Reactive Attachment Disorder
Reactive attachment disorder (RAD) is a rare condition of emotional dysfunction in which a baby or child has difficulty forming a bond with parents or caregivers due to early neglect or mistreatment. The symptoms of reactive attachment disorder can mimic other conditions; it is important to have the affected child evaluated by a health professional for proper diagnosis and treatment. Without treatment, the condition may persist for years.
Children with Reactive Attachment Disorder, as defined by the DSM-5, exhibit:
- A consistent pattern of inhibited and emotionally withdrawn behavior toward caregivers; only occasional or minimal signs of seeking or responding to comfort when distressed
- At least two of the following:
- Minimal social and emotional responsiveness to others
- Limited positive affect
- Unexplained instances of irritability, sadness, or fear
- A past experience of extremely insufficient care, involving at least one of the following:
- Social neglect or deprivation, with basic needs for comfort, stimulation, and affection unmet
- Repeated change of primary caregivers that limits opportunities to form a stable attachment with a caregiver
- Growing up in an environment that seriously limits opportunities to form a stable attachment with a caregiver
For a child diagnosed with RAD, the experience of insufficient care is believed to account for the subsequent inhibited behavior toward caregivers. A child who receives this diagnosis should be at least 9 months of age, and the symptoms should be apparent before age 5. The child must not meet the criteria for Autism Spectrum Disorder.
What are the symptoms of reactive attachment disorder in adults?
Adults with reactive attachment disorder are withdrawn and detached. They do not show affection and have difficulties forming and maintaining meaningful relationships. They are also sometimes angry and impulsive.
Infants and children whose basic physical and emotional needs are neglected may learn not to expect normal caregiving and comfort. The risk of developing RAD is higher than average in babies and children who have a mother with postpartum depression, live in orphanages and other institutions, live in multiple foster-care situations, are separated from parents for an extended period, or have neglectful parents or caregivers.
Is disinhibited social engagement disorder related to reactive attachment disorder?
Disinhibited social engagement disorder is another type of attachment disorder, albeit of a different nature. Children who do not fear strangers may have this condition. These children are extremely friendly and will approach people they do not know without any doubts. They may even go so far as hugging an unfamiliar person. This can be a safety concern for parents and guardians.
Is reactive attachment disorder on the autism spectrum?
No. While children with autism have social difficulties and poor communication skills, autism is not related to reactive attachment disorder. However, the symptoms do sometimes overlap. Both reactive attachment disorder and the autism spectrum are associated with difficulties in relating to other people.
Symptoms of RAD may lessen or disappear completely when a child is moved to a consistently supportive and caring family environment or to caregivers who are emotionally available to respond to the child’s needs. Since children with RAD often have multiple difficulties, therapy and medical treatment may be advised to treat co-existing conditions. In some cases, attachment-based family therapy administered by a licensed, experienced therapist can help children and adults heal damaged family relationships and strengthen the parent-child bond. Medication may be considered when psychotherapy alone is not effective.
How do you discipline a child with reactive attachment disorder?
A child with reactive attachment disorder will not respond to lecturing or a focus on their unruly behavior. If the child, for example, is lying, then talk about lying in general and why people should not engage in it. A parent also needs to have defined limits and boundaries, a lot of patience, and realistic expectations.
How do you teach a child with reactive attachment disorder?
The child with reactive attachment disorder wants control over their environment; they want to make their own decisions and they rely on themselves. The teacher needs to be in control of the classroom, and this boundary must be made clear. However, admonishing the child in front of others is not a good strategy, a one-on-one discussion would be more helpful.
What is attachment therapy?
Therapy for reactive attachment should not be confused with attachment therapy, which is unconventional, unproven, and potentially harmful. This type of questionable treatment involves physical manipulation, restraint, deprivation, “boot camp-type” activities, and physical discomfort.