Reactive Attachment Disorder

It is healthy and expected for a child to become attached to his primary caregivers, those he/she looks to for nurturing and soothing. Reactive Attachment Disorder (RAD) is a rare condition that occurs when infants and young children who are subject to extreme neglect or abuse fail to establish that expected bond.

A child with RAD, which is diagnosed from 9 months to 5 years of age, rarely seeks or responds to comfort when distressed, shows limited positive affect, and has unexplained episodes of irritability, sadness, or fearfulness in contact with caregivers.

Signs of RAD in infants and toddlers include a withdrawn appearance, a failure to smile, and a failure to react when parents or caregivers attempt to interact with them. For instance, a child with the disorder may not reach out when picked up or respond to a game of peekaboo.

He may seem unaffected by the movements of others, and uninterested in watching others as they move about a room. Instead of seeking to nurture from a parent or caregiver, these children will attempt to nurture and soothe themselves. When distressed, they may calm down more quickly without the attention of an adult.

Common symptoms with inhibited RAD include:

• Detachment
• Unresponsiveness or resistance to comforting
• Excessive inhibition (holding back emotions)
• Withdrawal or a mixture of approach and avoidance
• Failure to seek affection from caregivers and other people
• A tendency to keep to themselves

Common symptoms with disinhibited RAD include:

• Indiscriminate sociability
• Inappropriate familiarity or selective in the choice of attachment figures
• No preference for their primary caregivers over other people
• A tendency to act younger than their age and to seek affection in potentially dangerous ways

A child who has experienced abusive, neglectful, or otherwise problematic care is at risk for Reactive Attachment Disorder (RAD). That said, the great majority of children who have been abused or neglected or who have been bounced around among multiple caretakers do not develop the disorder.

To be diagnosed with RAD a child must have a pattern of inhibited or withdrawn behavior towards caregivers, characterized by rarely or minimally turning to caregivers for comfort when distressed or responding to comfort when offered. The child must have experienced neglect or abuse in which the child’s early caregivers failed to meet his physical or emotional needs or repeated changes in caregivers that severely limited opportunities for the child to form selective attachments. The child must not meet the criteria for autism spectrum disorder and must be between 9 months and 5 years old.

Reactive Attachment Disorder (RAD) Treatment

Treatment for Reactive Attachment Disorder (RAD) usually involves both the child who has been diagnosed and his current caregivers. Treatment may include psychotherapy for the child, family therapy, parenting training, and special education services. Because RAD can be a painful and confusing experience for a child’s caregiver, psychotherapy or counseling may be advisable for parents, too.

Treatment of RAD has two important goals. The first is to ensure that the child is in a safe environment. This is especially important in cases where the child has been abused or neglected. The second goal is to help the child develop a healthy relationship with an appropriate caregiver.

Treatment for RAD often focuses on the caregiver. Therapy may help address issues that are affecting the caregiver’s relationship with — and behavior toward — the child. Teaching parenting skills also can help improve the relationship and develop attachment.

Treatment may also include playing therapy. This technique allows the child and the caregiver to express their thoughts, fears, and needs in the safe context of play.

There is no medication to treat RAD itself. However, the doctor may sometimes use medication to help manage severe behavioral symptoms, such as explosive anger or problems sleeping.

The use of so-called holding therapies and “rebirthing” techniques is controversial and potentially dangerous. There is no scientific evidence to support the effectiveness of such interventions.

Reactive Attachment Disorder (RAD) Prevention

Recognizing a problem with attachment and getting help as soon as possible is essential to preventing RAD. It may not always be possible to prevent RAD, but doing these things may help stave off its development:

• Engage often with your child through play and frequent talk, eye contact, and smiles.
• Learn to understand your baby’s cues, such as what their different types of cries tell you about how they feel and what they need.
• Show warmth and nurture your child when you bathe or feed them or change their diapers.
• Respond to your child with a warm tone of voice and with caring facial expressions and physical touches. 
• Take classes or volunteer with your child so you can build skills to nurture your child.

Reactive Attachment (RAD) Disorder Outlook

If not treated, RAD can have a negative impact on a child’s physical, emotional, behavioral, social, and moral development. Children with RAD generally are at higher risk for:

• Depression
• Anxiety
• Aggressive and/or disruptive behavior
• Anger Management Problems
• Learning difficulties and behavior problems in school
• Inability to form meaningful relationships
• Low self-esteem
• Eating disorders 
• Alcohol or drug dependence or abuse 

With treatment, it is possible for children with RAD to learn to trust others, and to lead healthy and productive lives.