Attachment with caregivers is a crucial part of a child’s development. When this is disrupted to the extreme — through abuse or neglect — a child may develop reactive attachment disorder (RAD).
For most children, bonding begins in the womb. Research shows that they can hear their parents’ voices and their mother’s heartbeat. They’re born with an attachment that’s already begun, and it grows stronger in those early months of life.
As time goes on, secure attachment can form if the infant has caregivers who are emotionally and physically available and if the child’s needs for survival are being met.
But not all children are born into ideal situations. When those early attachments are disrupted, most often as a result of the child abuse or neglect, attachment disorders can develop. Reactive attachment disorder (RAD) is one possible outcome.
A child with RAD is less likely to seek comfort when they feel distress. They may show limited positive emotions, but they can show more irritability, fear, or sadness when they come into contact with their caregivers.
Although attachment disorders can be very difficult to navigate, healing is possible. With effective treatment, care, and coping methods, children can bond and develop healthy childhood and adult relationships.
According to the American Academy of Child and Adolescent Psychiatry (AACAP), RAD forms as a result of negative experiences with adults in a child’s early years. Children with RAD may exhibit behaviors such as:
- trouble calming down
- a refusal to seek comfort from caregivers
- an apparent lack of emotions and emotional attachments
- disruptive emotions, such as irritability, sadness, fear, or anger when engaging with caretakers
- reduced brain growth in the left hemisphere, an area that specializes in logical and rational thought
- increased limbic system sensitivity, an area related to emotion regulation
- reduced hippocampus growth, an area important for memory
In addition to impacting attachment, these brain differences can contribute to an increased chance of:
When left untreated, symptoms of RAD and trouble forming attachments can carry over into adulthood.
According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), RAD is a condition that’s induced by trauma or stress in early childhood. Contributing factors may be neglect, maltreatment, and abuse.
Symptoms of RAD include:
- rarely seeking out or responding to comfort when upset
- withdrawing socially and isolating oneself
- showing limited emotional responsiveness to others
- having a negative affect
- being irritable
- being fearful
- being sad
- showing extreme responses to stress
- having working memory impairments
- showing executive functioning impairments
- exhibiting undeveloped or underdeveloped social skills
- showing increased aggression, fear, defiance, or rage
- showing psychomotor restlessness, including hand-flapping or rocking
In order to meet the diagnostic criteria for RAD, symptoms must begin before the age of 5 and the child must have a developmental age of at least 9 months old. A doctor might need to rule out autism spectrum disorder (ASD), as
RAD isn’t a diagnosis typically given to adults, but healthcare professionals recognize that untreated attachment disorders from childhood can carry over into adulthood. The symptoms of attachment disorders are similar between children and adults, with the main differences having to do with maturity and a better understanding of the world around them.
For instance, adults may be better at hiding some less socially acceptable behaviors than children, though they’ll still have difficulty forming secure attachments.
The DSM-5 is very clear that a difficult personal history must exist in order for a RAD diagnosis to be made. Known causes include a history of insufficient care involving at least one of the following scenarios:
- not receiving stimulation, comfort, and affection
- being socially neglected
- having a “revolving door” of caregivers
- having an unusual home life that limits the ability to form secure attachments
The Child Mind Institute further recognizes physical abuse and “problematic care” as increased risk factors for developing RAD, though they acknowledge that not every child who experiences these situations will meet the diagnostic criteria for RAD.
A diagnosis of RAD is most often given between the ages of 9 months and 5 years, though an older child can meet the diagnostic criteria if their symptoms began between those ages.
Diagnosis is typically made by a mental health professional, though they may need to rule out other disorders with similar symptoms first. These include:
Some of these conditions may occur with RAD (ODD and conduct disorders, for instance). But healthcare professionals need to rule out ASD in particular before making a diagnosis.
Receiving a diagnosis typically involves meeting with a mental health professional who will interview the child’s caretakers about what they’ve been witnessing and experiencing. Then, the specialist will spend some time with the child to discuss their experiences.
Common treatments for RAD include:
- Behavior management training (BMT). This method focuses heavily on
educating and trainingcaregivers to address behavioral concerns.
- Attachment therapy. This type of therapy brings the family together with the goal of producing secure attachments. It involves tools such as hug therapy, where a caregiver holds and looks at a child as they would an infant.
- Play therapy. This method uses play to help educate children on secure attachments and to model for them how such attachments might be formed.
In some cases, a doctor might prescribe selective serotonin-reuptake inhibitor (SSRI) medication, as
In adults, treatment of attachment disorders most typically involves psychodynamic therapy to help the person unpack and process the childhood experiences that inhibited their attachment style. In doing so, they can begin to recognize unhelpful patterns and to develop the tools for building a more secure attachment style.
While it may be difficult to think about the circumstances that could impair a child’s social development, remember that treatment is available. In addition, committed and loving caretakers can make all the difference.
If you’re concerned that your child may have RAD, start by reaching out to their pediatrician for advice. They may have mental health professionals that they can recommend to help with the next steps.
Remember that caretakers should take care of themselves, too. Parenting a child with RAD can be lonely and heartbreaking. Knowing that you aren’t alone and connecting with other caregivers who relate can help.
You may find comfort in joining the Reactive Attachment Disorder (RAD) Parent Support Group on Facebook or by asking your child’s doctor about other ways to connect with parents of children with RAD.
You’re not alone on this journey. And whether you’re an adult living with an attachment disorder or a caregiver parenting a child with one, there’s help available, and there are others who can empathize with you.
It’s possible to form more secure attachments. And with the help of a mental health professional, you can figure out the best plan for your situation.