What Is Reactive Attachment Disorder?

Reactive attachment disorder, also known as RAD, is a mood or behavioral disorder that affects babies and children. It involves difficulties with bonding and forming relationships, as well as having social patterns that are not appropriate, but without an intellectual disability or pervasive developmental disorder (such as autism) to explain these characteristics.

Additionally, reactive attachment disorder is caused by some type of issue with care, such as caregivers being unable to fully provide for the needs of the child, not fulfilling physical and emotional needs, inconsistency, or too many primary caregiver changes.

The term "reactive attachment disorder" is sometimes shortened to "attachment disorder," but reactive attachment disorder is actually a type of attachment disorder,

Reactive Attachment Disorder vs. Disinhibited Social Engagement Disorder

Attachment disorders are sometimes described as being inhibited or disinhibited. These terms are used to describe the behaviors of babies and young children.

Children who fall into the category of inhibited struggle to regulate their emotions, do not prefer any specific adult or caregiver, do not seek caregiver comfort, or do not show much affection, or they display a combination of these behaviors. On the other hand, children who fall into the category of disinhibited may engage or overly engage with all adults evenly, including strangers, and they do not prefer primary caregivers.

Reactive attachment disorder is the inhibited type of attachment disorder. There used to be only one diagnosis for both inhibited and disinhibited attachment, but that has changed with more recent research. The disinhibited type of attachment disorder is called disinhibited social engagement disorder, or DSED.

Characteristics

The characteristics of reactive attachment disorder are the inhibited type, meaning that the child behaves in ways that show little or no attachment to parents or other caregivers. This is seen in babies and young children. They are not able to bond with their parents or primary caregivers in a way that is healthy and secure.

Diagnosis

Reactive attachment disorder can be diagnosed by a mental health professional such as a psychiatrist or psychologist specializing in children. They do this by assessing the child based on the fifth edition of the “Diagnostic and Statistical Manual of Mental Disorders” (DSM-5) diagnostic criteria. Then they assess the child in terms of how the symptoms affect their ability to function.

Causes

The specific causes of reactive attachment disorder are not as simple as they may seem. While child abuse and neglect can lead to attachment disorders, there is more to it than that. Children who receive inconsistent care or who are placed with new primary caregivers are also at an increased risk of reactive attachment disorder. This can happen even when parents and other caregivers mean well and are doing their best.

Children may experience an event or challenge that is not overtly harmful, such as a geographical move, or something that cannot be avoided, such as the death of a family member. Even though they may be too young to understand what is happening, they may feel as though they are not loved, they are unsafe, or they are unable to trust their caregivers.

Treatment

Treatment for reactive attachment disorder goes beyond the child alone. The entire family may be included in order to support healthy bonding. The process involves a combination of talk therapy, other therapies, and education that benefit children as well as parents and other caregivers.

Coping

Coping with reactive attachment disorder involves strategies to support both the child and the adults who interact with the child. This is because bonding between children and their caregivers involves two or more people, and their interactions can help to form more secure attachment. For this reason, coping includes support, self-care, and stress management for the adults, as well as healthy nutrition and adequate sleep and physical activity for both children and adults.

A Word From Verywell

If your child or a child you know is struggling with attachment, help is available. Even if your child is diagnosed with reactive attachment disorder, it doesn't mean this was brought on by you or was your fault. Sometimes things happen that are beyond one's control, no matter how hard we try. The greatest concern is that the child gets the care they need.

Contact a family physician, primary care provider, or mental health professional for support for the child. It is also important that you and other primary caregivers for the child receive any needed support in order to care for the child.