Reactive Attachment Disorder

Definition

Reactive Attachment Disorder is a rare but serious condition in which infants or young children fail to establish healthy attachments with parents and/or caregivers.

Overview and Facts

What is Reactive Attachment Disorder (RAD)?

It’s a relatively uncommon condition in children (ages 9 months to five years old) marked by an inability to create healthy emotional attachments with their primary caregivers--often occurring as a result of grossly negligent care and inadequate nurturing.

What are the Symptoms of Reactive Attachment Disorder?

Children with RAD may appear sad and listless. They may also exhibit:

  • failure to seek or accept comfort
  • inability to smile
  • withdrawal and/or fear (won’t reach out when picked up)
  • disinterest in interactive play (for example, peek-a-boo)
  • irritability
  • lack of interest in watching the movements and activities of people around them
  • lack of interest in social interaction.

 

What Causes Reactive Attachment Disorder?

It's unclear why some babies and young children develop RAD and others do not. Children whose basic needs are not met, or are met with indifference and a lack of emotional connection from caregivers, may fail to expect care or comfort or to establish stable attachments.
Factors that may increase the risk of a child developing reactive attachment disorder include:

  • abuse, neglect, and/or mistreatment by caregivers
  • extended separation from parents or other caregivers (due to hospitalization, for example)
  • having parents whose parenting skills are compromised by substance abuse, mental health problems, criminal behaviors, etc.
  • Frequent moves from one foster home to another and/or frequent changes in caregivers.

NOTE: Children who meet the criteria for autism spectrum disorder may not be diagnosed with reactive attachment disorder.

 

How is Reactive Attachment Disorder Treated?

In order to arrive at a diagnosis of RAD, a thorough, in-depth examination must first be carried out by a qualified psychiatrist or psychologist. Any treatment plan should be individualized and involve both the child and the child’s current caregivers.

Treatment options may include psychotherapy (for the child) and special education services, as well as family therapy and training in parenting skills for caregivers. Due to the many difficulties associated with children who have RAD, parents and caregivers of children affected by the disorder may also benefit from psychotherapy or counseling.

 

Are there other risks associated with Reactive Attachment Disorder?

Yes. Younger children with RAD may experience developmental delays and delays in their physical growth. Later in life they may be at higher risk for depression, anxiety, anger management issues, eating disorders, difficulties in school, and abuse of alcohol and other drugs.