Reactive Attachment Disorder (RAD)
What Is Reactive Attachment Disorder?
Reactive attachment disorder (RAD) is a condition that can affect young children who haven’t developed a strong bond with their primary caregiver.
This condition can affect a child’s ability to form healthy attachments with other people in the future. In many cases, this disorder stems from a child experiencing emotional or physical abuse, neglect, or trauma at a young age. It can also be a result of growing up in atypical circumstances, such as in foster care or orphanages.
Reactive Attachment disorder can lead to behavioral problems and developmental delays for the child later on. This is because the child’s emotional needs may not have been met, and they may not have had the opportunity to grow up in a nurturing environment. Some people with RAD may struggle with other mental health conditions as well, including post-traumatic stress disorder (PTSD).
Did you know that in some cases, RAD can often be confused with other types of disorders? For example, because it can affect a child’s social skills, it may be mistaken for autism spectrum disorder.
By working with a mental health professional, children with RAD can get the mental health help they need so that this disorder doesn’t continue to impact them as they grow into adulthood. If you would like to learn more about what this disorder is and how it can be treated, our team at Sandstone Care can help.
How Is Reactive Attachment Disorder Defined According to the DSM-5?
The DSM-5, or Diagnostic and Statistical Manual of Mental Disorders, 5th Edition, defines RAD as a pattern of emotionally withdrawn or avoidant behavior by a child towards their primary caregiver.
It is considered a trauma and stress-related disorder. Children with this kind of disorder will usually avoid seeking comfort from adults when they are upset. They’ll also be unlikely to want to receive any kind of comfort.
How Common Is Reactive Attachment Disorder?
RAD is a relatively rare condition, and its prevalence is the highest among young children who have experienced abuse or neglect during early childhood.
In fact, it’s believed that this disorder only affects about 1-2 % of the population.
Among children who have lived in high-risk environments, such as orphanages, institutions, or unstable foster placements, rates are somewhat higher.
Reactive Attachment Disorder Signs
What Are the Signs of Reactive Attachment Disorder?
While RAD can look different from person to person, some common signs include developmental delays, struggling to form a healthy attachment with a caregiver, and trouble picking up on social cues.
What Do Signs of Reactive Attachment Disorder in Children Look Like?
A child with RAD will typically not seek or want to accept comfort or reassurance from their caregivers or other adults.
Some other signs may include:
- Being uncomfortable with affection
- Seeming emotionally distant
- Rarely expressing their feelings
- Being distrustful of adults
- Developmental delays
- Rarely making eye contact
- Seeming younger than they truly are
What Do Signs of Reactive Attachment Disorder in Adults Look Like?
Those who are still struggling with the effects of RAD in adulthood may struggle with forming close relationships with other people because they feel uncomfortable opening up or being vulnerable.
Some other signs may include:
- Having trouble trusting others
- Avoiding emotional intimacy
- Having trouble relating to others or feeling empathy
- Experiencing emotional numbness
- Feeling a need for control
- Preferring independence over having to rely upon others
Some people with RAD will experience co-occurring disorders. In other words, they may struggle with substance use disorder and RAD simultaneously. Substance misuse may be the way that some people try to cope with this disorder and the effects it can have on their lives. If this is something that you’re experiencing, our team at Sandstone Care can help.
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Types of RAD
What Is Inhibited Reactive Attachment Disorder?
Inhibited reactive attachment disorder is the typical form of RAD in which a child does not turn towards caregivers for comfort.
A child with this type of disorder will often seem withdrawn and avoidant and will rarely show emotional responses. They may also avoid eye contact, show little interest in social interaction, and appear afraid around caregivers or other adults.
What Is Disinhibited Reactive Attachment Disorder?
While disinhibited reactive attachment disorder has connections to RAD, they are categorized as two separate disorders, with disinhibited reactive attachment disorder being associated with a child being overly social, particularly with strangers.
Both of these disorders can stem from a child experiencing trauma or maltreatment at a young age. However, the reaction to that trauma is the opposite in a child with disinhibited reactive attachment disorder in comparison to typical RAD.
Someone with disinhibited reactive attachment disorder will rarely show caution around adults, even those they don’t know or have not been around before. This can be a dangerous problem, as the child may be more likely to wander off with a stranger. They may also be less likely than other children to check in with their primary caregiver, even when they are in new or unfamiliar settings.
Is RAD a Form of Autism?
No, RAD and autism are two separate conditions. However, RAD can be confused with autism spectrum disorder in some cases due to similarities in how these conditions present themselves.
For example, a symptom that both of these conditions often share is little to no eye contact and, at times, differences in social skills. There can also be developmental delays and limited emotional expression tied to both of these disorders.
One of the primary differences between these conditions is how they are developed. RAD is most often the result of abuse or trauma. However, autism spectrum disorder is caused by differences in the brain and is considered a neurodevelopmental disorder.
Reactive Attachment Disorder Causes
What Are the Causes of Reactive Attachment Disorder?
The most common causes of RAD are abuse, trauma, or neglect that a child experiences at a very young age.
For example, maybe a child had a parent or caregiver who struggled with substance abuse or mental illness and was not able to care for the child’s emotional or physical needs. Or maybe the child grew up in an environment that was full of frequent changes, for example, moving around to different foster home placements.
In some cases, a child may have had their physical needs met but not their emotional needs. For example, maybe they had access to basic necessities like food and shelter but had a caregiver who was emotionally distant or unavailable. It is important to look back through a child’s history to determine what specific circumstances may have led them to develop this type of disorder.
When Does RAD Develop?
RAD typically develops in early childhood and is most often diagnosed prior to the child turning 5 years old. It can be diagnosed as early as when the child is just 9 months old.
How Do Behavioral and Mental Health Issues in a Caregiver Contribute to the Development of RAD?
Some behavioral or mental health issues can lead to a caregiver becoming emotionally distant or unavailable, which, as a result, prevents their child from forming a safe and healthy attachment to them.
Certain mental health issues, especially when not treated, can also lead to erratic or unstable conditions. For example, substance abuse disorders or a mental health condition like bipolar disorder can impact a person’s ability to provide consistent and reliable care for their child. As a result, the child may withdraw socially and emotionally and will come to not expect comfort or care from the adults in their life.
Reactive Attachment Disorder Symptoms
What Are the Symptoms of Reactive Attachment Disorder?
Some symptoms of RAD may include avoiding eye contact, withdrawing socially or emotionally, and not seeking comfort or reassurance from adults.
A child with this type of disorder will typically struggle to form a healthy bond with their caregivers. They may also have some developmental delays and tend to rarely show emotion, even positive emotion, such as smiling or laughing.
What Do Reactive Attachment Disorder Symptoms Look Like in Infancy and Early Childhood?
In infancy and early childhood, a child with RAD may rarely cry or seek comfort from caregivers or other adults.
Instead, they may try different self-soothing techniques like rocking back and forth. They may not like to be shown affection and may show little interest in social games most children enjoy, such as peekaboo. They may also not show any preference for particular adults in their life, unlike most babies or toddlers who prefer being held by parents or family members they are very familiar with.
Young children with RAD may rarely laugh, babble, or make eye contact with other people. They may also dislike unfamiliar environments and seem unusually shy and withdrawn.
What Do Reactive Attachment Disorder Symptoms Look Like in Childhood and Adolescence?
As children with RAD grow older, they may still exhibit developmental delays and social withdrawal and may struggle with forming bonds with other people.
Some people with RAD may struggle with defiance, aggression, and distrust towards adults. They may struggle to connect with their peers, dislike being shown affection, and prefer independence over having someone do things for them.
Many children with RAD will seem younger than they really are due to potential developmental delays. They may also struggle with not knowing how to express their emotions or how to respond to social cues.
What Do Reactive Attachment Disorder Symptoms Look Like in Adulthood?
In adulthood, someone with RAD may continue to struggle to form healthy bonds with other people, and this may affect their friendships and romantic relationships.
They may also have trouble trusting other people or being vulnerable around others. If they don’t seek treatment for RAD, it can affect their future parenting skills and how they interact with their own children. For example, because someone did not grow up with an emotionally available caregiver, they may not understand how to provide that when they become parents themselves.
However, consistent counseling can help a person to break this cycle and learn how to form stable attachments with others.
Reactive Attachment Disorder Diagnosis
How Is Reactive Attachment Disorder Diagnosed?
RAD is most commonly diagnosed in early childhood, before the age of 5, by a mental health professional who has experience treating disorders related to abuse or trauma.
The mental health professional will use the DSM-5 to diagnose RAD. There are several different criteria that have to be met for this disorder to be diagnosed.
This includes:
- Showing withdrawn behavior towards caregivers
- Social and emotional disturbances or abnormalities (such as rarely showing emotion by smiling or laughing) abnormalities
- A history of neglect, abuse, or trauma
- The child’s behavior must be connected to that history of insuffient care, abuse, or trauma
- Autism spectrum disorder must be ruled out
- Any disturbances in development or behavior must have taken place before the age of 5 years old
- The child must be at least 9 months old
Can Reactive Attachment Disorder be Misdiagnosed as Autism Spectrum Disorder?
Yes, RAD can be misdiagnosed as an autism spectrum disorder because there are some similarities between the two conditions, such as struggling socially, limiting emotional reactions, and having trouble forming healthy relationships.
The key difference between RAD and autism spectrum disorder is found in the causes of the condition. RAD is caused environmentally in most cases, while autism has strongly inherited, biological causes.
Is RAD a Controversial Diagnosis?
RAD can be considered a controversial diagnosis because it is so rare and is so commonly misdiagnosed.
It is not controversial because experts argue over whether or not the condition exists. RAD is a proven diagnosis. The controversies usually arise because so many of the symptoms of RAD, such as relationship issues and isolation, overlap with other mental health issues such as anxiety, depression, or developmental disorders.
Reactive Attachment Disorder and Relationships
Can People With RAD Feel Love?
Yes, people with RAD can feel love, but they may be uncomfortable expressing it in the way that others without this disorder do.
RAD develops when children do not receive consistent, nurturing care during their earliest years, which disrupts their sense of safety in relationships.
As a result, they may struggle to express affection, accept closeness, or believe that others’ love is genuine.
Does Reactive Attachment Disorder Create Trust Issues in Relationships?
Yes, it can cause trust issues within relationships because those with RAD may have trouble believing that they are deserving of love and that their partner is not going to leave them or abandon them the way others may have done to them when they were young.
Does RAD Cause Emotional Detachment?
Yes, emotional detachment is a common symptom that many who have RAD experience.
Children who develop RAD have often experienced severe neglect, abuse, or repeated disruptions in caregiving during their earliest years.
Because of this, they may learn to shut down emotionally or distance themselves from others as a way to avoid being hurt or abandoned again.
What may look like coldness, indifference, or lack of interest in relationships is often a survival strategy that once helped them cope with unsafe environments.
Can Reactive Attachment Disorder Lead to Intimacy Issues?
Yes, RAD can lead to intimacy issues because many people with this disorder may struggle to open up and be vulnerable with their partner.
What Are Some Social Challenges Related to RAD?
Some social challenges related to Reactive Attachment Disorder include difficulty trusting others, struggles with emotional closeness, and problems interpreting or responding to social cues.
Because RAD stems from early disruptions in caregiving, children and teens often grow up with a deep sense of uncertainty about whether others are safe or reliable.
This can make them appear withdrawn, overly cautious, or even resistant to forming connections. At the same time, some may act in ways that seem overly clingy or superficially charming, which can create confusion in their relationships.
Can You Build Healthy Relationships If You Have Reactive Attachment Disorder?
Yes, you can build healthy relationships if you have RAD, but working with a mental health professional may play a helpful and necessary role in accomplishing this.
Over time, many people with RAD are able to replace early coping strategies, such as withdrawal, distrust, or pushing others away, with healthier ways of relating. While the process requires patience and commitment, individuals with RAD are not destined to remain disconnected.
Reactive Attachment Disorder Treatment
How Do You Treat Reactive Attachment Disorder?
Reactive Attachment Disorder is treated through therapy that strengthens the bond between a child and their caregivers while teaching them skills to create a stable, nurturing environment.
Because the disorder stems from early neglect or disrupted caregiving, treatment focuses on rebuilding trust and teaching the child how to form healthy attachments.
This often involves attachment-based therapy, parent–child interaction therapy, or other family-centered approaches that guide caregivers to respond consistently and sensitively to the child’s needs.
Supportive methods like play therapy or trauma-focused counseling may also be used to help children process emotions and practice new ways of relating to others. While there are no medications specifically for RAD, doctors may prescribe treatment for co-occurring conditions such as anxiety, depression, or ADHD.
Progress is usually gradual and requires patience, but with consistent care and professional guidance, children with RAD can learn to feel safe in relationships and develop stronger emotional skills over time.
What are Effective Treatment Options for Reactive Attachment Disorder?
Some mental health professionals will utilize attachment-based therapies that can help build a strong and healthy connection between a child and their caregivers.
This is often used in the case of a pair of adoptive parents trying to build a healthy attachment and sense of trust between themselves and their adoptive child. An example of this might include dyadic developmental psychotherapy (DDP). This involves creating a sense of safety and connection between a child and a caregiver in which the child can feel comfortable being emotionally vulnerable.
What Does Treatment for Children With Reactive Attachment Disorder Look Like?
First and foremost, the child must experience a stable and nurturing relationship in which their caregivers are emotionally available and can provide for their mental and emotional needs.
Trauma-informed counseling can also help the child to understand that they deserve love and that it is okay for them to express and receive love. It can also help them to learn how to better regulate their emotions, how to be vulnerable, how to trust others, and how to build healthy relationships with other people.
In many cases, parents or caregivers of children with RAD may need to educate themselves on how to best provide for their needs. Working with a child psychologist or attending support group meetings can help with this.
What Does Treatment for Adults With Reactive Attachment Disorder Look Like?
Treatment for adults with RAD can involve working with a therapist to address past trauma that is continuing to affect the individual to this day through exercises from talk therapies such as DBT or family therapy.
It might also involve cognitive behavioral therapy (CBT). This type of treatment can help make you more aware of negative thought or behavioral patterns. You can then adjust these things and replace them with the most positive thoughts and behaviors.
Attending couple’s counseling can also help those with RAD to learn how to open up to their partner and form a healthy emotional bond with them.
Let’s take the next steps together
Unhealthy neurosis can cause many issues in a person’s life. Sandstone Care is here to support teens and young adults with mental health and substance use disorders.
