title: A fragile bond: adoptive parents' experiences of caring for children with a diagnosis of reactive attachment disorder.
abstract: OBJECTIVE
  To understand how adoptive parents caring for children with a diagnosis of reactive attachment disorder (RAD) make sense of their life-worlds by establishing the meanings that underlie and structure their experiences of their everyday lives.
  
  
  BACKGROUND
  Reactive attachment disorder is a serious psychosocial disorder of childhood that causes short- and long-term relationship, health and social consequences for children. It is more likely to be observed in children being cared for by foster carers, kinship carers or adoptive parents. Exploration of adoption from parents' perspectives is not well documented, and no previous work has been undertaken to understand the challenges of caring for children with a diagnosis of reactive attachment disorder.
  
  
  METHODS
  The study was guided by Husserl's phenomenology, which aims to uncover the underlying essential meanings intrinsic to a phenomenon. Three concepts are central to this approach: essences, intuiting and eidetic reduction.
  
  
  METHODS
  Semi-structured interviews were conducted with eight adoptive parents. Data were analysed using an adaptation of Colaizzi's method.
  
  
  RESULTS
  Four essential elements fundamental to participants' lived experiences of caring for a child with a diagnosis of RAD were uncovered: being profoundly unprepared, being insecure, being assailed by unexpected emotions and being committed.
  
  
  CONCLUSIONS
  The parent-child relationship is a fragile bond developed at an unexpectedly high personal cost; it is a committed relationship but vulnerable to continual destabilisation. The involvement in the preparation of adoptive parents of child and adolescent mental health (CAMH) staff with expertise in the impact of early neglect or separation on children should be considered.
  
  
  CONCLUSIONS
  The development of systems to prepare, screen and identify potential challenges and problems prior to adoption might help adoptive parents. Access to a CAMH professional in the pre and postadoption phases might assist potential adoptive parents in making informed decisions around the choice of a child for adoption.
authors.affiliation: Specialist Children's Services, Templeton Business Centre, Glasgow, UK.
authors.forename: Michael
authors.initials: M
authors.lastname: Follan
authors.forename: Martin
authors.initials: M
authors.lastname: McNamara
mesh_terms: D000300:Adoption; D002648:Child; D006801:Humans; D016487:Parenting; D019962:Reactive Attachment Disorder / Q000523:psychology*; D006113:United Kingdom
keywords: RAD; adoption; adoptive parents; attachment disorder; attachment theory; child and adolescent mental health; reactive attachment disorder