Reactive Attachment Disorder Basics

A child with reactive attachment disorder (RAD) has been subject to neglect or abuse and fails to establish the expected bond with his primary caregivers, resulting in irritability, sadness, fearfulness and difficulty interacting with adults or peers. This guide will help parents understand how to spot reactive attachment disorder, and how it's diagnosed and treated.

RAD: What Is It?

It is healthy and expected for a child to become attached to his primary caregivers, those he looks to for nurturing and soothing. Reactive attachment disorder (RAD) is a rare condition that occurs when infants and young children who are subject to extreme neglect or abuse fail to establish that expected bond. A child with RAD, which is diagnosed from 9 months to 5 years of age, rarely seeks or responds to comfort when distressed, shows limited positive affect, and has unexplained episodes of irritability, sadness or fearfulness in contact with caregivers.


RAD: What to Look For

Signs of RAD in infants and toddlers include a withdrawn appearance, a failure to smile, and a failure to react when parents or caregivers attempt to interact with them. For instance, a child with the disorder may not reach out when picked up or respond to a game of peekaboo. He may seem unaffected by the movements of others, and uninterested in watching others as they move about a room. Instead of seeking nurturing from a parent or caregiver, these children will attempt to nurture and soothe themselves. When distressed, they may calm down more quickly without the attention of an adult.

RAD: Risk Factors

A child who has experienced abusive, neglectful or otherwise problematic care is at risk for reactive attachment disorder. That said, the great majority of children who have been abused or neglected or who have been bounced around among multiple caretakers do not develop the disorder.

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RAD: Diagnosis

To be diagnosed with reactive attachment disorder a child must have a pattern of inhibited or withdrawn behavior towards caregivers, characterized by rarely or minimally turning to caregivers for comfort when distressed or responding to comfort when offered. The child must have experienced neglect or abuse in which the child’s early caregivers failed to meet his physical or emotional needs, or repeated changes in caregivers that severely limited opportunities for the child to form selective attachments.

To be diagnosed with RAD. the child must not meet the criteria for autism spectrum disorder, and must be between 9 months and 5 years old.

RAD: Treatment

Treatment for reactive attachment disorder usually involves both the child who has been diagnosed and his current caregivers. Treatment may include psychotherapy for the child, family therapy, parenting training, and special education services. Because RAD can be a painful and confusing experience for a child’s caregiver, psychotherapy or counseling may be advisable for parents, too.

RAD: Risk For Other Disorders

Children who have experienced neglect in care-giving may also experience developmental delays and delays in physical growth. Older children may be at risk for eating disorders, anger management problems, depression, anxiety, difficulties in school, and drug and alcohol abuse.