Teen Reactive Attachment Disorder

According to J. Bowlby (1982), Attachment may be defined as a composite of behaviors in an infant, toddler, or young child that is designed to achieve physical and emotional closeness to a mother or preferred caregiver when the child seeks comfort, support, nurturance, or protection. Here we take a quick look at what Teen Reactive Attachment Disorder is and how to deal with it. 

Attachment may be defined as a composite of behaviors in an infant, toddler, or young child that is designed to achieve physical and emotional closeness to a mother or preferred caregiver when the child seeks comfort, support, nurturance, or protection. Attachment experiences are vital for sound social and emotional development. Effects of secure attachment include trust, intimacy, affection, development of reciprocal relationships, positive self-esteem, future independence and autonomy, ability to manage impulses and emotions, and resilience in the face of adversity.

From an attachment theory perspective (Ainsworth, Blehar, Waters, Wall, 1978), the inability to securely bond leads to anxious, ambivalent, and avoidant attachments. The effects are anxiety and distrust of oneself and others. Children with these problems have depressed moods and feel helpless and hopeless; they adapt but feel unloved, worthless, rejected, and abandoned. They perceive the world as unsafe. Their anger is often self-directed. They are often regressed and fixated with motives of pain avoidance and self-protection.

According to the American Psychiatric Association (2000), Attachment disorders are the effects of significant disruptions in attachment, especially disturbed social relatedness, mostly because of abuse, neglect, or prolonged maltreatment during early development. Pathogenic care is the cause of the disorder. The effects of disrupted attachment are the converse of a secure attachment.

What is Reactive Attachment disorder? (RAD)

Reactive attachment disorder, commonly abbreviated as RAD, is a disorder that begins in early childhood and is diagnosed before the age of five. It occurs when a child experiences severe emotional neglect and can be caused by a variety of issues with the parents or caregivers. While the condition takes hold during early childhood, it can affect an individual throughout childhood, adolescence, and even adulthood. If you know an adolescent with teen reactive attachment disorder, read on to learn more about the condition, how it can affect the adolescent, and what to expect going forward.

Reactive attachment disorder stems from not having basic emotional needs met during infancy, toddlerhood, and the preschool years. New parents usually meet their babies’ needs by cuddling, soothing, rocking, and interacting. Moms and dads generally react with empathy when their babies or toddlers are upset, they celebrate with smiles and hugs when their little ones first walk and reach other milestones, and they meet physical needs by feeding their babies when they cry and changing diapers when they are soiled. All of these actions, along with countless others, show babies and toddlers that they are loved. As a result, they develop a strong bond with their parents and other caregivers and feel secure and content most of the time.

When a baby is ignored, neglected, and abused, however, emotional needs are not met. They might cry for hours and nobody answers. Or they might find that when they reach milestones, nobody reacts. They might have little to no interaction at all; this can be the case even when the parents or caregivers meet their physical needs. For example, a mother or father might feed the baby without making eye contact or holding them. Or they might bathe and dress their child without talking or playing.

When this occurs, the child will often not forge any bonds to his or her caregivers. They might feel stressed and sad most of the time. They don’t know how to communicate in a loving manner and they are anxious when they are in the company of their caregiver. When the main caregiver leaves, they don’t show any signs of separation anxiety, which is common in babies and young children. As time goes by, the child will grow up not knowing how to bond to others because they have not learned this vital skill during the earliest weeks, months, and years of their life. Note that RAD shares many of the same signs as autism. While the two conditions might present similarly in some ways, they are not related.

The reasons that a parent might not bond with his or her baby can vary. If the mother has been abused or neglected herself, she might not know how to show love to her baby. If she or the child’s father is using drugs or other substances, they both might be unable to meet the child’s emotional needs. Sometimes, a mental health disorder or a mental impairment on the part of the parent is the cause of the problem. Other times, the parents are abusive and neglectful for some other reason. Many children who suffer from RAD end up in the foster care system or are placed for adoption. Others, particularly those who are having their physical needs met and are not being physically abused, will continue to live with their parents (Boris, Zeanah, 2005).

While reactive attachment disorder begins and is diagnosed prior to the age of five, its effects last for many years. Teens with the condition often have trouble bonding with their parents, their friends, and romantic partners. They often withdraw from and avoid others. When they are experiencing negative feelings, they are more likely to want to be alone and will usually not want to involve others or share their feelings with them. They often lack basic social skills and do not know how to show empathy to others. They might feel awkward and ill at ease in all social situations, including in the classroom and anywhere where they are part of a group.

Teens with RAD might be more prone to mental health conditions such as anxiety, depression, obsessive-compulsive disorder, and eating disorders. They are also more prone to substance abuse and addiction.

Treatment for RAD centers around therapy for both the teen and his or her current caregivers. If the teen is living with his or her parents, the parents will often need parenting classes to help them learn how to communicate and bond with their teenager. If the teen is living with other family members, an adoptive family, or foster parents, those adults will also need guidance as they learn how to help the teen create bonds and develop social skills. Cognitive behavioral therapy for the teen is a must so he or she can learn how to cope with negative feelings and communicate with others in effective ways.

Teens who have RAD along with substance addiction or an additional mental health disorder will need to have treatment for the coexisting disorder as well. For example, an adolescent with teen reactive attachment disorder might need inpatient rehabilitation for an alcohol or drug addiction or a different type of therapy or medication for anxiety, depression, or post-traumatic stress disorder. A full evaluation is necessary to make sure that the clinician knows what conditions are affecting the teen so a treatment plan can be created.

Understanding and coping with the behaviors of an adolescent who has teen reactive attachment disorder can be difficult for caregivers, so individual therapy for the adults involved can be helpful. With love and consistency, your teen can get past his or her rough start and go on to have a fulfilling life complete with relationships with family members, friends, and even romantic partners. Talk to your adolescent’s pediatrician or family doctor about the treatments available for reactive attachment disorder. He or she can refer your family to the appropriate behavioral health specialist such as a clinical psychologist.

This article is provided by Dr. Ralph Kueche (Child Psychologist). Dr. Kuechle is a Child and Adolescent Clinical Psychologist who specializes in treating children and their families who may be struggling with mood and behavioral issues. Learn more about Dr. Kuechle.