Caregivers raising a child with reactive attachment disorder (RAD) can see positive changes with the right diagnosis.
Children typically have complex emotions. But some behaviors signal an attachment disorder resulting from trauma or stress. Reactive attachment disorder (RAD) causes serious emotional problems due to early childhood neglect.
Many kids spend their youngest years with loving caregivers who meet their emotional and physical needs. Still, this isn’t the case for all children.
When a safe and caring scenario that allows for secure attachment is absent, an attachment disorder, like RAD, may develop.
Rather than seeking comfort from their caregivers when they’re distressed, children with RAD won’t approach caregivers for reassurance when something goes wrong. Parents who offer an upset child a hug may have that affection refused.
While RAD can be difficult to address, children can overcome RAD to form healthy relationships. Getting the right diagnosis is often the first step for parents in finding treatment solutions to help their children and family.
Children with RAD display specific behavior that is different from other kids of the same developmental age.
They also have experienced abuse or extreme neglect in early childhood, resulting in these behaviors. Before arriving at a diagnosis of RAD, doctors eliminate the possibility of other mental health and medical conditions.
The Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM 5) outlines specific criteria for a RAD diagnosis.
Emotionally withdrawn behavior toward caregivers
A child with RAD will have a pattern of being emotionally withdrawn or inhibited. When the child experiences distress, they won’t seek comfort from caregivers.
When parents or adults offer reassurance or compassion, they rarely respond.
Both of these must occur for the RAD diagnosis:
- The child does not seek comfort.
- The child does not respond to comfort.
Social and emotional disturbance
Children with RAD have different social interactions and emotional behaviors than children without the diagnosis. To meet the DSM-5 criteria, at least two of three criteria must be met:
- The child is rarely happy or positive.
- The child rarely interacts socially or emotionally with others.
- The child has unexplained irritability, sadness, or fearfulness, even when not feeling threatened.
Children with RAD may rarely appear joyful or engage in healthy play with other kids. They may have unexplained bouts of negative emotion, even when their child is safe and cared for from a parent’s perspective.
The child may also have extreme responses to stress.
Background of insufficient care
Doctors diagnose RAD not just from symptoms but based on what the child has experienced in their life. Insufficient care is assumed to be the reason for the child’s lack of seeking comfort — and lack of response to it.
That lack of care may have happened in the child’s own home, foster care, or an institutional setting like an orphanage.
The child must have experienced one of the following:
- social neglect through ongoing lack of meeting emotional needs for comfort, stimulation, and affection by adult caregivers
- repeated changeover of caregivers so the child is unable to form stable emotional attachments
- an environment where the ability to form selective attachments is discouraged or limited
Many different backgrounds can give rise to this insufficient care. A child may have never had a stable upbringing or may have been subject to abuse or neglect in their own home.
In addition to the child’s background and behavior, there are other factors doctors must assess before making a RAD diagnosis.
These criteria help avoid the possibility of an inaccurate diagnosis and increase the chances of implementing effective treatment.
Here are some additional criteria the child must meet:
- withdrawal and lack of comfort-seeking behavior is the result of insufficient care
- does not meet the criteria for autism spectrum disorder (ASD)
- developmental age of at least 9 months
- symptoms appear before age of 5
These factors help doctors look at other possible diagnoses while
It’s important to rule out ASD, as
Likewise, a child with RAD may seem to be depressed. But those living with depression can and will still seek and receive comfort. Overall, doctors should not be able to explain RAD symptoms by any other medical cause.
Doctors also attempt to categorize the severity of RAD as part of the diagnosis.
According to the DSM-5, the condition is severe if the child has all possible symptoms and occurs at a high level. For example, the child might be frequently withdrawn or experience irritability or sadness.
The RAD is persistent if it lasts for at least 12 months.
A 2020 study noted that RAD symptoms resolve for most young children once they are in nurturing caregiving environments.
The researchers state that when signs persist, they may result from another condition, post-traumatic stress disorder (PTSD). Although the study had no specific solutions, it proposed hypotheses to investigate how RAD manifests in older kids.
The DSM-5 doesn’t recommend making a diagnosis in children over 5 years old. Doctors don’t know whether the condition exists in older children, although signs of RAD can last for several years after a childhood diagnosis.
The signs may become less severe when the child is placed in a caring environment.
Doctors also hesitate to diagnose a child too young.
Very young children and babies are not yet capable of creating emotional attachments, even in nurturing environments free of trauma. For a RAD diagnosis, the child must have reached the developmental age of 9 months.
As difficult as it may be to be a caregiver of a child with RAD, the child isn’t choosing this behavior. Children with RAD have experienced severe neglect or caregiving environments that prevented them from forming healthy emotional attachments.
Signs of RAD include not seeking comfort and not responding to comfort. Children with RAD are rarely happy and experience unexplained periods of sadness, irritability, or fear. They rarely socialize with others and don’t connect emotionally.
There is evidence that RAD symptoms resolve when a child experiences a loving caregiving environment. Still, signs of RAD may also persist for many years.
Parents raising a child with RAD can work toward healthy relationships for the child and family with the right diagnosis and by pursuing options for treatment.