What is Reactive Attachment Disorder (RAD)?
Reactive attachment disorder (RAD) is a disruption in a child’s emotional development, causing difficulties bonding with caregivers.
Experts believe that RAD is influenced during the early years of a child’s life. It is often seen in children who were victims of verbal or physical abuse or neglect. It can also develop when a child had several caregivers, for example through foster care. (1)
A child with RAD is likely to exhibit less interest in interacting with other people. They may not seem distressed when separated from caregivers, and are not moved by their return.
Children will often identify attachment figures during the first months of life. Parents are usually the primary ones. They are the first set of people a child will bond with, feel safe around and seek comfort from. (2)
Approximately around the age of three months, a baby will be able to recognize his/her attachment figures. They may carry social “conversations” with the help of eye contact and cooing.
Typically when a child reaches three years of age, he/she will have formed a “secure base” within the primary figures. A child will usually not wander too far and will return when feeling distressed or in need of nourishment.
Attachment is an important element of future relationships and social behavior. It gives a child the ability to form a sense of self-worth, and the feeling that they are deserving of care.
It builds their confidence and molds the base of being able to establish healthy relationships.
Every relationship requires a two-way effort, and a bond with a child is no exception. It must be reinforced from both sides. If one person is lacking the ability to support the other, instability will occur.
A child will depend entirely on these experiences from their primary figures. RAD may occur if parents or caregivers do not meet the emotional and physical needs of the child.
Various factors may contribute to this. However, it is often seen if the caregivers are very young, lack parenting skills or are intellectually disabled. (3)
When doctors try to diagnose this disorder, they may look for the following signs:
Avoidance of Caregivers
A reason why a child with RAD tends to avoid the caregiver may come down to how the primary figures respond to the child’s emotions. (4)
For example, if the parent continually reacts to the child’s distress in avoiding, rejecting, or ridiculing ways, the child will respond accordingly. He/she may not feel as though their ways of expressing feelings of injury or discomfort are welcomed, and so will avoid the caregiver.
This avoidance of the caregivers is a sign of insecurity and will contribute to the development of adjustment problems in the future.
Avoidance of Physical Contact
A child with RAD tends to be very reluctant to be in physical contact with other people. (5)
The child is most likely not used to physical contact, or associates it with abuse. Therefore they will often avoid it or meet it with negative emotions, such as a cry or flinch. They might even express pain.
When caring for a child who seems reluctant to be in physical contact, try to comfort them in other ways. Forcing them into a hug can make matters worse.
Difficult to Comfort
Children with RAD are often challenging to comfort. When stressed or caught up in emotions, they tend to act out and rarely seek support from a caregiver. (6)
This is usually the result of receiving inappropriate responses to distress, or an effect of neglect or abuse. It is also may occur when a child was left too often to self-soothe.
When socializing with a person who has RAD, it might be noticed that they lack emotions. (7)
They might not express happiness or sadness the same way others would. This again could be the result of improper responses from primary figures. The child associates emotional expression with something negative.
If a child doesn’t receive healthy responses, it hinders the ability to establish relationships with others. The affected might be quick to withdraw from social situations. (8)
There are no distinct stages of RAD. However, research studies conducted on attachment development have distinguished four types of attachments. (9)
A secure attachment can be exhibited by a toddler who readily explores and engages with strangers while the primary figure is present. The child will show distress when the caregiver leaves, but finds comfort when they return. (10)
The child knows that in times of distress it is safe to return to base. The parent has been relatively consistent in responses, creating a secure and loving quality of caregiving.
If a caregiver is consistently non-responsive or reacts to distress with rejection, ridiculing or blame, the child will act accordingly. They will often avoid the person and show minimal emotions in their presence. (11)
This type of caregiving is labeled as insensitive or a rejection of caregiving. The child’s reaction can be considered organized. The child knows that in times of need and distress, the caregiver should be avoided. This may lead to adjustment issues for the child.
Children may tend to exaggerate their needs or emotions out of desperation. They might be sending out a signal to their caregiver, whose response is usually inconsistent or unpredictable. (12)
The primary figures may lay their burdens on the child, expecting them to understand. The child will eventually catch on and think this is the way to get attention. He/she might amplify negative emotions in the hope that they will be heard.
Children exploited in this way have an increased chance of developing social and emotional maladjustments.
If a child has a disorganized attachment, they typically have a chaotic or “atypical” caregiver. (13)
The caregiver may respond unpredictably, sometimes in frightening ways that are not limited to distressful times. The child will likely find it difficult to adjust to the constant changes.
Studies have shown that atypical caregivers usually have unresolved emotions following their own events such as loss or abuse.
Treatment of RAD is very individualized. It depends entirely on the child and caregivers. (14)
It generally revolves around two parts: securing the child in a safe environment, and strengthening the relationship with primary caregivers.
A therapist will usually meet with the child and caregivers for a few sessions each week. They will likely discuss the issues and help find solutions, such as ways to deal with misbehavior and stress. (15)
It is crucial to seek treatment for RAD as it can lead to various social complications in the future.
What is reactive attachment disorder (RAD)? RAD is a mental health disorder which keeps a child from forming healthy relationships with others.
What are the signs of reactive attachment disorder (RAD)? Children with RAD often exhibit signs of abuse and neglect. This could include avoidance of primary caregivers and physical contact. Difficulty being comforted, asocial behavior and little to no expression of emotions are also signs.
How do you develop reactive attachment disorder (RAD)? RAD develops when a young child fails to establish an attachment to primary caregivers. It is often caused by abuse or neglect. However, it could also occur after losing a parent. It is often seen in children enrolled in foster or institutionalized care. (16)
How are you diagnosed for reactive attachment disorder (RAD)? Specialists will generally look at the complete history, do a physical examination and a psychiatric evaluation. They will usually also evaluate the parents if there are any, to be sure the child is in a safe environment. (17)
What is the best treatment of reactive attachment disorder (RAD)? Treatment will depend on the child and situation. It usually involves therapy with the caregivers to find solutions and ways of dealing with stress. Some children might need behavioral training. (18)
What are the long term complications of reactive attachment disorder (RAD)? If RAD is not treated the child can have difficulty establishing relationships and connecting with people. It may lead to depression, anxiety or other psychological problems, including post-traumatic stress disorder (PTSD). (19)
Is reactive attachment disorder (RAD) considered a disability? RAD is a mental health disorder. However, sufferers are not considered to be mentally disabled as they often show average intellectual levels. (20)
Is there any cure for reactive attachment disorder (RAD)? RAD can be cured with therapy and a supportive, loving environment.
Is reactive attachment disorder (RAD) life threatening? The disorder can cause severe depression which has shown to be a cause of suicide. (21)
Reactive attachment disorder (RAD) is a very unfortunate mental health condition. When a child is the victim of neglect or abuse, they can miss the fundamental development of healthy attachment.
The child will generally display asocial behavior and lack of emotions. Most children with RAD have been physically or mentally abused. They will often avoid caregivers and be reluctant to engage in physical contact.
When a parent is feeling overwhelmed it is not always easy to be consistent. However, it is essential to seek help. Negligence, intentional or not, can have severe consequences for the child. Fortunately, with treatment and support, this situation can be overcome.