What is reactive attachment disorder (RAD)?

Reactive attachment disorder (RAD) is a condition in which an infant or young child does not form a secure, healthy emotional bond with his or her primary caretakers (parental figures).

Children with RAD often have trouble managing their emotions. They struggle to form meaningful connections with other people. Children with RAD rarely seek or show signs of comfort and may seem almost fearful of their caretakers, even in situations where the current parent figures seem quite loving and caring. These children are often irritable or sad, and may report feeling unsafe and/or alone.

Who is likely to have reactive attachment disorder (RAD)?

Reactive attachment disorder is most common among children between 9 months and 5 years who have experienced physical or emotional neglect or abuse. While not as common, older children can also have RAD since RAD sometimes can be misdiagnosed as other behavioral or emotional difficulties. Children may be more likely to develop RAD if they:

  • Have had many different foster care providers or spent time in an orphanage
  • Were taken away from primary caretakers after forming a healthy bond
  • Have had multiple traumatic losses early in life

What causes reactive attachment disorder (RAD)?

Although there is no exact cause, researchers believe that lack of an appropriate level of loving and consistent caretaking contributes to development of RAD. Inadequate caregiving can make a child feel abandoned, alone and uncared for – all of which can prevent that child from developing a healthy and secure emotional bond with his or her primary caretakers.

Young children form healthy relationships when their basic needs are consistently attended to – this builds a sense of trust between the young child and caretakers. Examples of inappropriate, ongoing caretaking situations that place a child at greater risk of developing RAD include:

  • A baby whose diaper is soiled and not changed for many hours.
  • A baby who is hungry and not fed for many hours.
  • A baby who is crying and not attended to and who is not comforted when they are in distress.
  • A baby who is not held, touched, talked to, or interacted with for many hours at a time.
  • An infant whose needs are met only some of the time (the caregiving is not consistent).
  • A young child who only gains the attention of caretakers by acting up/or being disruptive.
  • A baby or young child who has had multiple primary caretakers (especially if the care provided is inconsistent and/or from unfamiliar people).
  • Any situation in which the child has been physically or emotionally neglected or abused by primary caretakers or other adults.

What are the symptoms of reactive attachment disorder (RAD)?

Symptoms of reactive attachment disorder vary from child to child. Infants and young children who may have RAD show common signs such as:

  • Failure to show an expected range of emotions when interacting with others; failure to show “emotions of conscience” such as remorse, guilt, or regret
  • Avoiding eye contact and physical touch, especially with caregivers
  • Expressing anger; having tantrums; being irritable, unhappy and sad; disobedience and arguing (beyond what would be “usual” for the child’s age and situation)
  • Displaying inappropriate affection toward strangers while demonstrating a lack of affection for and/or fear of their primary caretakers.

When children with RAD grow older, their symptoms usually fall into one of two general patterns:

  • Inhibited RAD symptoms. Children are aware of what happens around them, but they do not respond typically to outside stimuli. Children showing inhibited RAD symptoms are withdrawn and emotionally unresponsive. They may not show or seek affection from caregivers or others, keeping largely to themselves.
  • Disinhibited RAD symptoms. Children may be overly friendly toward strangers. Children with disinhibited RAD symptoms do not prefer their primary caretakers over other people. In most cases, these children act younger than their age and may seek out affection from others in an unsafe way.

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