Reactive Attachment Disorder (RAD) Symptoms and Treatments

Reactive attachment disorder, also known as RAD, is a mood or behavioral disorder that affects babies and children. RAD symptoms include difficulty with bonding and forming relationships and inappropriate social patterns. There is no intellectual disability or pervasive developmental disorder (such as autism) to explain these characteristics.

Reactive attachment disorder is caused by some type of care issue, such as caregivers being unable to fully provide for the needs of the child, not fulfilling physical and emotional needs, inconsistency, or too many primary caregiver changes.

This article goes over the symptoms of reactive attachment disorder and how it is treated.

Reactive Attachment Disorder vs. Disinhibited Social Engagement Disorder

Attachment disorders are sometimes described as being inhibited or disinhibited. These terms are used to describe the behaviors of babies and young children.

Children who fall into the category of "inhibited" struggle to regulate their emotions, do not prefer any specific adult or caregiver, do not seek caregiver comfort, do not show much affection, or display a combination of these behaviors. On the other hand, children who fall into the category of disinhibited may engage or overly engage with all adults evenly, including strangers, and they do not prefer primary caregivers.

Reactive attachment disorder is the inhibited type of attachment disorder. There used to be only one diagnosis for both inhibited and disinhibited attachment, but that has changed with more recent research. The disinhibited type of attachment disorder is called disinhibited social engagement disorder, or DSED.

What Is Reactive Attachment Disorder?

Children with reactive attachment disorder behave in ways that show little or no attachment to parents or other caregivers. The condition is usually seen in babies and young children. Children with reactive attachment disorder are not able to bond with their parents or primary caregivers in a way that is healthy and secure.

RAD Symptoms in Children

Symptoms of RAD in children include:

• Avoidance of comfort when distressed
• Avoidance of physical touch
• Difficulty managing emotions
• Not being affected when left alone
• Not making eye contact, smiling, or engaging
• Emotional detachment
• Excessive rocking or self-comforting
• Inability to show guilt, remorse, or regret
• Inconsolable crying
• Little or no interest in interaction with others
• Need to be in control
• Tantrums, anger, sadness
  

What Happens When Children With RAD Become Adults?

RAD is considered a condition of childhood, however, children with RAD may continue to have problems when they reach adulthood.

Research has found that people who were diagnosed with RAD as children are more likely to develop mental health problems as adults. One recent study found that around 73% of those who had RAD as children will develop a substance use disorder as adults and around 29% will attempt suicide. The study also found high rates of psychiatric hospitalization in this group (around 71%).

Children with RAD are also less likely to become successful as adults. Rates of high school and college graduation are lower in this group than in the general population, and rates of unemployment are higher. People who had RAD as children are also more likely to have legal issues later in life.

Diagnosis

Reactive attachment disorder can be diagnosed by a mental health professional such as a psychiatrist or psychologist specializing in working with children. They do this by assessing the child based on diagnostic criteria in the fifth edition of the “Diagnostic and Statistical Manual of Mental Disorders” (DSM-5). Then they evaluate the child in terms of how the symptoms affect their ability to function.

Reactive Attachment Disorder Diagnostic Criteria

The diagnostic criteria for RAD are as follows:

• A pattern of not seeking comfort or not being responsive when distressed
• Two or more forms of social and/or emotional distress, such as minimal engagement with others, limited positive affect, and episodes of unexplained irritability or fearfulness in non-threatening interactions with caregivers
• A history of needs not being met, changes in caregivers, or an unusual setting that prevents attachment
• Does not meet the diagnostic criteria for autism spectrum disorder
• Behavioral symptoms that began before age 5
• At least 9 months old, measured as developmental age

What Causes Reactive Attachment Disorder?

The specific causes of reactive attachment disorder are not as straightforward as they may seem. While child abuse and neglect can lead to attachment disorders, there is more to it than that. Children who receive inconsistent care or who are placed with new primary caregivers are also at an increased risk of reactive attachment disorder. This can happen even when parents and other caregivers mean well and are doing their best.

Children may experience an event or challenge that is not overtly harmful, such as a geographical move, or something that cannot be avoided, such as the death of a family member. Even though they may be too young to understand what is happening, they may feel as though they are not loved, they are unsafe, or they are unable to trust their caregivers.

Potential causes of RAD include:

• Attention only when the child misbehaves (negative attention only)
• Being left alone for hours without interaction, touch, or play
• Emotional needs not being met consistently
• Experiencing a trauma or a very scary, difficult event
• Having an emotionally unavailable parent
• Hospitalization
• Inconsistent care or response to needs
• Loss of a caregiver or other family member, such as a sibling
• Multiple primary caregivers or changes in caregivers
• Neglect or abuse from parents, caregivers, or others
• Not being comforted when crying or distressed
• Not being fed when hungry for hours
• Not having a diaper changed for many hours
• Only some needs being met, or needs being met only sometimes
• Physical needs not being met consistently
• Separation from parents or other primary caregivers
  

Treatment for Reactive Attachment Disorder

Treatment for reactive attachment disorder goes beyond the child alone. The entire family may be included in order to support healthy bonding. The process involves a combination of talk therapy, other therapies, and education that benefit children as well as parents and other caregivers.

Treatment options for RAD include:

• Family therapy with the child and caregivers
• Parenting classes to learn effective strategies
• Play therapy with the child to teach social and other skills
• Teaching social skills in other ways
• Special education services in schools
• Talk therapy with the child, caregivers, or both
  

Preventing Reactive Attachment Disorder

RAD is largely believed to occur when a child doesn't develop a stable attachment to their caregiver. It can be prevented by adopting strategies to ensure that your child or a child you are caring for feels safe, secure, and loved. Some of these strategies include:

• Learning your baby's cues and make sure to meet their basic needs in a timely way
• Staying engaged with your child by playing with them, talking to them, and making eye contact
• Providing a nurturing environment where they feel safe and cared for
  

Coping With Reactive Attachment Disorder

Coping with reactive attachment disorder involves strategies to support both the child and the adults who interact with the child. This is because bonding between children and their caregivers involves two or more people, and their interactions can help to form a more secure attachment.

For this reason, coping includes support, self-care, and stress management for adults, as well as healthy nutrition and adequate sleep and physical activity for both children and their caretakers.

Summary

Reactive attachment disorder is a condition that occurs in early childhood. It is caused by inconsistencies in care or neglect that make a child feel unloved or unsafe.

Children with RAD are not bonded to their caregivers and may have emotional and behavioral problems that include tantrums, difficulty making eye contact, avoidance of touch, and inability to show remorse, among others. 

Treatment for RAD usually includes education and therapy for both the child and the child's caregivers. RAD can be prevented by providing a nurturing, safe environment where your child's needs are met consistently.