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HomeMental HealthReactive Attachment Disorder

12 Minutes

Edited & medically reviewed by THE BALANCE Team
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With the right diagnosis, people taking care of children with reactive attachment disorder (RAD) can see meaningful progress.

Children frequently experience complex emotions. However, certain behaviors indicate an attachment issue caused by trauma or stress. Due to early childhood neglect, maltreatment, or deprivation, reactive attachment disorder (RAD) results in severe emotional issues.

Numerous children spend their early years in the care of attentive caregivers who address their physical and emotional requirements. However, this is not true for all children.

An attachment disorder, such as RAD, may arise in the absence of a safe and caring environment that promotes stable attachment.

Children with RAD will not seek reassurance from their caretakers when they are distressed; they will not approach their caregivers in times of distress. A child who is upset may reject a parent’s attempt to comfort them with a hug.

Despite the difficulty of addressing RAD, children can overcome it and build good relationships. Getting an accurate diagnosis timely is frequently the best initial step for parents seeking treatment options for their children and family.

RAD is defined by a pattern of emotional disengagement in children, particularly during times of hardship. RAD symptoms are typically caused by poor care throughout early childhood. The child will appear uninterested in social interactions and will reject or refuse assistance from caretakers. Most children are diagnosed with RAD before they turn five years old, although the minimum age for diagnosis is nine months. Sadly, RAD is difficult to treat because it is frequently associated with other physical and mental disorders.

A child with RAD will exhibit unexplainable episodes of:

  • Irritability
  • Fearfulness
  • Sadness

Several causes of RAD include:

  • Fragmented bond owing to frequent changes in caregivers
  • Insufficient social warmth and stimulation
  • Few interactions with a caring parent or caregiver
  • A child with RAD may also exhibit the following symptoms:
  • Malnutrition
  • Language delays
  • Cognitive delays
  • Repetitive conduct or behaviors
  • Association of RAD with mental disorders such as depression
  • Avoidance of eye contact
  • Staying away from physical contact
  • Having frequent tantrums
  • Not displaying feelings such as happiness or love when dealing with others.

The symptoms and manifestations of RAD will not spontaneously disappear as a person ages. Even with the most effective therapy, a person may continue to have lifelong attachment problem symptoms. Because the individual was unable to build a safe attachment style as a child, they may suffer from anxious or avoidant attachment patterns, which might impact their present and future relationships.

Based on the exact conditions that influenced the child’s early development, a child with reactive attachment disorder will exhibit different signs and symptoms. Examples of possible symptoms shown by these children include:

Physical symptoms:

  • Being unable to acquire weight
  • Never smiling
  • Looking depressed, dejected, or joyless
  • Looking listless

Behavioral symptoms:

  • Inability or intentional avoidance of making eye contact
  • Not interacting with peers.
  • Asserting calmness when alone as opposed to in the presence of others.
  • Engaging in self-soothing actions, like caressing one’s arms or swaying back and forth repeatedly
  • Averting the face or turning away from an individual who is attempting to express affection
  • Minimal interpersonal responsiveness

Psychosocial symptoms:

  • Faces difficulties in being consoled or cannot be reassured and consoled
  • Persistent feelings of being frightened or unsafe
  • Extremely poor self-esteem
  • Internal feelings of emptiness
  • Feelings of insignificance
  • Without the capacity to trust others
  • Destitute of a sense of identity and belonging
  • Feeling unwelcome
  • Persistent and overpowering sadness
  • Persistent and overpowering anxiety

Cognitive symptoms:

  • Cognitive limitations
  • Language difficulties
  • Additional developmental delay
  • Delayed reactivity to stimuli

Due to the low prevalence of reactive attachment disorder, studies on this condition are scant. Consequently, there are no definite causes and risk factors for why some children acquire RAD while others do not. Nevertheless, the following characteristics have been identified as potentially influencing the onset of reactive attachment disorder:

Genetic: Although there is no particular genetic link to the emergence of reactive attachment disorder, genetic changes are referenced as playing a significant role in the progression of other attachment disorders; therefore, many experts hypothesize that genetic factors influence the progression of reactive attachment disorder as well.

Environmental: The majority of experts in the field of psychology believe that the circumstances in which a child is reared are the primary cause of the beginning of reactive attachment disorder. Denying a child an emotional, healthy, and caring connection with a caregiver might significantly impede his or her psychological development. In addition, when children grow up in households where they are subjected to abuse, they will regard dread as their predominant emotion. They are unfamiliar with the concept of attachment, thus they will subconsciously avoid situations that could foster its development.

Physical: How babies and their mothers or other caregivers communicate directly affects how the brain is developing. When emotional engagement is inadequate or nonexistent, brain development is altered, which can affect personality formation. This influences how a youngster perceives and experiences interpersonal connections, which can further decide whether RAD will develop.

Risk Factors:

  • Being socially abandoned
  • Growing up in a residential institution (for instance, an orphanage)
  • Moving between different foster homes
  • Being forcibly removed from a household of abuse or neglect
  • Having a mother with extreme postpartum depression
  • Experiencing further painful losses or big changes with a primary caregiver

Young children and infants with reactive attachment disorder face tremendous long-term risks with adult-life repercussions. Adults with reactive attachment disorder may struggle to adapt in numerous areas of life. Adults who suffer from RAD have low self-esteem and a lack of confidence in their abilities because they were never shown affection or encouragement as children. This is especially true for persons with reactive attachment disorder who have not gotten treatment.

Perhaps the greatest risk that adults with reactive attachment disorder face are in their relationships. The initial attachment relationship is crucial for preparing the stage for subsequent relationships. Without building a tie with an adult caregiver, the individual frequently has trouble forming and/or maintaining long-term social and romantic relationships.

Adults with reactive attachment disorder are also susceptible to other mental problems. Individuals with reactive attachment disorder or other attachment difficulties frequently suffer from depressive disorders, anxiety disorders, personality disorders, and dissociative disorders.

Reactive Attachment Disorder Symptoms In Adults

RAD can last into adulthood if the child is not managed or if therapy or treatment is not effective to a hundred percent degree. The impacts of RAD in adulthood can be considerable and can impair the individual’s capacity to fully experience relationships, have a positive sense of self, and maintain mental health. Here are some symptoms of RAD in adults:

  • Disassociation or detachment
  • Withdrawal from relationships
  • Inability to maintain important platonic or romantic relationships
  • Inability to express affection or emotions
  • Reluctance to accept affection
  • Control issues
  • Anger difficulties
  • Impulsive behavior
  • Distrustful
  • Inability to fully understand feelings
  • A sense of emptiness or desolation
  • Absence of a feeling of belonging

Reactive attachment disorder is a mental health condition affecting around 1 percent of adolescents and children. Due to the similarity between the external symptoms of reactive attachment disorder and autism spectrum disorder in children, an appropriate diagnosis must be made with caution. Typically, symptoms and risk factors of reactive attachment disorder are apparent before the age of five years.

In the spectrum of mental conditions known as attachment disorders, reactive attachment disorder constitutes the most severe disorder.

Reactive attachment disorder is defined by the inability to form relationships with significant others. This is caused by the failure to meet the child’s emotional requirements in early life, or severe abuse or neglect. As a consequence, the child is unable to form appropriate attachments with caretakers or parents at such a young age, which might result in permanent psychological damage.

Various factors can contribute to reactive attachment disorder:

  • A parent’s struggles with a substance use disorder or mental health disorder may prevent them from forming an attachment with their child. These problems impede a parent’s capacity to offer their child affection and normal relationships.
  • A parent may have passed away, depriving the young child of the natural connection process.
  • Some children move frequently between foster care or foster home environments, preventing them from forming regular relationships with caretakers.
  • Some young children who were raised in institutions are devoid of warmth and physical connection.
  • Some young children suffer sexual or physical abuse at the hands of a caregiver.
  • All of these early experiences of childhood contribute to the incidence of attachment problems, a sense of profound mistrust, and a lack of emotional security, which can lead to reactive attachment disorder.

A psychiatrist or psychologist who specializes in pediatrics can undertake a comprehensive, in-depth assessment to diagnose reactive attachment disorder.

The evaluation of your child could entail the following:

  • Direct observation of parental or caregiver interactions
  • Details regarding the behavior trend throughout time
  • Their behavior is illustrated in many real-world examples.
  • Details regarding encounters with caregivers or parents and others
  • Questions regarding the home and living conditions since birth
  • An assessment of parenting methods and caregiving skills

Your child’s mental health professional will also wish to rule out other psychiatric diseases and determine whether other mental health concerns, such as:

The clinical diagnosis for reactive attachment disorder in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) published by the American Psychiatric Association may be utilized by your child’s mental health practitioner. Typically, a diagnosis is not made before the age of nine months. Typically, signs and symptoms emerge before the age of five years.

DSM-5 standards and guidelines for diagnosis include:

  • A pattern of emotionally detached conduct toward caretakers, manifested by infrequently seeking or reacting to comfort when troubled.
  • Persistent emotional and social difficulties, including minimal reaction to others, no positive response to encounters, or unexplainable irritation, sadness, or fear during interactions with their caregivers.
  • The persistent failure of caregivers to meet emotional demands for comfort, stimulation, and affection, or frequent changes in primary caregivers that limit possibilities to build stable attachments or care in an environment that significantly inhibits opportunities to form attachments (like an institution)
  • No autism spectrum disorder diagnosis

Understanding the motivation behind the misbehavior will help you implement RAD-compatible discipline. These children transgress, disobey or misbehave because they are controlled by insecurity and fear, are unable to cope with their emotions, and are unable to call out or ask for assistance. Your goal with discipline is to help your kids feel safe and comfortable.

Trust, bonding, attachment, connection, and love are the main elements of discipline for children with RAD. However, without a sense of security, the other aims of discipline cannot be achieved; moreover, your child will not care about connection, bonding and love until they know and trust you. Among the methods for meeting your child’s safety needs are:

Setting boundaries and limits help make your child’s world less frightening and more predictable

Developing dependable habits to help your youngster feel more in charge

Be upfront and clear about your expectations for your child, inappropriate behavior, and the repercussions for misbehaving.

As a primary caregiver of a kid with RAD, you should prioritize security, safety, trust, transparency, and predictability. When you discipline your child with reactive attachment disorder from this viewpoint, your feelings and actions will help you maintain composure during the process.

Teaching a Child with RAD: Discipline Strategies

Children with RAD require a method of punishment that is adapted to their specific requirements and the impact of their lack of attachment to a caregiver. This advice and techniques will assist you in disciplining your child while reducing his or her emotional responses.

  • Maintain composure in your interactions. Your youngster will feel insecure, frightened, and therefore unable to trust you if you become emotional (yell, display furious emotions, and angry posture).
  • After disciplining, make a fresh start. It demonstrates to your child that you will always be there for him or her no matter what.
  • Maintain boundaries firmly but gently.
  • Use logical consequences. Your child can either eat the school lunch or go hungry until supper time if they choose not to take their meal from home.
  • All repercussions should be relevant to the situation. Consequences that last for days are ineffectual and might lead children with RAD to believe they are being “punished” indefinitely; as a result, they are likely to disengage and ruin the trust you have worked so hard to establish.

You will be able to define your boundaries and repercussions for constructive discipline when guided by these concepts.

  1. Reactive attachment disorder. Psychology Today. Sussex Publishers. Available at: https://www.psychologytoday.com/us/conditions/reactive-attachment-disorder.
  2. Reactive attachment disorder in children: Symptoms and diagnosis, Psych Central. Available at: https://psychcentral.com/disorders/reactive-attachment-disorder-symptoms.
  3. Disciplining a child with reactive attachment disorder, HealthyPlace. Available at: https://www.healthyplace.com/parenting/discipline/disciplining-a-child-with-reactive-attachment-disorder.
  4. Reactive attachment disorder. Mayo Clinic. Mayo Foundation for Medical Education and Research. Available at: https://www.mayoclinic.org/diseases-conditions/reactive-attachment-disorder/diagnosis-treatment/drc-20352945.
  5. Reactive attachment disorder in adults, Choosing Therapy. Available at: https://www.choosingtherapy.com/reactive-attachment-disorder-in-adults/.

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