Reactive Attachment Disorder

Children require an emotional connection (attachment) to early caregivers to develop the skill of forming caring relationships. If a child does not develop an attachment to their caregiver(s) by the age of three years, it may be too late for their brain to develop the necessary wiring for healthy interactions with others.

Attachments are formed when an infant or young child has their needs met by primary caregivers. Children need affection, comfort, safety, and nurturing. If those things are absent, denied, or harshly given, the child is at risk for developing reactive attachment disorder (RAD). It is not known why some children develop RAD while others, with similar backgrounds, do not.

Symptoms of RAD

Symptoms are noticeable by age five, or sooner. Babies with RAD do not reach out to others when picked up, show little or no interest in toys, do not smile at appropriate times, and appear listless. When left alone, they are calm, and frequently use self-soothing behaviors such as stroking or rocking. Their interest in interactive games is nil, and they do not follow other people with their eyes.

Toddlers, older children, and adolescents with RAD isolate or withdraw from others, observe people but do not engage with them, hide feelings of distress or anger, and do not ask others for help. Their social awkwardness is apparent. They may be aggressive with peers, and turn away from positive or comforting gestures by others. Drug and alcohol abuse is frequently an issue.

Two Types of RAD

As children with RAD become older, they either demonstrate inhibited, or disinhibited behavior. Inhibited children avoid human interaction altogether. Those children disinhibited will seek attention from anyone and everyone. They may seem anxious, might display childish behaviors, and continuously ask for help. Disinhibited children usually had many early caregivers, or may have had multiple changes in caregivers.

RAD is a lifelong issue. There is no treatment that can restore a RAD child’s ability to connect emotionally. They can, however, learn how to cope with and manage the disorder, and be taught suitable ways to interact with others.

Children at risk are those who go into institutional care or an orphanage. Repeated changes in foster caregivers, extreme neglect, long hospitalizations, and a mother with postpartum depression are all RAD factors. Parents who are inexperienced, abusive, have a mental illness, or a substance addiction increase a child’s risk of RAD. Even court ordered removal from abusive or neglectful parents adds to the likelihood.

As adults, people with RAD may have difficulty keeping employment. They might engage in inappropriate sexual behaviors, have eating disorders, anxiety, depression, and drug or alcohol addictions.

A child that is suspected of having RAD should see a doctor for a full evaluation. RAD behaviors resemble symptoms of other disorders such as social phobia, adjustment disorders, and ADHD.

Further Reading


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