What Is Reactive Attachment Disorder?

RAD, Attachment Disorder

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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,

Common Reactive Attachment Disorder (RAD) Symptoms

Verywell / Joules Garcia

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.

Reactive Attachment Disorder Symptoms

Symptoms of RAD include:

  • Avoidance of comfort when distressed
  • Avoidance of physical touch
  • Difficulty managing emotions
  • Not being affected when left alone
  • Not making eye contact, smiling, or engaging
  • Emotional detachment
  • Excessive rocking or self-comforting
  • Inability to show guilt, remorse, or regret
  • Inconsolable crying
  • Little or no interest in interaction with others
  • Need to be in control
  • Tantrums, anger, sadness

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.

Reactive Attachment Disorder Diagnostic Criteria

  • Pattern of not seeking comfort or not being responsive when distressed
  • Two or more forms of social and/or emotional distress, such as minimal engagement with others, limited positive affect, and episodes of unexplained irritability or fearfulness in nonthreatening interactions with caregivers
  • A history of needs not being met, changes in caregivers, or an unusual setting that prevents attachment
  • Does not meet the diagnostic criteria for autism spectrum disorder
  • Behavioral symptoms that began before age 5
  • At least 9 months old, measured as developmental age

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.

Reactive Attachment Disorder Causes

Potential causes of RAD include:

  • Attention only when the child misbehaves (negative attention only)
  • Being left alone for hours without interaction, touch, or play
  • Emotional needs not being met consistently
  • Experiencing a trauma or very scary, difficult event
  • Having an emotionally unavailable parent
  • Hospitalization
  • Inconsistent care or response to needs
  • Loss of a caregiver or other family member, such as a sibling
  • Multiple primary caregivers or changes in caregivers
  • Neglect or abuse from parents, caregivers, or others
  • Not being comforted when crying or distressed
  • Not being fed when hungry for hours
  • Not having a diaper changed for many hours
  • Only some needs being met, or needs being met only sometimes
  • Physical needs not being met consistently
  • Separation from parents or other primary 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.

Reactive Attachment Disorder Treatment

Treatment options for RAD include:

  • Family therapy with the child and caregivers
  • Parenting classes to learn effective strategies
  • Play therapy with the child to teach social and other skills
  • Teaching social skills in other ways
  • Special education services in schools
  • Talk therapy with the child, caregivers, or both

Mental Health Resources

If you or a loved one are struggling with reactive attachment disorder, contact the Substance Abuse and Mental Health Services Administration (SAMHSA) National Helpline at 800-662-4357 for information on support and treatment facilities in your area.

For more mental health resources, see our National Helpline Database.

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.

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5 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
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