What is Reactive Attachment Disorder?

Children display behaviors of attachment directed towards a parent or caregiver. These behaviors typically include seeking comfort when feeling distressed, scared or ill, maintaining close proximity, and the desire to play or interact. 

As for the adults, attachment behaviors include responding to a young child’s wants or needs. These behaviors are exhibited by the child and adult are universal around the world.

Unfortunately, not every child—or adult—receives the proper attention and nurturing. This can lead to the development of several mental disorders as well as attachment issues later in life. Read on to learn more about Reactive Attachment Disorder.

<H2>What is Attachment Psychology?</H2>

Attachment psychology is the study of human bonds and relationships. Disinhibited social engagement disorder or disinhibited attachment disorder are also types of attachment disorders. This is forged during infancy through the age of five, and strengthens and evolves throughout life. Since attachment begins to develop almost immediately after birth, attachment psychology tends to focus on the very early years of human life. 

Attachment psychology, or theory, enables us to understand how the parent/caregiver-child relationship is formed, and how it affects the rest of the child’s life. Research has shown that interactions between infants and adults spur the growth of neural pathways in infants’ brains. These pathways eventually form the basis of how we react to the surrounding world. In other words, children begin to learn the behaviors that make us human.

The origins of attachment psychology date back to the 1930s when British psychologist John Bowlby (1907-1990) began to treat and study emotionally disturbed children. He noticed that there was a commonality in the relationship between children’s behavior and how they were being raised. Bowlby also discovered that their emotional problems were the direct result of separation from their mothers. This was particularly evident during World War II, when children were often evacuated, without parents, to safe locations.

Bowlby often encountered children who exhibited signs of significant distress. He began to formulate the attachment theory to explain how children’s relationships with their mothers influence their social, emotional, and cognitive development as well as future behavior. 

Bowlby’s ideas challenged the prevailing understanding of child development at the time, called behavioral theory. The behavioral theory argued that children become attached to their mother through the act of breastfeeding. 

In contrast, Bowlby asserted that a child’s capacity to form relationships comes from the parent or caregiver’s ability to provide the child with comfort, security, and safety. In this sense, attachment should to be understood in the context of evolution, i.e. that the baby’s chance of survival increases with a caring and responsive adult.  

<H2>What is Reactive Attachment Disorder or RAD?</H2>

When infants or children are unable to form strong relationships with the parent or caregiver, they typically suffer from Reactive Attachment Disorder (RAD). The American Psychiatric Association officially recognizes RAD as a mental disorder. RAD is the result of neglect and maltreatment on the part of the parent or caregiver, who fails to provide the necessary emotional and physical support the baby or young child needs. 

As a consequence, children with RAD do not learn how to expect or accept comfort or affection from others. It is possible to see effects of RAD on the brain itself, specifically in the left primary visual cortex—the area of the brain that regulates our responses to stress. Brain scans of children with RAD have revealed that the amount of gray matter (brain tissue) in this part of the brain is lower than children without the disorder. This means that the brain is underdeveloped. 

As a result, these children show symptoms of detachment, indifference, and other abnormal behavior. RAD is typically diagnosed between nine months to five-years-old. It can hinder emotional development and last well into adulthood. RAD is more likely to occur in children who live in orphanages, foster care homes, or who were separated from parents for a long period of time. RAD is also present in children whose mothers suffered from postpartum depression.

<H2>Reactive Attachment Disorder in Adults vs. Children</H2>

The main difference between RAD in children and adults is that the disorder is the adult’s responsibility. As stated above, without treatment a child with RAD will mature into an adult and exhibit many of the same symptoms and behaviors. 

These symptoms and behaviors can include the following:

  • Anger
  • Control issues
  • Low self-esteem
  • Withdrawal from family and friends
  • Avoidance of social situations
  • Difficulty in establishing and maintaining relationships
  • Inability to give or receive affection or even to understand emotions
  • Loneliness
  • General distrust of others

Additionally, adults may wrongly perceive that their parents are hostile towards them. Having RAD as adult also increases the risk of developing other mental disorders or even co-occurring disorders, such as depression, anxiety, and multiple personality disorder. 

<H2>Reactive Attachment Disorder Symptoms</H2>

For anyone who witnesses a child with RAD, the symptoms are readily apparent. Most babies and RAD kids tend to display signs of insecure attachment. These signs can include not responding to being picked up, wary of others around them, or may appear listless, irritable, sad or fearful. 

They also may not show some of the following signs or behaviors:

  • Lack of interest in playing games
  • Display abnormal eating patterns
  • Avoid eye contact with parents or caregivers
  • Lie persistently
  • Disinhibited behaviors
  • Lack of social relatedness (close friends or relationships)
  • Be preoccupied with fire
  • Display difficulty learning
  • Act overly affectionate towards strangers
  • Lack the ability to understand consequences of their actions 

Whenever the parent or caregiver does happen to show signs of affection, the child will respond with aloofness or confusion. Many of these symptoms are intensified in adulthood.

<H2>Reactive Attachment Disorder in DSM 5 | Diagnosis</H2>

According to the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders, which is published by the American Psychiatric Association, the following criteria must be met to diagnose RAD:

  1. Consistent patterns of introverted, detached behavior toward the parent or caregiver, specifically when the child does not seek or respond to comfort when distressed
  2. Constant social or emotional stress, particularly when the reasons for the stress are unknown
  3. Exposure to long-term insufficient care from parents or caregivers, multiple caregivers (like foster homes), or unusual or institutional settings (orphanages)
  4. Criteria 3 is responsible for the problems associated with criteria 1
  5. The criteria do not meet the requirements for autism
  6. The symptoms must be apparent before the child reaches age 5
  7. The child has a developmental age of at least nine months
  8. The child has manifested signs of the disorder for more than 12 months  

When assessing the situation, therapists need to carefully distinguish RAD from other mental disorders. Some other mental disorders have the same symptoms as RAD. These other disorders include attention-deficit hyperactivity disorder ADHD, anxiety disorder, post-traumatic stress disorder, and oppositional defiant disorder. In fact, studies have shown a correlation between pathogenic care and the development of ADHD symptoms.

However, treatment for RAD typically does not work for these other disorders. For example, one approach to assist a child with RAD is to remove him or her from a harmful living situation. This will likely not have any benefit for an autistic child.

<H2>Reactive Attachment Disorder Treatment</H2>

Although the situation may seem hopeless, treatment for and recovery from RAD is possible for both children and adults. The first step is to determine whether or not a child has the disorder, using the criteria stated in DSM-5. 

If a child is displaying RAD symptoms, then the child must be removed and placed in a more supportive and caring environment. In some cases, this is all it takes for RAD symptoms to disappear.

Next, a psychotherapist will assess the situation and devise a treatment plan. Treatment plans can involve trauma-focused cognitive behavioral therapy, psychotherapy for the child, parenting training, family therapy, self-soothing behaviors and special education services. 

Given that the source of RAD is parental/caregiver neglect or mistreatment of the child, the parent or caregiver may require therapy or counseling as well. The psychotherapist will likely evaluate the attitudes and opinions of the parent/caregiver as this is crucial to the overall success of the treatment. 

Other forms of support can include housing, social, and financial support. Medication may be prescribed as well. The ultimate goal of treatment, of course, is to rebuild the children’s capacity to establish bonds with the parents or caregivers.

<H2>Reactive Attachment Disorder: Final Thoughts</H2>

Attachment to others is a fundamental part of human life. It is not only necessary for our survival but it is also what makes life meaningful. This is what makes reactive attachment disorder (and certainly other disorders) so troubling. 

Although not every child who doesn’t receive affection, love, and comfort early in life develops RAD, the situation can become quite serious for those who do. Fortunately, with proper medical intervention, overcoming RAD is definitely possible. A healthy attachment figure not only benefits the youngster, but also overall family life.

As a result, it is essential for parents or caregivers who identify potential symptoms of Reactive Attachment Disorder in their children to seek a consultation from a medical professional as soon as possible to plan an effective treatment and counseling strategy. These important tools will make a nurturing home life possible, which is crucial to those suffering from RAD.
















author avatar
Angel Rivera
I am a Bilingual (Spanish) Psychiatrist with a mixture of strong clinical skills including Emergency Psychiatry, Consultation Liaison, Forensic Psychiatry, Telepsychiatry and Geriatric Psychiatry training in treatment of the elderly. I have training in EMR records thus very comfortable in working with computers. I served the difficult to treat patients in challenging environments in outpatient and inpatient settings
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