The Effects of the Border Crisis: Childhood Neglect and RAD

Examining evidenced-based disorders associated with childhood neglect.

Posted Jun 27, 2018

"To the lost and the broken, I hear your cries
I won't stand still, I'll break through the walls of silence.
I'll hold my arms open to comfort your fears and provide you with safety, warmth, and love.
To the traumatized souls, the bodies alone, the racing minds and hearts, know that I care and I hear your cries.
I won’t stand still; I'll break through the walls of silence.
The children, the faces, the confusion and loneliness... the children, I cry with you. 
We will find a way, you will find your way." —
Yvonne Temal

This past week, I spent three days working on the Texas/Mexico border delivering medical care to all children and adolescents in need. “From mid-April to May this year, the US Department of Homeland Security says it has separated nearly 2,000 children from their parents after the families crossed the border into the US,” according to the BBC. This dire and unprecedented situation has been broadcast all over the globe and many physicians and mental health professionals are weighing in on this humanitarian crisis: "Separating children from their parents contradicts everything we stand for as pediatricians, protecting and promoting children’s health," AAP President Colleen A. Kraft, M.D., M.B.A., FAAP, said in a press statement. The Academy’s opposition to family separation stems from the serious health consequences this practice has on children. Its 2017 policy statement Detention of Immigrant Children urges that separation of a parent or primary caregiver from his or her children should never occur unless there are concerns for the child’s safety at the hand of the parent. Highly stressful experiences, including family separation, can cause irreparable harm to lifelong development by disrupting a child’s brain architecture. Toxic stress, which is caused by prolonged exposure to heightened stress, has detrimental short- and long-term health effects.

Defining childhood neglect

Regardless of politics or the legalities of the situation, there has been evidence that many of these children are being neglected. Child neglect is defined as a type of maltreatment that refers to the failure to provide age-appropriate care which includes food, shelter, education, supervision, clothing and other basic needs that are required for physical, emotional and intellectual development. It has been reported and documented by many news media outlets that there is a tremendous amount of adult supervision lacking in these detention centers; not to mention the lack of physical comfort that children yearn for in order to develop emotionally and many allegations of reported physical and verbal abuse.

Reporting child neglect

Childhood neglect is considered a form of child abuse and is the most commonly reported form of childhood mistreatment. As physicians, we are mandated to report childhood neglect to child protective services. According to studies, child neglect is the most commonly reported form of maltreatment. Risk factors for childhood neglect increase when children are isolated from their families or communities, the exact predicament that is currently occurring at our borders. So when this type of child abuse is occurring on our borders, as physicians, who do we report this to?

Effects of childhood neglect

Experiencing any form of neglect in childhood can lead to chronic and debilitating effects in adolescence and adulthood. Children who are neglected are more likely to be diagnosed with conduct disorder, mood disorders, eating disorders, anxiety disorders, post-traumatic stress disorder, substance abuse disorders and are more likely to engage in criminal activity, not to mention the cognitive and emotional delays. There are many factors at play here including the age and developmental stage at which maltreatment occurred, the severity of maltreatment, the child’s perceptions of the abuse, and whether the child received therapeutic services to assist them in recovery. It is also clear that our government and society becomes financially stressed when any child is neglected, since mental health treatment and navigating the legal system cost a hefty amount in tax dollars each year. Psychological care, hospitalization, court hearings, imprisonment, substance abuse counseling and trauma therapy are not free; whether we pay it in taxes or through our insurance, it is putting a strain on our economy. Neglect at a young age can also lead to a disorder known as Reactive Attachment Disorder.

Reactive Attachment Disorder

According to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, (DSM-5) symptoms of Reactive Attachment Disorder (RAD) must be evident before five years of age and the child must have a developmental age of at least nine months. The child often shows consistent emotionally withdrawn behavior towards caregivers; specifically, he/she minimally responds or seeks comfort when he/she is emotionally distressed. The second criterion includes a limited positive affect, episodes of unexplained irritability, sadness or emotional turmoil during non-threatening interactions with caregivers and minimal social or emotional responsiveness to others. The third criterion is characterized by a pattern of insufficient care such as neglect, physical or sexual abuse, or repeated changes between primary caregivers.

Signs and symptoms of Reactive Attachment Disorder

  • Aversion to touch and physical attention. The child does not like to be held or hugged and instead may squirm away.
  • Being in control. The child often needs to be in control and will throw excessive temper tantrums, and will be disobedient, defiant and argumentative.
  • Lack of emotion during punishment. When a child is asked to go in time out they are often relieved they can be alone and punishment shows them reinforcement that they are “unwanted”.
  • Inappropriate affection. The child will often be inappropriately affectionate towards strangers but will show no signs of affection towards their primary caregiver.

Risk factors for RAD

Children who develop reactive attachment disorder will have a history of abuse or neglect. If a young child repeatedly feels abandoned, isolated, powerless, or uncared for, whatever the reason, they will learn that they can’t depend on others and the world is a dangerous and frightening place. This often happens when the following circumstances are repeated overtime:

  • A baby or child cries without any comfort or response from the parent.
  • A baby is hungry or left in a wet diaper and is not attended to for hours.
  • The baby or child is socially ignored.
  • The infant or child is separated from their parents and/or is moved from one caregiver to another such as in adoption or foster homes.

Trauma and PTSD

Posttraumatic stress disorder is often linked to war veterans returning home from the battlefield who are riddled with nightmares and flashbacks, however, PTSD often occurs in individuals who undergo any form of a traumatic event including being held in a refugee camp, fleeing their country, or being taken away from parents at a young age. Early trauma exposure in childhood and subsequent witnessing trauma later in life are highly linked to PTSD. Childhood adversity and preexisting anxiety and depression are also known risk factors for this disorder. Children with PTSD may exhibit signs of social withdrawal, parent attachment, excessive clinging, nightmares, and poor academic performance whereas adolescents generally display the same signs and symptoms as adults.

Signs and symptoms of trauma 

Each individual may react differently to trauma. There are many ways the body experiences grief reactions to traumatic events. A reaction can become unhealthy if the behavior and mood is prolonged and is affecting your lifestyle. The following are signs and symptoms associated with emotional and psychological trauma:

  • Shock or denial
  • Difficulty with concentration or declining academic performance
  • Irritability and mood swings
  • Guilt and shame
  • Social withdrawal
  • Feeling sad or hopeless
  • Aches and pains
  • Muscle tension
  • Insomnia or nightmares
  • Fatigue
  • Agitation
  • Nightmares
  • Night terrors
  • Change in sleep patterns
  • Trouble with relationships
  • Flashbacks
  • Anger

Can we unite to find a better solution for a world’s youth?