Reactive attachment disorder (RAD)

Reactive attachment disorder is a condition in which a child doesn't establish healthy attachments with their parent(s) or caregiver(s). RAD may develop if the child's basic needs of comfort, affection and nurturing aren't met.

With the right treatment, RAD children may develop more stable and healthy relationships with caregivers and others. Treatments for RAD include learning how to create a stable, nurturing environment and providing positive child and caregiver interactions. Parent or caregiver counseling and education can help as well.

Without the right treatment, RAD can continue for several years and may have lifelong consequences. These struggles can include problems with relationships, social interactions, mental and physical health, behavior, boundary issues, intellectual development, and substance abuse. Although RAD is a childhood disorder when not treated properly RAD can be taken into adulthood.

Symptoms

Signs and symptoms may include:

• Unexplained withdrawal, fear, sadness or irritability

• Sad appearance

• Not seeking comfort or showing no response when comfort is given

• Failure to smile

• Avoiding eye contact

• Watching others closely but not engaging in social interaction

• Failure to reach out when picked up

• No interest in playing interactive games

• Behavior problems

• Boundary issues

• Failing to seek support or assistance

symptoms taken into adulthood

Signs and symptoms may include:

• Detachment

• Withdraw

• Inability to develop and/or maintain relationships, romantic or otherwise

• Inability to show affection

• Resistance to giving and receiving love despite craving it

• Control issues

• Anger issues

• Impulsivity

• Sense of distrust

• Inability to fully grasp emotions

• Feeling of loneliness and emptiness

• Lack of sense of belonging

• Boundary issues

On the outside, behaviors of RAD children might look like aggression, manipulation, or destruction, but at the heart of it all is deep fear. It’s important to understand that the root of it all is trauma, loss and a PTSD response.

Causes

To feel safe and develop trust, children need a stable and caring environment. Their basic emotional and physical needs must be consistently met by caregivers. For example, when a child cries, the need for comfort, a meal or a diaper change must be met with a shared emotional exchange that may include eye contact, smiling and caressing.

A child whose needs are ignored or who is met with a lack of emotional response from caregivers does not come to expect care or comfort or form a stable attachment to caregivers.

The risk of developing RAD from severe social and emotional neglect or the lack of opportunity to develop stable attachments may increase in children who, for example:

• Live in a children's home or other institution

• Frequently change foster homes or caregivers

• Have parents who have severe mental health problems, criminal behavior or substance abuse that impairs their parenting

• Have prolonged separation from parents or other caregivers due to repeated out-of-home placement, hospitalization or death of a primary caregiver