After running the alphabet soup of misdiagnoses, someone finally comes up with a diagnosis that answers the questions of what might have gone wrong with your child. You have a diagnosis of reactive attachment disorder.

What now?

We were faced with this about six months after our nephew came to live with us at the age of twelve. He was diagnosed by a neuropsychologist who specialized in children, yet he had never treated a patient with reactive attachment disorder.

He was willing to learn but, rapidly approaching the age of thirteen, we weren't convinced that our nephew could wait. Puberty was just around the corner. Talk therapy wasn't working. Neither was play therapy, or any of the other tricks that his psychologist had up his sleeve.

Once we had a diagnosis, my wife and I did our homework. One of the first things we learned was that the diagnosis was a good fit. While he may well be suffering from depression, PTSD, and ODD, he did not suffer from ADHD, although he had taken ritalin much of his life, and it didn't seem possible to treat the associated disorders as long as the attachment disorder blocked the paths of communication.

While we were pleased with the effort put in by his neuropsychologist, we realized that we needed to find an attachment therapist.

We were fortunate. Although we didn't know at the time that he lived only a few hours from us, two of the books that we purchased while we were educating ourselves on reactive attachment disorder were written by Dr. Dan Hughes. We didn't call him because we didn't know, at the time, that he lived in Maine, or that he would be accessible.

But we did learn that there was something wrong with pretty much any kid that our nephew brought home with him. At the time, anyhow; he does somewhat better now.

One of the kids who he brought home with him had been adopted by a family living on the other end of the same street that we lived on. Being an outgoing sort of person, my wife introduced herself to the boy's mother and ... surprise, surprise - he suffered from reactive attachment disorder.

Our new friend worked for a childcare agency and was an enthusiastic advocate for attachment therapy. Through her, we were introduced to a therapist who was no longer taking attachment patients but who did refer us to a therapist by the name of Stephanie, who had just moved to Maine from Massachusetts, in order to work under Dr. Dan Hughes.

We knew that name. We'd read his books, so there was a certain comfort level reached from the onset.

Stephanie agreed to take our nephew on as her very first attachment patient here in Maine. Better yet, she hadn't yet realized that she was supposed to be charging us a whole lot more than she was. After the first year, we actually had to insist that she raise her rates.

New to the field of attachment therapy or not, Stephanie was wonderful. She consulted with Dr. Hughes as necessary and, while we met with him only twice, we were aware that she had the benefit of his many years of expertise.

While he remains a major pain in the butt (the official acronym is PITA, I think), our nephew no longer suffers from reactive attachment disorder. Now we get to work on the depression, the PTSD, and the other results of his having been nobody's priority during his younger years.

It worked for us, but a lot of it was a matter of luck. We could just as easily have wound up with someone who might have done more harm than good.

Had we not done our own homework, we might have let him remain in traditional therapy until after his window of recovery had closed.

What should you look for in an attachment therapist?

First of all, the person with the most impressive credentials might not be the best person for the job. While there is nothing to say that a psychiatrist or a psychologist can't do effective attachment therapy, my impression is that most of them don't. In too many cases, these are the same people who have been misdiagnosing your children over all of these years.

In time, perhaps this will change. But if you don't have the time, who can you find now to help your child?

If your child has been diagnosed with reactive attachment disorder, ask whoever made the diagnosis for a referral to an attachment specialist; that is, assuming that they are not themselves trained in attachment therapy.

Do you know anyone else whose child has been diagnosed with reactive attachment disorder? Ask for suggestions.

Otherwise, look through some of the directories of attachment therapists that can be found on this site, on the ATTACh site, and elsewhere on the Internet. If you can find someone near you, give him or her a call.

If you can't find anyone near you, call one of the attachment centers nearest you, even if it's way too far for you to drive. Ask them for a referral to someone nearer to you. Often, the attachment centers are involved in training therapists from a much larger area, so they might be aware of someone closer to you.

Contact some of the people who write the books on attachment therapy. They are almost certainly involved in training people from all over the world so, while they may live thousands of miles from you, they may have trained someone in your backyard.

Once you have a name of an attachment therapist who would be willing to take your child on as a patient, there are some steps that you can take to check up on them beforehand.

• Find out who they trained under.
• Look that name up on the Internet, to see if they trained under one of the people who write the books, or at one of the recognized attachment centers.
• Are they members of the Association for Treatment & Training in the Attachment of Children (ATTACh)?
• Are they working under a supervisor or advisor? Who? Our nephew's therapist worked under Dr. Hughes, for example.
• Have they continued their education through workshops and seminars?
• What techniques do they use in attachment therapy? Most attachment therapists use multiple techniques.
• EMDR
• Craniosacral therapy
• Theraplay
• Storytelling
• Holding therapy
• Roleplaying
• Are they familiar with associated disorders often coexisting with reactive attachment disorder?
• PTSD
• ADHD
• ODD
• Depression
• If your child requires medication for an associated disorder, does the therapist have a relationship with a prescribing physician? Our nephew's attachment therapist communicated often with the neuropsychologist, whom he continued to see, as well as with our nephew's pediatrician.
• Will the therapist be able to help you find other necessary resources, such as a respite provider or support group?

And, very important, what will be the role of the parents? In attachment therapy, at least one patient should almost always be in the room, and on the rare occasion when the therapist might see the child alone, there should be a monitor for you to use. Attachments do not see children privately.

Attachment therapy doesn't end when the session is over. A qualified attachment therapist should be able to help you, the parent, continue the healing process at home through therapeutic parenting.

Lastly, once you are satisfied that you have found an attachment therapist, give the process a chance to work. Keep the lines of communication open, but don't expect instant cures. Attachment therapy is a difficult process, and it might be a long while before you see light at the end of the tunnel.

We learned to judge the effectiveness of our nephew's therapy sessions by his subsequent behavior. When the therapy session was particularly effective, and if she were able to draw him out, if only for a little while, it would scare the heck out of him, and he would rage into the night.

When he was closed down, faking his way through the therapy session, there was no backlash.

It does get better eventually, but you may well find that every important step forward is followed by several steps backwards. Be prepared for it, and don't punish your therapist for doing a good job.