Definition

What is reactive attachment disorder?

Reactive attachment disorder (RAD) is a condition found in children who may have received grossly negligent care and do not form a healthy emotional attachment with their primary caregivers — usually their mothers — before age 5.

Attachment develops when a child is repeatedly soothed, comforted, and cared for, and when the caregiver consistently meets the child’s needs. It is through attachment with a loving and protective caregiver that a young child learns to love and trust others, to become aware of others’ feelings and needs, to regulate his or her emotions, and to develop healthy relationships and a positive self-image. The absence of emotional warmth during the first few years of life can negatively affect a child’s entire future.

How common is reactive attachment disorder?

It is difficult to know exactly how many children have RAD, since many families affected by the disorder never seek help. However, it is generally believed that RAD is uncommon. Please discuss with your doctor for further information.

Symptoms

What are the symptoms of reactive attachment disorder?

The common symptoms of reactive attachment disorder are:

  • Unexplained withdrawal, fear, sadness or irritability
  • Sad and listless appearance
  • Not seeking comfort or showing no response when comfort is given
  • Failure to smile
  • Watching others closely but not engaging in social interaction
  • Failing to ask for support or assistance
  • Failure to reach out when picked up
  • No interest in playing peekaboo or other interactive games

There may be some symptoms not listed above. If you have any concerns about a symptom, please consult your doctor.

When should I see my doctor?

Consider getting an evaluation if your child shows any of the signs above. Signs can occur in children who don’t have reactive attachment disorder or who have another disorder, such as autism spectrum disorder. It’s important to have your child evaluated by a pediatric psychiatrist or psychologist who can determine whether such behaviors indicate a more serious problem.

Causes

What causes reactive attachment disorder?

To feel safe and develop trust, infants and young children need a stable, caring environment. Their basic emotional and physical needs must be consistently met. For instance, when a baby cries, the need for a meal or a diaper change must be met with a shared emotional exchange that may include eye contact, smiling and caressing.

A child whose needs are ignored or met with a lack of emotional response from caregivers does not come to expect care or comfort or form a stable attachment to caregivers.

It’s not clear why some babies and children develop reactive attachment disorder and others don’t. Various theories about reactive attachment disorder and its causes exist, and more research is needed to develop a better understanding and improve diagnosis and treatment options.

Risk factors

What increases my risk for reactive attachment disorder?

There are many risk factors for reactive attachment disorder, such as:

  • Live in a children’s home or other institution
  • Frequently change foster homes or caregivers
  • Have parents who have severe mental health problems, criminal behavior or substance abuse that impairs their parenting
  • Have prolonged separation from parents or other caregivers due to hospitalization

However, most children who are severely neglected don’t develop reactive attachment disorder.

Diagnosis & treatment

The information provided is not a substitute for any medical advice. ALWAYS consult with your doctor for more information.

How is reactive attachment disorder diagnosed?

As with adults, mental disorders in children are diagnosed based on signs and symptoms that suggest a particular condition. If physical symptoms are present, the doctor may perform a complete medical history and physical exam, including a review of developmental milestones. Although there are no lab tests to specifically diagnose RAD, the doctor may sometimes use various tests, such as neuroimaging studies or blood tests, if there are concerns that a physical illness or medication side effects might be causing the symptoms.

If the doctor cannot find a physical cause for the symptoms, he or she will likely refer the child to a child and adolescent psychiatrist or psychologist, mental health professionals who are specially trained to diagnose and treat mental illnesses in children and teens. Psychiatrists and psychologists use specially designed interview and assessment tools to evaluate a child for a mental disorder. The doctor bases his or her diagnosis on reports of the child’s symptoms, and his or her observation of the child’s attitude and behavior.

How is reactive attachment disorder treated?

Treatment of RAD has two important goals. The first is to ensure that the child is in a safe environment. This is especially important in cases where the child has been abused or neglected. The second goal is to help the child develop a healthy relationship with an appropriate caregiver.

Treatment for RAD often focuses on the caregiver. Counseling may be used to address the issues that are affecting the caregiver’s relationship with and behavior toward the child. Teaching parenting skills also can help improve the relationship with the child and help develop attachment. Treatment may also include play therapy. This technique allows the child and the caregiver to express their thoughts, fears, and needs in the safe context of play.

There is no medication to treat RAD itself. However, the doctor may sometimes use a medication as an adjunct to treatment to help manage severe behavioral symptoms, such as explosive anger or problems sleeping.

The use of so-called holding therapies and/or “rebirthing” techniques is controversial. There is no scientific evidence to support the effectiveness of such interventions.

Lifestyle changes & home remedies

What are some lifestyle changes or home remedies that can help me manage reactive attachment disorder?

The following lifestyles and home remedies might help you cope with reactive attachment disorder:

  • Educate yourself and your family about reactive attachment disorder. Ask your pediatrician about resources or check trusted internet sites. If your child has a background that includes institutions or foster care, consider checking with relevant social service agencies for educational materials and resources.
  • Find someone who can give you a break from time to time. It can be exhausting caring for a child with reactive attachment disorder. You’ll begin to burn out if you don’t periodically have downtime. But avoid using multiple caregivers. Choose a caregiver who is nurturing and familiar with reactive attachment disorder or educate the caregiver about the disorder.
  • Practice stress management skills. For example, learning and practicing yoga or meditation may help you relax and not get overwhelmed.
  • Make time for yourself. Develop or maintain your hobbies, social engagements and exercise routine.
  • Acknowledge it’s OK to feel frustrated or angry at times. The strong feelings you may have about your child are natural. But if needed, seek professional help.

If you have any questions, please consult with your doctor to better understand the best solution for you.

Hello Health Group does not provide medical advice, diagnosis or treatment.

Review Date: July 31, 2017 | Last Modified: July 31, 2017

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