Symptoms in Infants and Toddlers
1. Cries; miserable all the time, chronically fussy
2. Resists comforting or nurturance
3. Resists or dislikes being held
4. Poor eye contact or avoids eye contact
5. Flat, lifeless affect (too quiet)
6. Likes playpen or crib more than being held
7. Rarely cries (overly good baby)
8. Angry or rageful when cries
9. Exceedingly demanding
10. Looks sad or empty-eyed
11. Delayed milestones (creeping, crawling, etc.)
12. Stiffens or becomes rigid when held
13. Likes to be in control
14. Does not hold on when held (no reciprocal holding)
15. When held chest to chest, faces away
16. Doesn't like head touched (combed, washed)
17. Generally unresponsive to parent
18. Cries or rages when held beyond his wishes
19. Overly independent play or makes no demands
20. Reaches for others to hold him rather than parent
21. Little or reduced verbal responsiveness
22. Does not return smiles
23. Shows very little imitative behavior
24. Prefers Dad to Mom
25. Gets in and out of parents lap frequently
26. Physically restless when sleeping
27. Does not react to pain (high pain tolerance)
American Adoptions
The following is an excerpt from Dr. Buenning's Attachment and Bonding article:
In the last eight years, I have worked with the parents of babies and toddlers who had problems bonding. Through this work, I developed a 27 item Infant Attachment Checklist. A diagnosis of RAD can be made in an infant with only several items checked in a positive direction.
There are two major groups of unattached babies. The first group consists of babies who are fussy and unhappy. They are visibly disconnected and cry extensively. They are often inconsolable and reject nurturance and comforting from their parents. The parents are unable to appease or alter the infant’s unhappy condition.
The second group consists of babies who are overly good. They are calm, quiet, and appear independent. Usually, they have a flat affect and calm appearance. They make few demands upon their parents. For example, if the parents place them on the floor, they can happily entertain themselves for an hour or more. They rarely cry or are fussy. In one instance, I gave a three-hour talk to a group of adoptive parents. One of the mothers present was holding a six or seven month-old infant. The infant sat on the mother’s lap with her back to the mother. She did not make eye contact, smile, or make a sound. The baby did not fuss or make a single demand of the mother during the entire three-hour lecture. The mother saw her baby as a “well-behaved” baby because she sat so quietly and cooperatively for three hours.
It is understandable that parents and professionals can mistake this apparent “good behavior” as healthy. Rather than being genuinely content, happy, and emotionally connected, as her outward appearance might suggest, the baby was, in reality, sad, resigned and emotionally disconnected. The Infant Attachment Checklist determines whether the infant is in the unhappy and fussy group or the excessively good group.
RAD is detectable early in infancy. Originally, my work with RAD was with older children, not infants. As I worked with the parents of these older children, many reported thinking something was wrong with their child as an infant. Usually, the adoptive mothers were the first to recognize “problems” in their infants, but they could not adequately describe what was wrong. Often they sought help from numerous professionals who were unsuccessful in recognizing the RAD symptoms in their babies.
There is another scenario that is prevalent with RAD. Babies can appear bonded in infancy only to develop symptoms of RAD as they become toddlers. Over the years, many parents stated their babies appeared bonded during infancy. Either RAD was not present in infancy and developed later, or the parents did not recognize the RAD symptoms in their baby. As their baby grew older, he either developed RAD or the condition then manifested itself in ways the parents could easily recognize.
Early detection and intervention leads to the most complete healing of children with RAD, with the least financial cost and emotional trauma to the child and his family.
The following general statements will help you to answer the checklist items and develop an understanding of RAD in an infant.
* Early in infancy, most babies with RAD reject at least some of their parents’ love. This dynamic is apparent in many small ways. Ask yourself these questions: “Does your child accept your affection or love? Does he accept your touch when you hold or cuddle him? Does he enjoy your physical closeness?”
* Does your baby let you nurture him when he is upset, hungry, frightened, or uncomfortable? When you care for him, does it help him feel better? When you love him, does it make a difference to him? Often when the parents give love and affection to their baby with RAD, he does not receive or accept it. Many mothers say, “No matter what I do with my baby, it doesn’t seem to help or affect him.”
* Try to determine if there is a growing emotional connection between you and your baby. Is there a relationship of love, trust, and reciprocity developing? This is evidenced by eye contact and imitative or reciprocal behavior. Does your baby look at you, notice you, and respond to you? After working with one mother and baby for a week, the mother stated, “I notice my baby staring at me. She watches me like she hasn’t seen me before.” Remarkably, the baby had lived in this home for seven months, but the mother reported, “It is as though she is seeing me for the first time.”
* Does your baby prefer being close to you rather than being alone? The overly good baby is disarming because he appears to be easy, cooperative, and content. He can appear bonded because he seems to accept whatever you give him and makes little or no demands. Overtly, he acts happy and problem free but internally he is unbonded.
With a medical illness, the patient is often the first person to recognize that a problem may exist. Adequate medical information helps these individuals know whether to seek professional assistance. The same is true with RAD. As parents, you are in a position to see the early signs of problems in your baby. Even if the condition is mild, RAD is serious and should not be ignored. A mild attachment problem in infancy that is manageable or undetected can lead to significant emotional and behavioral problems in toddlers and older children.
If you have questions or concerns about your infant, consult with an attachment clinician in your area.
Dr. Buenning has had a private practice in Colorado Springs for the past five years. Prior to working with adoptive families, he worked for twenty years in mental health centers in several Western states.
Used with permission from:
Walter D. Buenning, Ph.D.
1773 S. 8th Street, Ste. 202
Colorado Springs , CO 80906
(719) 477-9033
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