What Is Reactive Attachment Disorder (RAD)?

Some neglected children develop serious emotional problems

Portrait of a young mother stressed out by her son
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Reactive Attachment Disorder (RAD) is a rare but serious mental health disorder in which a child is unable to form healthy social relationships, particularly with a primary caregiver. Often children with RAD will seem charming and helpless to outsiders, while waging a campaign of terror within the family. RAD is frequently seen in children who have had inconsistent or abusive care in early childhood, including children adopted from orphanages or foster care.

Some of the risk factors which may lead to RAD include:

While all of the challenging situations described above are fairly common, however, RAD is quite rare. Even children who are severely neglected or who grow up in institutional setting are likely to develop normal emotional attachments when the opportunity arises. No one knows for sure why some children develop RAD while others don't.

How Is RAD Diagnosed?

Because RAD is the result of neglect, it may be present but unrecognized. It is not clear whether RAD can develop in children over the age of five, because too few studies have explored this question. When parents do see symptoms, evaluation can determine whether the symptoms are caused by neglect or abuse, or whether they are caused by other issues such as injury, developmental delay, autism, or illness.

There are two forms of RAD -- inhibited and disinhibited. Children with inhibited RAD may presented symptoms such as:

  • withdrawal from social interaction
  • feelings or appearance of sadness, depression, or irritability
  • self-marginalizing (standing on the outskirts of social interaction)
  • lack of interest in engaging with others 
  • lack of social affect (no smiling, laughing, etc.)
  • no reaction when caregivers or parents leave

Uninhibited RAD presents with almost the opposite symptoms. Children with uninhibited RAD may be extremely social, often in inappropriate ways. They may also demand attention from strangers and relative strangers who are not part of their community.

If you think a child may be suffering from RAD, it is best to seek an evaluation by starting with the child's primary care physician. In most cases, you will be referred to a specialist who has specific experience with RAD. It is particularly important to find someone with RAD experience because the symptoms of RAD do have a great deal in common with the symptoms of certain developmental delays, psychiatric disorders, and injuries. Symptoms such as lack of social engagement may be the result, for example, of autism, depression, or social anxiety.

Treatment for RAD

In most cases, treatment for RAD starts with changing the child's situation.  A stable, consistent home environment is key, as are predictable, positive interactions with parents and caregiving.

Talk therapy may also be helpful, depending upon the age of the child.

Get more information.

Also Known As: Attachment Disorder (AD)

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