Reactive Attachment Disorder (RAD): Diagnosis, Cause And Treatment

Updated May 12, 2021

Medically Reviewed By: Nicole Gaines, LPC

We all, at birth, were pre-programmed to bond with a significant person- a primary caregiver or parent. Attachment is the deep bond or relationship that an infant may have with a primary caregiver. Being the first interactive relationship of a child’s life, it greatly affects the child’s development and determines how they would relate with other people throughout his/her life. The absence or inadequate caregiving during infancy and early childhood may make children develop attachment issues such as reactive attachment disorder and disinhibited social engagement disorders.

Attachment issues may vary from mild problems, which can be easily corrected, to the more serious one known as reactive attachment disorder rad. Reactive attachment or disinhibited social engagement disorder is a condition in which a child cannot consistently connect or form a healthy attachment bond with his or her primary caregivers (parents or guardians) due to being grossly neglected by these caregivers. The effects of attachment disorder go beyond early childhood as the quality of childhood attachment experiences an infant has the foundation upon which his or her verbal and non-verbal communication in future relationships rests. Children with attachment issues or social engagement disorders may exhibit callous-unemotional traits, may be unable to express emotions, or understand other people's feelings around them, which, consequently, may limit their ability to build and maintain healthy relationships in their later years.

For children to feel a sense of safety and develop trust, their basic needs- emotional and physical- must be met. A young child that does not enjoy adequate care may begin to feel abandoned, unloved, and uncared for. Thus, the child may develop reactive attachment disorder rad, which can hinder them from cultivating secure attachment and emotional bond with the caregivers and make them exhibit negative traits and comorbid disorders. While sometimes, the situations that lead to attachment issues may be unavoidable, the child is still too young to understand the circumstances and reasons these things happen. So they end up with insecure attachment, feeling no one cares about them, believing they can’t depend on others, and that the world is a cruel and dangerous place.

When a child enjoys a stable and secure attachment, they grow into adults who can:

• Cultivate and build successful intimate relationships
• Maintain emotional stability
• Quickly rebound from disappointment, failure, discouragement, and hardship.
• Be satisfied with being themselves and also enjoy the company of others.
• Be sensitive to the feelings of other people and treat them right.
• Positive self-image.
• Live life to the fullest.

Little children can quickly build a sense of trust and form healthy attachments with their caregivers when their basic needs are consistently met. They will feel loved and easily trust and connect with caregivers who promptly attend to their needs and make them feel comfortable and cared for. The level of secure attachment bond a baby feels when their mother- or primary caregiver- promptly responds to and takes care of their needs from the baby’s first love relationship and shapes the baby’s brain development process.

Attachment issues such as reactive attachment disorder rad are commonly found in children between 9 months to 5 years old who may have been neglected or abused physically or emotionally. Though not common, reactive attachment disorder can continue beyond early childhood to the child’s more senior years, which may sometimes be misdiagnosed as some other type of emotional or attachment problems.

Causes Of Reactive Attachment Disorder

Reactive attachment disorder may likely develop if a child’s basic needs for love, care, comfort, nurture, and affection are not met. The child may not establish a good relationship and form a stable attachment with primary caregivers and thus, begin to exhibit reactive attachment disinhibited behaviors and traits. Some of the situations that may cause attachment issues in a child include:

• A baby who is left hungry, wet, or/and unattended to for hours
• When a child cries, and there is no one to respond or offer comfort.
• A young child who is abused continuously or mistreated
• Lack of emotional response, or negligence, or insensitivity to the child’s basic needs
• A child who is not held, smiled at, touched, talked to, interacted with, affirmed, or comforted when in distress may develop attachment issues
• An emotionally unstable or unavailable parent who is depressed, ill, or given to substance abuse
• A child who gains attention only when he or she acts up throws tantrums or displays extreme behaviors
• Frequent disruptions and changes in primary caregivers- resulting from adoption, foster care, death of parents, etc., may cause attachment issues in the child
• A child who has been emotionally or physically abused or neglected by parents, primary caregivers, or other adults may end up with insecure attachment.

Signs Of RAD

The symptoms of reactive attachment disorder (RAD) may vary from child to child. Some of the signs in infants and young children with attachment disorders include:

• Avoiding eye contacts and doesn’t smile
• Inconsolable cries and wailings
• Eating disorders
• Consistent withdrawal and fearfulness
• Does not reach out to be carried
• Children with RAD rarely show ’emotions of conscience’ like guilt, remorse, or regret.
• Irritable, unhappy, expressing anger, throwing tantrums, rebelling, disobedient, and always argues (beyond what is normal for the child’s age and the situation)
• Never seeking comfort and rejects comfort when it is offered
• Does not seem to care or notice when left alone
• Likes to be alone and never engaging in social interaction when with others
• Does not make sounds or coo
• Exhibits eating disorders
• Coldhearted and callous-unemotional traits.
• Not showing expected emotions
• Not interested in playing games or bonding with others
• Conduct disorder traits

Adolescents with reactive attachment disorder rad may exhibit symptoms that fall under these two categories:

Inhibited Reactive Attachment Disorder: In this case, children are aware of what is happening around them- are sometimes hyper-vigilant- but they do not respond or react typically. Children with these disorders tend to be callous-unemotional and insensitive, may be extremely withdrawn, emotionally detached, and resist comfort even when offered. They choose to keep to themselves and rarely show or seek affection from their caregivers and other people. They are excessively inhibited, i.e., holding back their emotions.

Disinhibited Reactive Attachment Disorder: Children with this attachment disorder may be excessively friendly towards outsiders or strangers. The child seems to seek and prefer the comfort and attention of outsiders or strangers to their parents. Children with reactive attachment disorder may act much younger than their age, they may be extremely dependent, and seek attention from just anybody in an unsafe way.

Diagnosis:

Children with RAD need to seek pediatric psychiatrists or psychologists who have been trained to diagnose and treat mental disorders in children and teens for an in-depth and thorough examination of the child. The symptoms found in children with RAD may also apply in cases of other mental disorders like autism spectrum disorder and bipolar disorder, so it is important to avoid giving a child this label without first reading a manual of mental disorders or conducting a comprehensive evaluation. Psychiatrists use specially designed assessment tools and interviews to evaluate the child’s behavior, and this evaluation may include:

• Review of development milestones
• Observation of the child’s interaction with caregivers, caregivers, and others
• A sampling of behavior in various situations
• Evaluation of the parents’ or caregiver’s styles and abilities
• Questions about the home and living conditions of the child since birth
• Details about the child’s behavioral pattern overtime

Treatment For RAD

It is believed that children with attachment problems or bipolar disorder can form a healthy and secure attachment, but their past experiences hindered their ability to do so. Children who have not enjoyed bonding in their early years may have a hard time accepting love and care, but with time, consistent efforts, and repetition, they can learn to trust again and accept love.

While there is no quick fix for reactive attachment disorder, early intervention is key. Reactive attachment disorder treatment usually involves a combination of therapy, parental education, and counseling to help the child have a loving and safe living environment/condition, develop a healthy relationship and positive interactions with caregivers and improve peer relationships. This treatment, most of the time, involves both the child and the parents or caregivers. Some of the treatment strategies for reactive attachment disorder include:

• Individual psychological counseling: Psychologists or therapists may have a session with the child alone- or while the parents are observing- to sample or monitor the child’s emotions and behavioral patterns.
• Family therapy: Most times, attachment problems are carried out on both the child and the caregiver or parent. These therapy sessions mostly involve fun activities to enhance a secure attachment bond and help caregivers and other family members understand the symptoms of reactive attachment disorder and provide effective interventions and lasting solutions to attachment problems.
• Play therapy: This allows the child and the caregiver to express their feelings, needs, fears, and thoughts in the safe confines of play and is geared towards helping the child to learn the appropriate skills needed to build healthy interactions with peers and handling social situations.
• Parenting skills training: This is done to educate parents and caregivers on attachment disorders and teach the needed parenting skills.

Other Strategies Include:

• Deliberately providing a loving, positive, and interactive environment for the child.
• Identifying and encouraging actions that feel good to your child, which they may have missed out on in earlier years
• Provide warm, loving, and nurturing interactions with your child, like during feeding, bathing, etc.
• Helping the child to identify emotions and express their needs
• Showing genuine love and care always give reassuring and encouraging words.
• Appropriately addressing and taking care of the child’s safety, housing, and medical needs.
• Encouraging stable and secure attachments for the child by providing consistent caregivers can help solve attachment problems.

Final Thoughts

Regardless of the stage of reactive attachment disorder your child may currently be going through- even if the disorder has gone beyond early childhood- or how exhausting or frustrating it may have been for you, attachment problems can be treated. With the help of verified pediatric psychiatrists or psychologists like the ones at ReGain, you can learn how to boost childhood attachment, repair existing reactive attachment or disinhibited social engagement disorder, and help your family develop a healthy and loving relationship.