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.
RAD is a rare condition in which a child or adolescent experiences difficulties forming attachments with others. According to the Diagnostic and Statistical Manual 5th Edition (DSM-5), RAD is the 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.
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 signs 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
- 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.
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.
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 typically 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.
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 anxiety
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.
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
- eating disorders
- drug and alcohol abuse
If a person does not receive treatment for RAD during childhood or adolescence, the above complications may occur.
A doctor or therapist will diagnose RAD according to the DSM-5 guidelines. These guidelines 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.
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.
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.