Reactive Attachment Disorder in Children

What Is Reactive Attachment Disorder?

Reactive attachment disorder (RAD) is an uncommon but serious condition that prevents babies and children from forming a healthy bond with their primary parents. Children with RAD have often been neglected physically and emotionally, orphaned early in life, or abused. RAD develops when a child’s most basic needs for nurturing, affection, and comfort have not been met. This stops them from forming healthy relationships with others.

RAD can take two forms, either causing the child to avoid relationships or to be overly friendly.

This condition can have negative effects on a child’s development and may stop him or her from forming future relationships. Although RAD is a lasting condition, with treatment and support, children are eventually able to develop healthy and stable relationships with others.

What Causes RAD?

RAD occurs when a child’s parent neglects the child’s needs for:

  • food
  • human contact
  • emotional connection
  • physical safety

The risk of parental neglect increases when:

  • the main parent is mentally or emotionally challenged
  • the parents lack appropriate parenting skills
  • the parents are teenagers
  • the parents are socially isolated
  • the parents change frequently, as is the case in foster care

Children who are adopted at an early age from overseas orphanages are also at a greater risk of being affected by RAD.

What Are the Symptoms of RAD?

According the Mayo Clinic, symptoms of RAD will appear before the age of five, often when the child is still an infant (MC). Symptoms in infants may be more difficult to discern than in older children. Signs of RAD in infants may include listlessness and withdrawal, no interest in toys or games, and not reaching out to be picked up.

Older children will show more noticeable signs of withdrawal from others. They may appear awkward in social situations and may avoid comforting words or actions from others. Feelings of anger may be hidden or may be openly displayed as aggressive outbursts toward their peers. If the disorder continues into the teen years, it may lead to drug or alcohol abuse.

As children with RAD grow older, they may develop either disinhibited or inhibited behavior. Some children develop both.

Disinhibited Behavior

Signs of this type of behavior include:

  • attention seeking from everyone, even strangers
  • frequent requests for help
  • childish behavior
  • anxiety

Inhibited Behavior

Signs of this type of behavior include:

  • avoidance of relationships
  • refusal of help

How Is RAD Diagnosed?

In order to make a diagnosis of RAD, a doctor must determine that the infant or child meets the criteria outlined by the American Psychiatric Association.

The criteria for RAD include:

  • inappropriate social relationships before the age of five years, which are not caused by delays in development
  • either being inappropriately social with strangers or unable to respond to interaction with others
  • failure of primary parents to meet the child’s physical and emotional needs

A detailed psychiatric evaluation of the child will also be required. This may include:

  • observation and analysis of the child with the parent
  • details and analysis of the child’s behavior in different situations
  • examination of the child’s behavior over a period of time
  • gathering of information about the child’s behavior from other sources, such as extended family or teachers
  • details of the child’s life history
  • assessment of parents experience and daily routines with the child

The doctor will also need to be sure that the child’s behavioral problems are not due to another behavioral or mental condition. The symptoms of RAD may sometimes resemble those of the following disorders:

  • attention-deficit hyperactivity disorder (ADHD)
  • social phobia
  • anxiety
  • post-traumatic stress disorder
  • autism

What Are the Treatments for RAD?

After a psychiatric evaluation, the doctor will develop a treatment plan that is suitable for both child and parent. The most important part of the treatment is to ensure that the child is in a safe and nurturing environment.

Once this has been addressed, the next stage is to improve the relationship between the parent and child. This may be done with a series of parenting classes designed to increase parenting skills, combined with family counseling to help improve the bond between parent and child. The bonding process will be facilitated by gradually increasing comforting physical contact between the parent and child.

Special education services may help if the child is having difficulty in school.

In some cases, medications, such as selective serotonin reuptake inhibitors (SSRIs), may be prescribed if the child is suffering from anxiety or depression. Examples of SSRI medications include fluoxetine (Prozac) and sertraline (Zoloft). According to the National Institute of Mental Health, fluoxetine (Prozac) is the only FDA-approved SSRI medication for children ages eight and older (NIMH).

Children taking these types of medications should be closely monitored for signs of suicidal thoughts or behavior. This is a potential, but uncommon, side effect. In an FDA review published in a 2007 issue of the Journal of the American Medical Association, four percent of 2,200 children being treated with SSRIs experienced suicidal thoughts or behavior (NIMH).

What Is the Long-Term Outlook for RAD?

The outlook for a child with RAD is good if the child receives the appropriate treatment as soon as possible. Although there have been few long-term studies of this disorder, doctors know that if RAD is not treated, it may lead to other behavioral problems in later life (Zeanah & Fox, 2004). These problems range from extreme controlling behavior to self-harm.

What Complications Are Associated with RAD?

If RAD is not appropriately treated as soon as possible, the child may develop other, related conditions, such as:

  • depression
  • anxiety
  • post-traumatic stress disorder (PTSD)

How Can I Prevent RAD in My Child?

RAD can be avoided by attending to your child’s physical and emotional needs appropriately. This is especially important if you are adopting a very young child, particularly if the child has spent a period of time in foster care. The risk of RAD is higher in children whose caregivers have changed often.

It may be helpful to talk with other parents, seek counseling, or attend parenting classes. There are plenty of books written about RAD and healthy parenting that may also be of help.