Reactive attachment disorder (RAD) is a condition found in children who may have received grossly negligent care and do not form a healthy emotional attachment with their primary caregivers -- usually their mothers -- before age 5.
Attachment develops when a child is repeatedly soothed, comforted, and cared for, and when the caregiver consistently meets the child's needs. It is through attachment with a loving and protective caregiver that a young child learns to love and trust others, to become aware of others' feelings and needs, to regulate his or her emotions, and to develop healthy relationships and a positive self-image. The absence of emotional warmth during the first few years of life can negatively affect a child's entire future.
What Are the Symptoms of Reactive Attachment Disorder?
RAD can affect every aspect of a child's life and development. There are two types of RAD: inhibited and disinhibited.
Common Symptoms of Inhibited RAD Include:
- Unresponsive or resistant to comforting
- Excessively inhibited (holding back emotions)
- Withdrawn or a mixture of approach and avoidance
Common Symptoms With Disinhibited RAD Include:
- Indiscriminate sociability
- Inappropriately familiar or selective in the choice of attachment figures
What Causes Reactive Attachment Disorder?
RAD occurs when attachment between a young child and his or her primary caregiver does not occur or is interrupted due to grossly negligent care. This can occur for many reasons, including:
- Persistent disregard of the child's emotional needs for comfort, stimulation, and affection
- Persistent disregard of the child's basic physical needs
- Repeated changes of primary caregivers that prevent formation of stable attachments (for example, frequent changes in foster care)
How Common Is Reactive Attachment Disorder?
It is difficult to know exactly how many children have RAD, since many families affected by the disorder never seek help. However, it is generally believed that RAD is uncommon.
How Is Reactive Attachment Disorder Diagnosed?
As with adults, mental disorders in children are diagnosed based on signs and symptoms that suggest a particular condition. If physical symptoms are present, the doctor may perform a complete medical history and physical exam, including a review of developmental milestones. Although there are no lab tests to specifically diagnose RAD, the doctor may sometimes use various tests, such as neuroimaging studies or blood tests, if there are concerns that a physical illness or medication side effects might be causing the symptoms.
If the doctor cannot find a physical cause for the symptoms, he or she will likely refer the child to a child and adolescent psychiatrist or psychologist, mental health professionals who are specially trained to diagnose and treat mental illnesses in children and teens. Psychiatrists and psychologists use specially designed interview and assessment tools to evaluate a child for a mental disorder. The doctor bases his or her diagnosis on reports of the child's symptoms, and his or her observation of the child's attitude and behavior.
How Is Reactive Attachment Disorder Treated?
Treatment of RAD has two important goals. The first is to ensure that the child is in a safe environment. This is especially important in cases where the child has been abused or neglected. The second goal is to help the child develop a healthy relationship with an appropriate caregiver.
Treatment for RAD often focuses on the caregiver. Counseling may be used to address the issues that are affecting the caregiver's relationship with and behavior toward the child. Teaching parenting skills also can help improve the relationship with the child and help develop attachment. Treatment may also include play therapy. This technique allows the child and the caregiver to express their thoughts, fears, and needs in the safe context of play.
There is no medication to treat RAD itself. However, the doctor may sometimes use a medication as an adjunct to treatment to help manage severe behavioral symptoms, such as explosive anger or problems sleeping.
The use of so-called holding therapies and/or "rebirthing" techniques is controversial. There is no scientific evidence to support the effectiveness of such interventions.
What Is the Outlook for Children With RAD?
If not treated, RAD can have a negative impact on a child's physical, emotional, behavioral, social, and moral development. Children with RAD generally are at higher risk for:
Aggressive and/or disruptive behavior
Learning difficulties and behavior problems in school
Inability to form meaningful relationships
With treatment, it is possible for children with RAD to learn to trust others, and to lead healthy and productive lives.
Can Reactive Attachment Disorder Be Prevented?
Recognizing a problem with attachment and providing interventions as soon as possible are essential to preventing RAD.