Reactive Attachment Disorder

What is it?

Reactive attachment disorder (RAD) is a rare condition that occurs when infants and young children fail to bond with parents or care-givers due to extreme neglect or abuse. A child with RAD, which is diagnosed from 9 months to 5 years of age, rarely seeks or responds to comfort when distressed and has unexplained episodes of irritability, sadness or fearfulness with caregivers.

A child with RAD has significant difficulties interacting with adults or peers. It’s a lifelong condition, but children can learn to develop healthy relationships.

Signs and Symptoms

Signs of RAD in infants and toddlers include withdrawal, 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 people’s movements and disinterested in watching others. Instead of seeking comfort from a parent or caregiver, these children will attempt to soothe themselves. When distressed, they may calm down more quickly without an adult.

Diagnosis and Treatment

To be diagnosed with RAD, a child must be inhibited around caregivers; she must rarely turn to them for comfort when distressed or respond to comfort when offered. The child’s early caregivers must have failed to meet her physical or emotional needs, or repeated caregivers changed so often that she was unable to form a bond with them. To meet the criteria for RAD, the child must not have autism spectrum disorder, and must be between 9 months and 5 years old.

Treatment for RAD usually involves both the child 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.

What are the risk factors for children?

A child who was abused or neglected is at risk for reactive attachment disorder. However, most children who have been abused or neglected or who have been bounced around among multiple caretakers do not develop the disorder. Children with RAD may also experience developmental delays and delays in physical growth. Older children may be at risk for eating disorders, anger problems, depression, anxiety, difficulties in school, and drug and alcohol abuse.