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Overview of The Trust Builders Group

The Trust Builders is a structured group intervention designed to help children and adolescents between the ages of 8-12 years old who have experienced trauma, neglect, or attachment disruptions develop healthy interpersonal skills, emotional regulation, and self-esteem. The primary goal of the group is to create a safe, predictable, and supportive environment where participants can learn to build trust with adults and peers.

Key Components:

Relationship-focused activities: Exercises that encourage sharing, active listening, and collaborative problem-solving to strengthen interpersonal connections.

Social-emotional skill-building: Lessons on identifying and expressing emotions appropriately, managing anger or anxiety, and coping with stress.

Attachment repair strategies: Opportunities for participants to experience consistent, supportive interactions with caring adults to counter past attachment disruptions.

Empowerment and self-esteem development: Activities that help participants recognize strengths, set personal goals, and develop a sense of agency.

Target Population:
Children and adolescents who have experienced trauma, neglect, unstable caregiving, or have difficulty forming trusting relationships.

Intended Outcomes:

Improved ability to trust and connect with adults and peers.

Enhanced emotional regulation and coping skills.

Increased self-esteem and confidence in social situations.

Reduced behavioral issues stemming from past trauma or attachment disruptions.

This group is typically facilitated by a school counselor, therapist, or trained mental health professional in a small-group setting, and it often complements individual therapy or broader school-based interventions.

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Reactive Attachment Disorder, Causes, Signs and Symptoms, Diagnosis and Treatment.

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By the end of the program, participants will be able to:

1. Build and Maintain Trusting Relationships:

Demonstrate the ability to engage in positive interactions with peers and adults.

Show increased comfort in seeking support from caring adults.

2. Develop Emotional Awareness and Regulation Skills:

Identify and label personal emotions accurately.

Apply coping strategies to manage anger, anxiety, or frustration in social settings.

3. Enhance Social Skills and Communication:

Practice active listening and turn-taking in group discussions.

Demonstrate respectful communication and conflict-resolution skills.

4. Increase Self-Esteem and Personal Agency:

Recognize and articulate personal strengths and achievements.

Set realistic personal goals and take steps toward accomplishing them.

5. Foster Resilience and Adaptive Coping:

Utilize learned strategies to navigate stressors related to trauma or attachment challenges.

Reflect on personal progress and demonstrate increased confidence in handling difficult situations.

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Supporting a Child with Reactive Attachment Disorder | UPMC

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If your child has reactive attachment disorder (RAD), it may be difficult to build a bond with them. Learn ways to show your support.

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Resources for The Trust Builders Group

1. Books and Curricula:

“The Body Keeps the Score” by Bessel van der Kolk (2014): Explains the impact of trauma on the brain and body, offering strategies for healing.

“Building the Bonds of Attachment” by Daniel Hughes (2011): Provides techniques for repairing attachment disruptions in children.

“The Zones of Regulation” by Leah Kuypers (2011): Curriculum to teach emotional regulation and self-control.

“Trauma-Focused Cognitive Behavioral Therapy for Children and Adolescents” by Cohen, Mannarino, & Deblinger (2017): Evidence-based strategies for addressing trauma.

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7 Effective Ways to Teach Students with RAD

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Here are effective ways to teach students with Reactive Attachment Disorder (RAD) including discipline, classroom management, and behavior plans.

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Session Structure (Example)

Frequency: Weekly, 45–60 minutes, On Wednesday during Lunch at School.
Group Size: 6–10 participants (8-12 Years old)
Facilitator: QMHP

Sample Session Outline:

1. Check-In & Mood Meter (5–10 min)

Participants share current emotions using emotion cards or a “mood meter.”

2. Warm-Up Activity (5–10 min)

An icebreaker or cooperative game to foster connection and engagement.

3. Main Activity / Skill Lesson (20–25 min)

Role-playing, trust-building exercises, emotion regulation practice, or collaborative problem-solving.

4. Reflection & Discussion (5–10 min)

Guided conversation on experiences during the activity and how skills apply to real life.

5. Closing & Take-Home Skill (5 min)

Participants share one goal or coping strategy to practice until the next session.

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Two Truths and a Lie

An Icebreaker Activity for Middle and High School
(10 minute version or 25 minute version)

Start by modeling the process by telling two truths and a lie (preferably something that could plausibly be true) about yourself. Ex statements such as:
I have two children.
I once won a pie-eating contest.
When I was ten, I hated science.

Allow the class to guess which is the lie. Allow about a minute for every student to think of two truths and a lie about himself/herself.

Have the students form groups of four, preferably with people they do not know well (or assign at random). They should sit together for the remainder of the activity.

Within each group, students mst first learn each other's names. Then they are to tell each other two things that are true about themselves and one that is a lie (preferably something that MIGHT be true). The others in the group must determine which the lie is. Allow about five to six minutes for the groups to complete this.

Tell each group they must choose two of the truths about the members of their group and one lie to share with the class. Have them write them down legibly. For example: One member of our group once traveled to Russia, one member... etc.

(Ten minute version stops here)

Ten minute version conclusion:
Ask if the class found out any surprises through this process, then proceed to rest of the "truths" about the course, etc. Perhaps throw in one "lie" to keep them attentive.
Teacher can post some of the results on class web page, bulletin board, or as the fact of the day on the blackboard for the next week or two.

Continuing (longer version):

Have the groups report back to the class and allow other groups to guess which were the truths and lie from each group. Once the truth is known, each group should tell the names of all members and which person the truths are about.

After all groups have reported and been guessed, if there is time compose as a class:

Two truths and a lie about the class as a whole
(Ex. In Mrs. Jones' 4th period class, one person.... and another person ....)

What they believe to be two truths and a lie about the subject they will be studying (Ex. Biology will involve memorizing tons of Latin words.)

POST the whole-class truths and lies on a bulletin board for the first month of school and revisit them, if appropriate. You could even ask which of their preconceived "truths" about the class have proven to be "lies" and vice versa.

Want to see more ideas?
See a full list of reviewed resources ideal for first day activities.

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Two Truths and a Lie - An ice-breaker from TeachersFirst

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An Icebreaker Activity for Middle and High School (10 minute version or 25 minute version) Start by modeling the process by telling two truths and a lie (preferably something that could plausibly be true) about yourself. Ex statements such as: I have two children. I once won a pie-eating contest.

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What is reactive attachment disorder?

Children with reactive attachment disorder (RAD) are not able to form the important bond that usually develops between a child and their caregivers. Children with reactive attachment disorder seem sad, fearful, or irritable, and they have a hard time interacting with others. Reactive attachment disorder can happen to young children whose basic needs for comfort, nurturing, and affection have not been consistently met.

Reactive attachment disorder is rare. It is only diagnosed in children between the ages of nine months and five years.

What are the symptoms of reactive attachment disorder?

Signs that a child might have reactive attachment disorder include:

Not smiling

Being irritable for no reason

Seeming sad and fearful, especially around caregivers

Not feeling better when an adult tries to comfort them

Calming down more easily when left alone

Not showing interest in or looking at other people around them

Not reacting when picked up by an adult

Not laughing or playing interactive games like peek-a-boo

How is reactive attachment disorder diagnosed?

Children are only diagnosed with reactive attachment disorder between the ages of nine months and five years. A doctor will make sure that the child does not have autism before diagnosing reactive attachment disorder, since the two disorders have some of the same symptoms.

To be diagnosed, the child must be seem sad or fearful and not respond when their caregiver tries to make them feel better. The child must also have experienced serious abuse or neglect, or multiple changes in caregivers at a young age.

It's important to note that not all children who experience abuse or neglect develop reactive attachment disorder.

How is reactive attachment disorder treated?

Because kids with RAD are so young, therapy involves both the child and the parents or main caregivers. Parents learn how to create a consistent, responsive, and safe environment with positive child and caregiver interactions. It usually combines a few different therapies, including:

Individual psychotherapy for the child and sometimes for the parents too

Family therapy for the child, siblings and parents

Parenting training to teach parents how to help their child bond with them

Special education services can also help kids with RAD.

Young children who have been neglected or abused may also have developmental delays and delays in their physical growth. Older children may be at risk for disorders including eating disorders, anger issues, depression, anxiety, problems in school and drug and alcohol abuse.

This guide was last reviewed or updated on December 18, 2024.

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Quick Guide to Reactive Attachment Disorder - Child Mind Institute

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Download our free guide to reactive attachment disorder. Children with reactive attachment disorder (RAD) do not form the important bond that usually develops between a child and their caregivers. Children with reactive attachment disorder seem sad, fearful or irritable and have a hard time interacting with others.

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Overview

Reactive attachment disorder is a rare but serious condition in which an infant or young child doesn't establish healthy attachments with parents or caregivers. Reactive attachment disorder may develop if the child's basic needs for comfort, affection and nurturing aren't met and loving, caring, stable attachments with others are not established.

With treatment, children with reactive attachment disorder may develop more stable and healthy relationships with caregivers and others. Treatments for reactive attachment disorder include psychological counseling, parent or caregiver counseling and education, learning positive child and caregiver interactions, and creating a stable, nurturing environment.

Products & Services

Symptoms

Reactive attachment disorder can start in infancy. There's little research on signs and symptoms of reactive attachment disorder beyond early childhood, and it remains uncertain whether it occurs in children older than 5 years.

Signs and symptoms may include:

Unexplained withdrawal, fear, sadness or irritability

Sad and listless appearance

Not seeking comfort or showing no response when comfort is given

Failure to smile

Watching others closely but not engaging in social interaction

Failing to ask for support or assistance

Failure to reach out when picked up

No interest in playing peekaboo or other interactive games

When to see a doctor

Consider getting an evaluation if your child shows any of the signs above. Signs can occur in children who don't have reactive attachment disorder or who have another disorder, such as autism spectrum disorder. It's important to have your child evaluated by a pediatric psychiatrist or psychologist who can determine whether such behaviors indicate a more serious problem.

Causes

To feel safe and develop trust, infants and young children need a stable, caring environment. Their basic emotional and physical needs must be consistently met. For instance, when a baby cries, the need for a meal or a diaper change must be met with a shared emotional exchange that may include eye contact, smiling and caressing.

A child whose needs are ignored or met with a lack of emotional response from caregivers does not come to expect care or comfort or form a stable attachment to caregivers.

It's not clear why some babies and children develop reactive attachment disorder and others don't. Various theories about reactive attachment disorder and its causes exist, and more research is needed to develop a better understanding and improve diagnosis and treatment options.

Risk factors

The risk of developing reactive attachment disorder from serious social and emotional neglect or the lack of opportunity to develop stable attachments may increase in children who, for example:

Live in a children's home or other institution

Frequently change foster homes or caregivers

Have parents who have severe mental health problems, criminal behavior or substance abuse that impairs their parenting

Have prolonged separation from parents or other caregivers due to hospitalization

However, most children who are severely neglected don't develop reactive attachment disorder.

Complications

Without treatment, reactive attachment disorder can continue for several years and may have lifelong consequences.

Some research suggests that some children and teenagers with reactive attachment disorder may display callous, unemotional traits that can include behavior problems and cruelty toward people or animals. However, more research is needed to determine if problems in older children and adults are related to experiences of reactive attachment disorder in early childhood.

Prevention

While it's not known with certainty if reactive attachment disorder can be prevented, there may be ways to reduce the risk of its development. Infants and young children need a stable, caring environment and their basic emotional and physical needs must be consistently met. The following parenting suggestions may help.

Take classes or volunteer with children if you lack experience or skill with babies or children. This will help you learn how to interact in a nurturing manner.

Be actively engaged with your child by lots of playing, talking to him or her, making eye contact, and smiling.

Learn to interpret your baby's cues, such as different types of cries, so that you can meet his or her needs quickly and effectively.

Provide warm, nurturing interaction with your child, such as during feeding, bathing or changing diapers.

Offer both verbal and nonverbal responses to the child's feelings through touch, facial expressions and tone of voice.

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Reactive attachment disorder - Symptoms and causes

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Reactive attachment disorder is a rare but serious condition in which an infant or young child doesn't establish healthy attachments with parents or caregivers. Reactive attachment disorder may develop if the child's basic needs for comfort, affection and nurturing aren't met and loving, caring, stable attachments with others are not established.

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Part III-10 things you didn’t know about Reactive attachment disorder (RAD) - Smarter Parenting

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Smarter Parenting is your source for parenting support. Learn how our positive parenting solutions can assist you! Part III-10 things you didn’t know about Reactive attachment disorder (RAD)

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Lesson 1- Building a foundation of safety and trust. 

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Lesson 1- Building a foundation of safety and trust. 

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This approach is fundamental for working with children with Reactive Attachment Disorder (RAD) whose early life experiences have damaged their capacity for trust and security, according to the American Psychiatric Association

1. Child-Led Creation

1. Allow the group to help decorate and choose items for the calm corner, giving them a sense of ownership and choice.

2. No Punishment-

1. Frame the space as a positive tool for self-soothing and not as a consequence for not behaving

3. Calming tool-kit.

1. Stock the corner with sensory items like weighted blankets, stress balls, or visual aids like emotion charts

4. Confidentiality statement

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To engage in a collaborative activity that models how mutual cooperation and careful contributions build something strong and stable (Gleason et al., 2011).

1. Focus on process and not product

2. Participation from Facilitator-

The group leader can participate in model turn-taking and problem-solving.

3. Process the outcome- Afterwards, discuss how the tower’s strength was dependent on each person’s efforts, linking it to the group's trust

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To provide a visual and physical tool for calming the body and mind during moments of high emotion

1. Mindfulness focus- Instruct the children to focus on the swirling glitter as a mindfulness exercise

2. Create with a purpose- Frame the activity by saying “ we are making a tool for our calm down corner to help us when we feel big scary feelings.”

3. Practice with the tool created shake the jar and sit with the children as the glitter settles, reinforcing the idea of a calm mind following a calmed body

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How to Make Slime and Calming Glitter Jars

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Lesson 4- Developing Positive Social Skills 

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Lesson 4- Developing Positive Social Skills 

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To promote empathy and positive peer interactions by having the children create a character with valuable social-emotional “powers”

1. Focus on internal traits-

Guide the children to focus on “kindness” or “empathy” rather than physical strength (Gleason et al., 2011).

2. Group sharing time- to invite the children to share their superheroes and the powers with the group, this builds positive recognition within the group.

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To offer a safe place with an indirect way for children to explore social dynamics and practice new behavior

1. Role-Play scenarios- The group facilitator can introduce a scenario such as “the puppets are playing outside and one feels frustrated because the other won’t share their sand truck with them” then ask the children to act out different ways to respond.

2. Practice “I” statements: The pupples can model using “I feel…” to express their emotions calmly during a conflict.

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To build self esteem and create a positive, supportive group atmosphere that counter negative self talk often rooted in trauma. (Substance Abuse and Mental Health Services Administration, 2014).

1. Model positve affirmations

2. Normalize receiving compliments- for children who struggle seeking positive attention, the group leader can gently support them in accepting the compliment without minimizing it.

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1. Assess readiness for a relationship-based group: Ensure the student can engage in a supportive environment.

2. Identify needs and strengths: Helps facilitators match participants with appropriate support.

3. Screen for risks: Address safety concerns (behavioral issues, trauma triggers, self-harm).

4. Set expectations: Explain confidentiality, group norms, and the role of facilitators.

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Initial Contact

Meet with the student individually (in-person or virtually).

Introduce the group’s goals: building trust, support, and personal growth.

Explain the screening is to ensure the group is safe and beneficial for everyone.

Assessment Tools

Short intake form covering:

Age, grade, and school environment

Support systems (family, mentors, teachers)

Presenting challenges (emotional, social, academic)

Coping skills and previous group experiences

Risk assessment checklist (suicidal thoughts, self-harm, aggression).

Interview Questions

Motivation: “Why are you interested in joining this group?”

Goals: “What would you like to get out of being in the group?”

Comfort with group participation: “How do you feel about sharing experiences in a small group?”

Relationship building: “Can you describe an adult you trust or feel comfortable talking to?”

Behavior and readiness: “Have you had challenges in group settings before?”

Risk & Safety Assessment

Ask gently about stress, trauma history, or behavioral concerns.

Evaluate whether additional support (individual counseling) is needed first.

Document any immediate safety concerns and action steps.

Consent & Orientation

Explain group rules: respect, confidentiality, and participation.

Obtain signed informed consent/parental permission if needed.

Clarify what the group can and cannot provide (e.g., it’s not therapy).

Feedback & Placement Decision

Determine if the student is ready to join, needs individual prep, or alternative support.

Keep notes for facilitators to personalize engagement strategies.

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Documentation

Intake form

Interview notes

Risk assessment

Consent form

Recommendations for group placement

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Trust Builders Group-Pregroup Screening packet

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Legal Requirements: Teachers, counselors, and others working with children, especially those with special needs like RAD, are often legally required to protect the confidentiality of sensitive student information. This includes any diagnoses, treatment plans, or personal details shared in a group setting.

FERPA (Family Educational Rights and Privacy Act) in the U.S. ensures the privacy of student records.

In some countries, similar laws or regulations exist (e.g., GDPR in the European Union).

Ethical Considerations:

Only share information on a need-to-know basis.

Be transparent with students and their guardians about what information will be shared and with whom.

Discuss the limits of confidentiality, especially in cases where there is risk of harm (e.g., abuse or neglect).

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Legal Requirements: In a professional setting ( teachers, counselors, or therapists), maintaining appropriate boundaries with students is essential. Legal violations can include physical, emotional, or sexual misconduct, which may be subject to criminal or civil consequences.

Ethical Considerations:

Respect the personal boundaries of students, especially with those who may have experienced attachment trauma (as is common in RAD).

Be cautious about physical touch, emotional intimacy, or other behaviors that may be misinterpreted or inappropriate in certain contexts.

Ensure that students understand what is appropriate and inappropriate in terms of their interactions with adults.

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Legal Requirements: The Behavioral Intervention Plans (BIP) and Individualized Education Programs (IEP) that are developed for students with RAD should be followed to ensure that interventions are legally compliant and that staff are trained to handle challenging behaviors in a non-punitive, non-abusive way.

Ethical Considerations:

Use de-escalation techniques and trauma-informed care when interacting with students with RAD, as these students may have intense reactions due to their attachment issues.

Avoid punitive measures; instead, employ strategies that promote emotional regulation and healthy attachment patterns.

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Bowlby, J . (1982). Attachment and loss: Retrospect and prospect. American Journal of Orthopsychiatry, 52(4), 664–678. This is a foundational text summarizing attachment theory, upon which much of RAD treatment is based. Porges, S. W. (2011). The polyvagal theory: Neurophysiological foundations of emotions, attachment, communication, and self regulation. W. W. Norton & Company. This book provides insight into the physiological underpinnings of trauma responses, a key component of trauma-informed care. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders: DSM-5 (5th ed.). American Psychiatric Association. Substance Abuse and Mental Health Services Administration. (2014). SAMHSA's concept of trauma and guidance for a trauma informed approach. Zeanah, C. H., & Boris, N. W. (2000). Disturbances of attachment. In C. H. Zeanah (Ed.), Handbook of infant mental health (2nd ed., pp. 367–379). Guilford Press.