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Reactive Attachment Disorder (RAD) 
Signs, Symptoms, Treatment, and Recovery |
San Diego, CA

What is Reactive Attachment Disorder (RAD)?

Attachment refers to the physical, psychological and even biological bond that occurs between a child and their primary caretaker such as the mother and father. For the baby, attachment begins while in utero when nourishment is needed from the mother’s placenta. For the mother, attachment begins immediately after birth. The attachment bond can become stronger throughout infancy and childhood with more physical touch and comfort. Strong emotional and physical attachment to a parent is important for the childhood to develop so they can have secure relationships in adulthood.

For many adopted children, their attachment bond is broken, sometimes multiple times, as they are passed around foster care and finally settle into their permanent adoptive family. This bond can be reformed overtime with the proper physical and emotional care.  However, adoptive children are at an increased risk for reactive attachment disorder, which results from the disruption of the attachment process by neglect, physical abuse, sexual abuse, or frequent change in the primary caregivers in the first few years of the child’s life.

Reactive Attachment Disorder Overview

According to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, (DSM-5) symptoms of Reactive Attachment Disorder (RAD) must be evident before five years of age and the child must have a developmental age of at least nine months. The child often shows consistent emotionally withdrawn behavior towards caregivers; specifically he/she minimally responds or seeks comfort when he/she is emotionally distressed.

The second criterion includes a limited positive affect, episodes of unexplained irritability, sadness or emotional turmoil during nonthreatening interactions with caregivers and minimal social or emotional responsiveness to others. The third criterion is characterized by a pattern of insufficient care such as neglect, physical or sexual abuse, or repeated changes between primary caregivers.

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Signs and symptoms of Reactive Attachment Disorder

  • Aversion to touch and physical attention- The child does not like to be held or hugged and instead may squirm away
  • Being in control- The child often needs to be in control and will throw excessive temper tantrums, and will be disobedient, defiant and argumentative
  • Lack of emotion during punishment- When a child is asked to go on time out they are often relieved they can be alone and punishment shows them reinforcement that they are “unwanted”
  • Inappropriate affection- The child will often be inappropriately affectionate towards strangers but will show no signs of affection towards their primary caregiver

Warnings signs insecure attachment

Insecure attachment is on the mild side of the spectrum for attachment disorders whereas Reactive Attachment Disorder is more serious. Recognizing early signs of attachment problems and seeking action to repair this behavior can prevent Reactive Attachment Disorder (RAD). The following are warning signs of insecure attachment:

  • Failure to engage in play or games with other
  • Failure to reach out when being picked up by a caregiver
  • Failure to smile
  • Watching other closely but not engaging in social interaction
  • Failure to ask for help or support
  • Avoids eye contact
  • Cries inconsolably
  • Spends ample time rocking or comforting themselves or talking to themselves
  • Does not react when left alone by a primary caregiver 

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Treatment for Reactive Attachment Disorder (RAD)

Specific parenting patterns in conjunction with professional psychological therapy are the first-line approach to helping a child cope with attachment disorders. The three therapeutic ingredients for a child to develop new patterns of emotional attachment are security, stability and sensitivity. The primary caregiver must practice extreme patience and give ample time for the child to express his or her emotions. Boundaries must be set but in a loving and empathetic fashion. A stable and repetitive everyday routine must be practiced for the child to regain trust and normalcy in their life. Waking up at the same time everyday, eating breakfast, practicing the same activities or going to school while keeping the same evening and dinner routine are crucial to ensure stability in the child’s life. The primary caregiver must practice love and sensitivity even when the child acts out. It is important to attend to the child’s needs in the most sensitive manner possible. This process may take a very long time, even years, however keeping a solid foundation of these three therapeutic ingredients will lead to a transition in emotions and behavior in the child.  Play therapy is the most proven approach used by therapists for children with Reactive Attachment Disorder (RAD). This approach should take place in front of the primary caregivers to allow the child to express his/her needs, anxieties and fears through the context of play.

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