Reactive attachment disorder (RAD) is a serious condition that occurs in infants or young children who fail to establish healthy attachments with parents or caregivers. This disorder may develop when a child’s basic needs for comfort, affection, and nurturing are not met, and they are unable to form stable and loving attachments with others.
With appropriate treatment, children with reactive attachment disorder can develop more stable and healthy relationships with caregivers and others. Treatments involve creating a stable and nurturing environment and providing positive interactions between the child and caregiver. Parent or caregiver counseling and education can also be beneficial.
Reactive attachment disorder usually begins in infancy and may include the following signs and symptoms:
If your child displays concerning signs that persist over time, consider getting an evaluation. Some symptoms may occur in children without reactive attachment disorder or those with other conditions such as autism spectrum disorder. To determine whether the behaviors indicate a more serious problem, consult a pediatric psychiatrist or psychologist.
Infants and young children require a stable and caring environment to feel safe and develop trust. When their basic emotional and physical needs are consistently met by caregivers, a stable attachment is formed. However, a child whose needs are ignored or met with a lack of emotional response from caregivers fails to expect care or comfort, leading to an unstable attachment.
The exact reasons why some children develop reactive attachment disorder while others don’t remain unclear. Various theories exist, and further research is necessary to enhance understanding and improve diagnosis and treatment options.
The risk of developing reactive attachment disorder may increase in children who:
However, it’s essential to note that most severely neglected children do not develop reactive attachment disorder.
If left untreated, reactive attachment disorder can persist for several years and lead to lifelong consequences. These complications may include issues with relationships, social interactions, mental and physical health, behavior, intellectual development, and substance abuse.
Further research is necessary to determine if problems in older children and adults are related to early childhood experiences of reactive attachment disorder.
While it’s not certain if reactive attachment disorder can be prevented, there may be ways to reduce the risk of its development. Infants and young children require a stable and caring environment, and their basic emotional and physical needs should be consistently met. The following parenting suggestions may help:
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Reactive attachment disorder (RAD) is a condition that primarily affects children, and a comprehensive evaluation by a pediatric psychiatrist or psychologist is essential for diagnosis.
The evaluation process for RAD may include:
During the evaluation, the mental health provider will also assess whether other psychiatric disorders coexist, such as intellectual disability, adjustment disorders, autism spectrum disorder, depressive disorders, or post-traumatic stress disorder.
The diagnostic criteria for reactive attachment disorder are outlined in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) by the American Psychiatric Association. Generally, diagnosis is not made before 9 months of age, and signs and symptoms typically appear before the age of 5 years.
The DSM-5 criteria for diagnosing reactive attachment disorder include:
Although there is no standard treatment for RAD, intervention should involve both the child and parents or primary caregivers. The treatment goals are to ensure the child has a safe and stable living situation and develops positive interactions and strengthens the attachment with parents and caregivers.
Mental health professionals provide education and coaching in skills that help improve RAD symptoms. Treatment strategies include:
Additional services that may benefit the child and family include individual and family psychological counseling, education about the condition for parents and caregivers, and parenting skills classes.
The American Academy of Child and Adolescent Psychiatry discourages the use of dangerous and unproven treatment techniques for RAD. These techniques may involve physical restraint or force to break down what’s believed to be the child’s resistance to attachments. Such practices are unsupported by scientific evidence and can be psychologically and physically damaging, leading to accidental deaths.
If considering unconventional treatment, consult with the child’s psychiatrist or psychologist first to ensure it is evidence-based and safe.
Parents or caregivers of children with RAD may experience feelings of anger, frustration, guilt, and distress. Coping strategies include:
If you suspect RAD in your child, start by visiting a pediatrician who may refer you to a child psychiatrist, psychologist, or a pediatrician specializing in child development. Before the appointment:
Prepare a set of questions to ask the healthcare provider, addressing the child’s behavior, possible causes, recommended treatments, and any available support services.
