What is reactive attachment disorder (RAD)?
Reactive attachment disorder (RAD) occurs when an infant or young child fails to establish a secure, healthy relationship with his or her primary caregivers (parents). The emotions of children with RAD are usually difficult to control. They have trouble connecting with others.
A child with RAD is unlikely to seek comfort from his or her caregivers and may come across as being almost terrified, even when the current caretakers seem to love and care for him or her. Frequently, these children feel alone or unsafe and are irritable or sad. Who is likely to suffer from reactive attachment disorder (RAD)?
Most children with reactive attachment disorder were neglected or abused during their first nine months or first five years of life. Older children can be diagnosed with RAD, but it is less common because RAD can be misdiagnosed as another behavioral or emotional problem.
There is a greater chance of RAD developing in children who:
- Having lived in an orphanage or fostered by various providers
- Having formed a healthy bond with their primary caregivers, they were taken away
- Have been the victim of multiple traumatic losses early in life
Read: Attention Deficit Hyperactivity Disorder (ADHD)
How does reactive attachment disorder affect people?
It is most prevalent in children who have been neglected or abused physically or emotionally. RAD can also develop in older children, though it is less common. There are several factors that may increase a child’s risk of developing RAD:
- Having multiple foster care situations, such as several different parents.
- Having bonded with their primary caregivers emotionally, they were taken away from them.
- Loses that occurred early in life were traumatic.
- Don’t have emotional closeness to their parental figures.
- Lacking a loving parental figure, like in an orphanage.
Some parents might find it difficult to bond with their adopted children, especially if the child is emotionally unstable if they don’t know the child’s history. New parents should see their child’s healthcare provider if their child is showing symptoms of RAD.
How common is reactive attachment disorder?
Reactive attachment disorder can affect up to 1% to 2% of children, but the exact rate of occurrence is unknown since many cases are not reported. A child who is removed from his or her home and placed in another setting, such as foster care, has a higher risk of developing RAD. Relationships are difficult to develop for almost half of these children.
What causes reactive attachment disorder (RAD)?
Researchers believe RAD is caused by the lack of a consistent and adequate level of love and care. The lack of adequate care can cause a child to feel abandoned, alone, and uncared for – all of which can hinder the development of an emotional connection between the child and his or her primary caregivers.
It is crucial to consistently make sure a child’s basics are met in order to develop a relationship of trust with caregivers. Following are a few examples of situations where a child is more likely to develop RAD if caretaker actions are inappropriate and ongoing:
- Soiled diapers have not changed for several hours.
- Having been hungry for hours without being fed.
- A crying baby who does not receive attention or comfort when they are in distress.
- A baby is left alone for long periods of time without being touched, talked to, or interacted with.
- Occasionally meets the needs of an infant (the caregiving isn’t consistent).
- The child only attracts caretakers’ attention when he or she is acting up or disrupting.
- A baby or young child whose care has been provided by multiple primary caregivers (especially when it was inconsistent and/or from someone unfamiliar).
- Often, the child has been abused or neglected by their primary caregivers or by others.
Read: Emotional Disorders
What are the symptoms of reactive attachment disorder (RAD)?
Each child has different symptoms of reactive attachment disorder. The common signs of RAD in infants and young children are:
- Failing to show a normal range of emotions in conversation, or failure to show feelings of regret, remorse or guilt
- Do not make eye contact with caregivers and avoid touching them
- Expressing tantrums, anger, and being irritable, sad and unhappy; too much disobedience, complaining and arguing (over and above what is “usual” for the child’s age and circumstances)
- Exhibiting inappropriate affection towards strangers while not showing affection toward or fear of their primary caregivers.
A child with RAD usually has one of two typical symptoms as they grow up:
- Inhibited RAD symptoms: The child is aware of what is going on around him but does not respond typically to external stimuli. When RAD symptoms are inhibited, children become emotionally withdrawn. Caretakers and others may not show affection to them, and they may keep largely to themselves.
- Disinhibited RAD symptoms: Strangers may feel overly welcomed by children. A child with disinhibited RAD symptoms does not prefer their primary caregivers to others. Many of these children behave younger than their actual age and may provide affection in an unsafe manner.
Check: Psychological Disorders
How is reactive attachment disorder (RAD) diagnosed?
During the diagnosis of reactive attachment disorder, your child’s doctor will ask you about patterns of behavior that suggest withdrawal from primary caregivers. When building an accurate diagnosis, it is important to have information about your child’s past, including any history of abuse or neglect.
Children need to be between the ages of 9 months and 5 years (or at least to display specific patterns of behavior characterized by RAD during this time period) in order to be diagnosed formally with RAD. Occasionally, the diagnosis will be first discussed in somewhat older children, even when they were never diagnosed with it.
Children with RAD will have their atypical functioning ruled out before being diagnosed with autism spectrum disorder (ASD). Autism spectrum disorder affects the behavior and communication of an individual and can come to appear quite similar to RAD. The early onset of autism spectrum disorder does not result from abuse or neglect.
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How is reactive attachment disorder (RAD) treated?
It is important to repair and/or establish emotionally healthy family bonds when treating reactive attachment disorder. The reactive attachment disorder (RAD) treatment aims to strengthen the bond between children and their caregivers in a way that will later assist the development of other healthy relationships
A tailored treatment plan benefits both children and parents. The following may be included in treatment:
- Psychotherapy/Counseling: A mental health provider assists children and their parents in many different ways, either one-on-one or jointly, often to build skills and reduce problematic behaviors.
- Family therapy: The goal of this therapy is to help the primary caregivers and the child learn to interact in a healthy way.
- Social Skills Intervention: The goal of this therapy is to teach the child how to interact appropriately in typical social settings with other children of the same age group. Usually, parents are also involved in helping their children learn the skills.
- Special education: Children who qualify can participate in these school-based programs that help them develop skills for academic success and social development.
- Parenting skills classes: Parental sessions may teach parents how to manage their child’s challenges more effectively. In particular, it can be helpful if your child has RAD since managing discipline can be challenging.
Related: 12 Simple Ways to Reduce Stress
When will my child have healthy relationships after treatment?
The symptoms of RAD could persist into adulthood, affecting the functions of children in society. Your child will receive long-term emotional support as part of the treatment. There is a possibility that it could last a lifetime. The best outcome is achieved when the child is treated with support from their caregivers, but there is no timeline for how long it will take for them to develop healthy relationships.
What can I do to help my child develop healthy relationships?
As their caretaker, you can help your child develop healthy bonds by:
- Limiting yourself: It is very important to set limits for all children to live in an environment with a consistent pattern. Children learn what to expect from their parents when they have reasonable limits and use appropriate non-physical discipline. Kids become less afraid and behave appropriately as a result.
- Staying calm despite your child’s actions: Do not respond to your child if you are angry when he is acting inappropriately. Establish and enforce rules that your child knows in order to discipline the child. Give your child your love and attention as soon as they settle down and are ready for positive contact. Even in challenging times, a child can count on you for support.
- Providing consistent attention and love: Make time for one-on-one interaction with your child. Engage them in conversation or singing. Get them involved in your play. Children who are more open to this type of affection will be rocked, held, or shown other signs of caregiver affection and love. It is never acceptable to punish someone with love and affection.
Complications of reactive attachment disorder (RAD)
A child with RAD who experiences neglect, abuse, and other forms of neglect has a higher risk for complications in adolescence and later in life. Some of these complications are:
- Developmental delays
- Physical development delays (related to eating difficulties)
- Anger management, depression, anxiety and other emotional problems
- Eating disorders
- Abuse and dependency on alcohol and drugs
- School-related problems (learning or behavioral)
- Relationship problems with peers, adults or partners (possibly later on)
Also check: Stress Management Techniques
How can reactive attachment disorder (RAD) be prevented?
A healthy bond between the child and their primary caregiver is the most effective means of preventing reactive attachment disorder. Caregivers form strong bonds when:
- Maintain a secure and consistent relationship with your family to promote family bonding
- Provide children with a sense of security and love
- Supporting children through their developmental phases
Healthy bonds can be developed by a number of specific actions:
Setting limits is very important for children with RAD since they need control and to live in a predictable environment. Children will know when they break rules if limits are not consistently set.
Keeping your cool even when your child acts up
Do not react if you are overly emotional when your child is acting inappropriately. Set clear rules and follow them with your child. Love and care should be shown the moment the child settles down and can engage in positive contact. It lets them know that even during difficult times, you will still be there for them.
Consistently showing love and attention
Face-to-face time is essential. Sing or talk to them. Have fun with them. Show affection and love by rocking or holding them or showing other signs of care and affection, recognizing that some children are more receptive to this type of affection than others. No one should be punished by withholding affection and love.
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The prognosis (outlook) of reactive attachment disorder (RAD)
When a child is treated for reactive attachment disorder, they often form stable, healthy relationships with their primary caretakers and others, providing a model for forming later important relationships.
Without treatment, children may face ongoing emotional challenges. Treatment for mental health and developmental problems, including RAD, is never too late.
Keep these points in mind
- Several children adopted from foster homes or orphanages go on to live healthy and flourishing lives; not all such youth suffer from RAD. The resilience of children is amazing!
- In addition to significant trauma, children with significant past trauma may also experience other risk factors for mental health or behavioral difficulties, such as drug exposure or alcohol consumption during prenatal development, or a family history of emotional difficulties, which can contribute to RAD or other difficulties.
Read: What is Perinatal Depression
How soon should I contact my doctor?
You should consult your child’s doctor if you observe any symptoms of reactive attachment disorder. A successful outcome for children with this condition is more likely if they receive early diagnosis and treatment.