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What is reactive attachment disorder?

Children with reactive attachment disorder (RAD) do not form the important bond that usually develops between a child and their caregivers. Children with reactive attachment disorder seem sad, fearful or irritable and have a hard time interacting with others. When they are upset, they are not comforted by adults’ attempts to make them feel better. Reactive attachment disorder can happen to young children who have been extremely neglected or abused.  

Reactive attachment disorder is rare. It is only diagnosed in children between the ages of nine months and five years.  

What are the symptoms of reactive attachment disorder?

Signs that a child might have reactive attachment disorder include: 

  • Not smiling 
  • Being irritable for no reason 
  • Seeming sad and fearful, especially around caregivers 
  • Not feeling better when an adult tries to comfort them 
  • Calming down more easily when left alone 
  • Not showing interest in or looking at other people around them 
  • Not reacting when picked up by an adult 
  • Not laughing or playing interactive games like peek-a-boo 

How is reactive attachment disorder diagnosed?

Children are only diagnosed with reactive attachment disorder between the ages of nine months and five years. A doctor will make sure that the child does not have autism before diagnosing reactive attachment disorder, since the two disorders have some of the same symptoms. 
To be diagnosed, the child must be seem sad or fearful and not respond when their caregiver tries to make them feel better. The child must also have experienced serious abuse or neglect, or multiple changes in caregivers at a young age. 

It’s important to note that not all children who experience abuse or neglect develop reactive attachment disorder. 

How is reactive attachment disorder treated?

Because kids with RAD are so young, therapy involves both the child and the parents or main caregivers. It usually combines a few different therapies, including: 

  • Individual psychotherapy for the child and sometimes for the parents too 
  • Family therapy for the child, siblings and parents  
  • Parenting training to teach parents how to help their child bond with them 

Special education services can also help kids with RAD. 

Risk for other disorders

Young children who have been neglected or abused may also have developmental delays and delays in their physical growth. Older children may be at risk for disorders including eating disorders, anger issues, depression, anxiety, problems in school and drug and alcohol abuse. 

This guide was last reviewed or updated on December 12, 2023.