What Is Reactive Attachment Disorder

What is reactive
attachment disorder?
● About RAD
● In children
● In adolescents and adults
● Complications
● Diagnosis
● When to see a doctor
● Summary
Reactive attachment disorder (RAD) is a

psychiatric condition wherein people have
difficulty forming attachments with others. It is
usually the result of early childhood trauma.
This article discusses what RAD is and how it may present in children,
adolescents, and adults. It also provides information on when to see a doctor.
About RAD

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RAD is a rare condition in which a child or adolescent experiences difficulties

forming attachments with others. According to the D
iagnostic and Statistical
Manual 5th Edition (DSM-5), RAD is t he result of experiencing neglect or abuse
during early childhood.
RAD can develop in children who do not form a predictable and nurturing bond
with a trusted parent or caregiver. This may happen as a result of:
● growing up in an overcrowded orphanage

● frequently changing foster homes
● having a parent or caregiver who has mental or physical health issues
● being taken away from a primary caregiver after establishing a bond
with them
● experiencing long periods of hospitalization
Being unable to form early emotional bonds can cause a child to stop
engaging with others emotionally and to develop behavioral problems.
RAD tends to develop in early childhood and typically affects children and
adolescents. However, the symptoms may also extend into adulthood for
some people.
RAD in children
A child can develop RAD following early life trauma that prevents them from
forming any consistent emotional bonds with others.
Some children may develop RAD as a result of early neglect, such as being left
crying, wet, or hungry for hours and having no one to interact with. Others may
develop RAD following emotional or physical abuse.
Neglect or abuse can cause feelings of isolation, abandonment, and fear.

Children who develop RAD tend to stop trying to form consistent emotional
bonds with others.
This can extend into adolescence and adulthood. For example, some people
may have difficulty trusting others and forming close personal relationships.
Signs and symptoms
Children with RAD may display some or all of the following s

igns and
symptoms:
● rarely seeking comfort when distressed

● not responding to comfort when distressed
● minimal emotional or social responses, such as avoiding eye contact
and not smiling
● persistent low mood and crying
● unexplained episodes of irritability, anxiety, or fearfulness
● a lack of interest in interacting or playing with others
● a lack of social skills
● cognitive problems
● hyperactivity
● repetitive movements, such as rocking back and forth or hand flapping
These symptoms must occur before the age of 5 years in order for the child to
receive a diagnosis of RAD.
Patterns
When children with RAD grow a little older, their symptoms usually fall into
one of two general patterns: inhibited RAD symptoms or disinhibited RAD
symptoms.
The following sections will discuss these in more detail.
Inhibited RAD symptoms
With this pattern, children are usually aware of what happens around them,
but they do not respond typically to outside stimuli.
Children showing inhibited RAD symptoms are often withdrawn and

emotionally unresponsive. They may not show or seek affection from
caregivers or others, instead preferring to keep to themselves.
Disinhibited RAD symptoms
With this pattern, children may be overly friendly toward strangers. Also, they
may not prefer their primary caregiver(s) over other people.
In most cases, these children act younger than their age and may seek
affection from others in a potentially unsafe way.
Treatments
Children who develop RAD can experience severe emotional and behavioral
issues. However, the condition is treatable.
Treatment will begin with diagnosing RAD and determining the possible
causes.
RAD treatment t ypically involves the child and their current caregiver(s). A
child may receive psychotherapy and special education services, while
caregivers may receive parental training or education so that they can provide
better support to the child.
Caregivers of children with RAD must be patient, remain positive, and have
realistic expectations about what is achievable. It is also important that
caregivers take care of their own mental and physical health and seek support
from others where necessary.
RAD in adolescents and adults

Without treatment, a child who develops RAD may continue to experience
issues throughout adolescence and adulthood. These issues may include:
● avoidance of physical contact

● difficulty displaying affection or care for others
● a lack of empathy
● poor social skills
● difficulty forming stable relationships with others
● cognitive problems, such as poor memory or problem solving skills
● anger problems
● control issues
● academic or workplace problems
● engaging in risky behaviors, such as substance abuse
● mental health problems, such as depression or a
nxiety
Treatments
Treatment for RAD in adolescents involves therapy for both the adolescent
and their caregiver(s). This therapeutic approach may also consist of
individual therapy with the adolescent to discuss their issues and help them
understand the consequences of their behaviors.
Adults may also benefit from therapy to build better relationships and to
address other areas of their life that RAD may affect.
Adolescents and adults may also receive treatment for related mental health
issues, such as depression or anxiety.
Complications
RAD can cause complications in children, adolescents, and adults.
Children with RAD may be at increased risk of developmental delays and

delayed growth.
Older children and adolescents may be at increased risk of:
● anger management issues

● difficulties in school
● depression
● anxiety
● eating disorders
● drug and alcohol abuse
If a person does not receive treatment for RAD during childhood or
adolescence, the above complications may occur.
Diagnosis
A doctor or therapist will diagnose RAD according to the D
SM-5 g
uidelines.
These g
uidelines state that a child must meet the following criteria in order to
receive a diagnosis of RAD:
● a consistent pattern of emotionally withdrawn behavior toward a parent

or caregiver, as evidenced by the child rarely seeking or responding to
comfort when distressed
● a consistent emotional or social disturbance, as characterized by at
least two of the following behaviors:
○ minimal social and emotional responsiveness to other people
○ limited displays of positive emotion
○ episodes of unexplained irritability, sadness, or fearfulness, even
during nonthreatening interactions with adult caregivers
● a traumatic experience that consists of one or more of the following:
○ social neglect or deprivation
○ repeated changes to the child’s primary caregiver
○ rearing in settings that severely limit the child’s ability to form
selective attachments
● not meeting the diagnostic criteria for an autism spectrum disorder
● experiencing signs of RAD before the age of 5 years
● having a developmental age of at least 9 months
Some of the signs and symptoms of RAD overlap with those of other
conditions, such as intellectual disabilities or attention deficit disorders. A
doctor will want to rule out these conditions before diagnosing RAD.
When to see a doctor

Most children will experience some symptoms of RAD occasionally. For
example, children may have unexplained episodes of irritability or anxiety, or
they may show an occasional lack of interest in playing with others. Such
feelings and behaviors do not necessarily indicate that a child has RAD.
However, a parent or caregiver should seek professional treatment for a child

who shows a consistent pattern of RAD signs and symptoms.
Summary
RAD is a rare condition in which a child has difficulty forming attachments
with caregivers or other people in their life. The condition tends to develop as
a result of early trauma, such as neglect or abuse.
Without treatment, RAD can continue into adolescence and adulthood. Older
individuals may have difficulties forming and maintaining close friendships
and romantic relationships. They may also experience related mental health
issues, such as anxiety or depression.
Treatment for RAD is available at all ages, though early intervention may help
reduce the risk of complications. The treatment will vary according to a
person’s life stage, but it typically involves some kind of talking therapy.
If a parent or caregiver is concerned that their child may have RAD, they
should take them to see a doctor.

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What is reactive

● In adolescents and adults

● When to see a doctor

Reactive attachment disorder (RAD) is a

Cavan Images/Getty Images

RAD is a ​rare condition​ in which a child or adolescent experiences difficulties

● growing up in an overcrowded orphanage

Neglect or abuse can cause feelings of isolation, abandonment, and fear.

Signs and symptoms

Children with RAD may display some or all of the following s

● rarely seeking comfort when distressed

The following sections will discuss these in more detail.

Inhibited RAD symptoms

Children showing inhibited RAD symptoms are often withdrawn and

RAD in adolescents and adults

● avoidance of physical contact

Children with RAD may be at increased risk of developmental delays and

Older children and adolescents may be at increased risk of:

● anger management issues

● a consistent pattern of emotionally withdrawn behavior toward a parent

When to see a doctor

However, a parent or caregiver should seek professional treatment for a child

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RAD is a rare condition in which a child or adolescent experiences difficulties