremity and start massaging. Let each child and adult pick their own lotion or oil. While the massage is going on, the people doing the massage focus completely on the massage and talk about all of his positive attributes, i.e. I love your hair, Michael, it is so thick and shiny. Or, Joan, you were really nice to the dog today. Or, It made me feel really good to see how happy you were at the birthday party today. Each massage should last, at most, about 5 minutes max. The timing should be dictated by the comfort level of the child or adult receiving the massage. This technique also allows the participants who are giving the massage an opportunity to experience unconditional giving.
Sing: At bedtime sing a song with the child, or to the child, that is not sung with anyone else. A stanza or two is enough, and make it a simple song such as You are my sunshine or a song from the chills country or culture of origin. This duplicates the early nursery songs that were not likely sung to her when she was an infant. The singing should happen every night whether or not the child is in trouble for negative behaviors. If possible, try to hold the child’s hand, or have him sitting on your lap, while singing.
Do not isolate at time out: Have time out happen at the kitchen table or some other central area in the home so that the child or teen stays in contact with the parent. This prevents secondary problems such as sneaking out of the room or breaking the bedroom window. It also makes it clear to the child that he is not being rejected.
Have a box of Lego or coloring or painting materials handy to occupy the child: Older children can work on a model car, or Barbie hair salon, or homework, while sitting at the table. Sometimes, the child will have to be restrained by the parent first before he can sit still. When this happens, hold the child on the parents lap wherever it is safest to do so, and then move the child to the kitchen table when he has calmed. Or, the child may be able to sit right away, but will throw or break anything that is put in front of him. When this is likely to occur, the parent can refrain from giving the child anything to do until he has calmed. In fact, having something to do can be the reward for calming.
Most negative behaviors are best handled with only a few minutes of time out. However, some children get into an emotional state in which they cannot manage their behavior around other people for several minutes, or even hours, after an outburst. It is then necessary to lengthen the time out period until the child is able to manage again in order to protect the others and to avoid a repetition of the same negative behavior. The important factor is that the parent stays in the room with the child. Most parents can find something to occupy them. Do the dishes, clean the refrigerator, wash the floor, rearrange the spice cupboard. Just do something that is independent of the child but keeps the parent in proximity.
Use rewards more frequently than consequences. Each time the child gets mad but does not hit or bite anyone or anything, reward her with a point. At five points, she should get a reward such as a small toy. At 25 points, she should get a large reward. Do not take points away when the child misbehaves. This may appear to be focusing on material goods, but it is often the only thing the unattached child can recognize as representing affection. Do not use time with a parent as a reward. The child is owed the time just because she is a child. He should be learning that she is important and worthy of positive parental attention without having to earn it.
Choose one or two battlegrounds at a time. Trying to change too much too fast is too difficult. If the child is stealing, setting fires, killing small animals, and hoarding food, then pick the issues that relate to safety, i.e. fires and killing, and leave the rest for next year. As well, do not begin by trying to fight battles that relate to culture or past ways of living. For example, children from some cultures have been taught to lick their plate after they eat. This is not acceptable in North America, but it is also something that will change with time. Most 30 year olds do not lick their plates in public places. Choose the battles that really impact on the parental ability to raise the child. Manners and customs are not important in the first few years, but safety and affection are crucial.
Let the child spend time in the adults bed. The age, stage, and experiences of the child will each impact on when and how the parent lets the child in the parental bed. However, at some point it can be helpful to re-create the early nesting that goes on with parents and infants. This can be done casually by adding a television to the parental bedroom so that once or twice a week, the parents and child(ren) watch a show together. Everyone can be fully dressed in day clothes, and can be sitting on top of the bedspread. Some children may eve need to have their shoes on in order to feel safe enough to want to participate. Story time could also happen on the parental bed, and again, everyone can be in day clothes and the bed fully made. It may be helpful for a child who is not sexually intrusive, to let him sleep with the parents one night a week. Or, the child may have a calmer bedtime if he falls asleep in the parents bed and then is moved to his own. This may be important regardless of the child’s age. Consider using the parental bed as a family get together place even with teens.
Sit with the child until she falls asleep. This is time consuming each evening and may need to go on for a year or more after placement but night time is often a source of significant terror for children with traumatic backgrounds and this is a concrete way to spend time alone with the child as well as to demonstrate parental commitment. Teens can benefit from this, although they may only wish to have the parent present for a short length of time. This should be a silent time, with little or no conversation. The adult can take a book or knitting or whatever will help to pass the time until the child is asleep. A comfortable rocking chair or a bean bag chair can also help make it more pleasant for the adult. Some children will do better if the adult can also stroke their head, or, can hold a hand. Sitting with the child should happen every night regardless of whether the child has been in trouble.
Find ways to be with the child that do not appear to be play. Some children arrive in an adoptive home with little or no experience of play and are threatened by the closeness that playing with a parent represents. They may also be overwhelmed with all of the new rules in the house and learning more for play such as board games or hoop games can be too much. To replace this, try cooking with the child. Even a young child can make milk puddings. Or, try working outside in the garden together. Planting and digging do not have to be done correctly, they have to provide a way to be together. For some, window shopping may work, or walking the family dog, or any activity in which the talk does not have to be focused on the child and the adult.
Find ways to play together: If the child can play with the parent, be sure that there is amply time for this. Children from extremely deprived backgrounds may no know how to play so this may be a learning experience as well as a time for bonding. It is likely that they child will need to have toys and recreational activities that are designed for a much younger child.
Feed the child: Find a reason to feed the child either part or all of their meals. Or, when being playful, feed him raisins or orange slices. This should be done in the same playful and considerate manner as is done with an infant of 6 to 12 months of age. However, the child can be any age, even a teen. It can also be helpful to feed the child or teen with a baby bottle. This can be done while swaddling, or while nesting in the parental bed, or any appropriate moment that presents.
Help the child cope with peer rejection and social isolation: Children who cannot form relationships with adults generally cannot form friendships with peers. The parent can help the child by ensuring she has access to socially appropriate clothing (which she may choose not to wear) and has the opportunity have her cut and styled in a manner that is socially acceptable to her classmates. If the parents suspects that no one is going to come to her birthday party, do not invite anyone. Instead, plan something fun and exciting that includes the whole family or make it a special hockey game out of town with dad. Check at school to see of the child is being teased or tormented by classmates. If she is, work with the school counselor, the teacher and the parents of the tormentors to reduce the problem. Help the child learn what to say when she is teased or tell her who she can go to for help if she is being bullied on the playground. If she is the bully, include the school counselor and principal in finding ways to curb her behavior.
Protect the parents, siblings, and pets: Some children with RAD are cruel to others both physically and mentally. It is important that families living with this type of child understand that it is all right to place safety above acceptance. In other words, it is good parenting practice to never let the child be alone with a family pet; or, for the mother to say that she needs to have a day away from the child; or for the siblings to get an extra treat or extra time alone with the parents; or, to go away on a family vacation and leave the raging child at home. The extremely cruel child thinks she needs to break the family up, or hurt the members of the family who make her mad, but the truth is that she needs the family to stay safely together and it is correct to take the necessary steps to ensure the overall emotional health and safety of the family as a whole.
Reduce the outside contacts: If the child is from another culture, or has spent been a residential treatment center, or has been moved through a series of foster homes, consider home schooling for the first few months. This will reduce the amount of new data the child has to integrate and will allow more physical and emotional energy for bonding. The child can slowly start to socialize by joining Cubs or Brownies, or taking classes at the local recreation center.
Do not try to trust the child: Children from traumatic or severely neglectful backgrounds do not have an understanding of trust, at least not in the way that most well meaning adoptive parents understand the concept. Telling a child that it is important that the adult can trust him is a set up for disappointment. The child has never lived a life where he can trust adults or where people trusted him. Consider this word to represent a totally alien concept and then give the child a few years in the home before allowing situations where trust may be an issue.
Source: Handout for AFFCNY 2003 conference workshop presented by Brenda McCreight, PhD, May 9, 2003, Albany, NY. Reprinted with permission of the author.