Reactive attachment disorder (RAD) is a rare condition where children don’t form an emotional bond with their caretakers. Children who are adopted may experience RAD. Treatment focuses on repairing and/or creating emotionally healthy family bonds.
Reactive attachment disorder (RAD) is a condition where a child doesn’t form healthy emotional bonds with their caretakers (parental figures), often because of emotional neglect or abuse at an early age. Children with RAD 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 fearful of or anxious around their caretakers, even in situations where their caretakers are quite loving and caring.
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Reactive attachment disorder is most common among children who experience physical or emotional neglect or abuse. While not as common, older children can also develop RAD. Children may be more likely to develop RAD if they:
In some cases, parents who adopt children without knowledge of the child’s history might have trouble forming a bond with the new addition to their family, especially if the child has any emotional instability. If you are a new parent and your child shows symptoms of RAD or you have difficulty connecting with them, talk with your child’s healthcare provider for an evaluation.
The exact rate of occurrence is unknown since many cases aren’t reported, but reactive attachment disorder can occur in up to 1% to 2% of children. Kids who are removed from their homes and placed in other settings, like foster care, are much more likely to experience RAD. Almost half of these children have difficulty developing relationships over time.
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Symptoms of reactive attachment disorder are unique to each child. Common symptoms among infants and young children with RAD include:
Inhibited reactive attachment disorder (RAD) is related to disinhibited social engagement disorder (DSED), but there are differences between each type.
Children with reactive attachment disorder are aware of what happens around them, but they don’t respond emotionally to what’s going on. They may not show or seek affection from caregivers or others and prefer to be alone. Symptoms of inhibited reactive attachment disorder include:
Children with disinhibited social engagement disorder may be overly friendly toward strangers and even go to them without checking with their parents. In most cases, children act younger than their age and may seek out affection from others in an unsafe way. Symptoms of DSED include:
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There is no exact cause for children diagnosed with reactive attachment disorder. Studies suggest that there could be several factors that contribute to a child who doesn’t form a bond with their caretakers including:
Young children form healthy relationships when their basic needs are consistently attended to. This builds a sense of trust between the child and their caretakers. If a child’s physical and emotional needs aren’t being met, they are at risk of developing RAD.
To diagnose reactive attachment disorder, your child’s healthcare provider will ask you about your child’s medical history and what symptoms they’re experiencing. Your providers might ask the following questions to better understand your child’s symptoms:
If your provider suspects RAD, they are likely to recommend you and your child visit a pediatric specialist, psychologist and psychiatrist to help diagnose your child correctly and recommend treatments that can help.
Before diagnosing a child with reactive attachment disorder, your provider will offer tests to rule out other causes, including autism spectrum disorder. Autism spectrum disorder is a developmental condition that affects a person’s behavior and communication and can, on the surface, have similar symptoms as RAD. For example, abuse or neglect doesn’t cause autism spectrum disorder but could contribute to a RAD diagnosis.
Treatment for reactive attachment disorder focuses on creating emotionally healthy bonds and/or repairing fearful or uncomfortable relationships between children and their caregivers. It strengthens children emotionally in a way that can later help the child to develop other healthy relationships. Both children and caregivers benefit from treatment plans. Treatment may include:
Physical, emotional and social neglect and abuse put children with RAD at higher risk for complications in childhood and adolescence. These complications may include:
Without treatment, children with RAD could experience symptoms into adulthood that will affect how they function in society. Treatment will be long term to offer emotional support to your child. It may be lifelong. There is no timeline for when your child will develop healthy relationships, but treatment, with support from their caregivers, leads to the best outcome.
The best way to prevent reactive attachment disorder is by ensuring children form healthy bonds with their parents and/or other primary caretakers. Healthy bonds form when caretakers:
As their caretaker, you can help your child develop healthy bonds by:
Many children who receive treatment for reactive attachment disorder form stable, healthy bonds with their primary caretakers and others in their life. Children who don’t receive treatment can face risks of ongoing emotional issues. Fortunately, it’s never too late to seek treatment for developmental and mental health conditions, including RAD. It is important to remember:
Reactive attachment disorder is a lifelong condition. Treatment and support for the child helps them develop healthy relationships throughout their life and can improve their emotional and social wellbeing.
If you notice that your child has trouble developing normal relationships or you see any symptoms of reactive attachment disorder in your child, contact your child’s healthcare provider for an evaluation or referral. Early diagnosis and treatment lead to more successful outcomes for children with this condition.
A note from Cleveland Clinic
It’s important to create a bond with your child and make sure they feel loved. Reach out to your regular healthcare provider if your child does not form a comfortable emotional bond with you or their primary caretaker. Asking your provider for advice or treatment doesn’t mean that you’re a bad parent. Instead, it opens the door to building a strong, healthy and lifelong relationship with your child.
Last reviewed on 02/22/2022.
Learn more about the Health Library and our editorial process.
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Cleveland Clinic is a non-profit academic medical center. Advertising on our site helps support our mission. We do not endorse non-Cleveland Clinic products or services. Policy