Reactive Attachment Disorder (RAD): Symptoms, Causes, Help

What is reactive attachment disorder (RAD)?

Reactive attachment disorder (RAD) is an attachment disorder in which a child has a difficult time emotionally connecting with others, including their parents. While some children are naturally introverted, a child with RAD can be extremely withdrawn and have a hard time managing their emotions. They rarely seek comfort when they’re distressed, and when their temper tantrums or moodiness spur you to comfort them, they tend to resist. A child with RAD will often ignore your soothing gestures, whether they’re cuddles, hugs, or verbal reassurances.

Having a child exhibit signs of RAD can be extremely distressing for parents or caregivers, and make it difficult to connect with your child. You may spend a lot of time and energy trying to bond, only to be rejected. This can cause you to second-guess your own parenting style, or feel guilt over your inability to break through your child’s walls. In more extreme cases of RAD, your child’s intense bouts of anger or aggression can become disruptive at home and school, or even dangerous.

While it’s normal to feel discouraged and even consider giving up, that will only complicate your child’s development. Children with RAD who experience neglect are more at risk for substance abuse and other problematic behaviors as they enter adolescence. There even appears to be an association between attachment disorders and emerging borderline personality disorder.

RAD is often the result of hardships that your child experienced early in life, such as being separated from a trusted caregiver or being bounced around in foster care. But that doesn’t mean the symptoms will remain a permanent barrier to your child’s ability to form social bonds and meaningful relationships. With the right resources, an informed approach, and plenty of patience, you can help your child gain a sense of security and improve their development.

DSED vs. RAD

Both RAD and disinhibited social engagement disorder (DSED) are attachment disorders that develop due to a disruption in early caregiving. While RAD is associated with detachment and problems with emotional regulation, DSED involves overly friendly behavior in social situations. A child with DSED is quick to reach out to strangers for comfort, and not even show a preference between their actual parent and a stranger.

[Read: Disinhibited Social Engagement Disorder (DSED)]

RAD causes

RAD develops when a child is unable to form a healthy attachment with a parent or caregiver. If they can't find consistent external comfort, the child may turn inwards and stop reaching out to others to meet their emotional needs. It’s possible the child experienced this emotional deprivation in an institution such as an orphanage, or in the foster care system. In fact, RAD is often mentioned as a challenge that adoptive parents may face.

Aside from institutionalization, other situations may also leave a child feeling abandoned or emotionally neglected. For example, the parent may have been struggling with a mental illness, such as depression or substance abuse, which interfered with their ability to provide consistent care. Or they were abusive, leading to RAD as well as other trauma-related disorders. RAD can also be caused by a child being separated from their parents for an extended period due to hospitalization.

Although RAD is more common in children who receive inadequate caregiving, not every child who experiences those conditions will develop the disorder. It’s possible that additional factors, such as genetics, make some children more vulnerable to RAD than others.

Signs and symptoms of RAD

Reactive attachment disorder affects 1 to 2 percent of children. However, the risk of the disorder is higher in children who have been in foster care. Research shows that about 35 to 40 percent of maltreated foster care children develop symptoms of RAD. While symptoms usually show up before a child reaches five years of age, they can vary in severity.

Some common signs to look for include:

Unwillingness to accept or seek comfort. Your child may not respond to your attempts to comfort them with hugs or other affectionate gestures. They may not even seek comfort during a scary situation, such as falling on the playground or being frightened by a dog's bark.

Withdrawn demeanor. In social situations, your child might not smile or maintain eye contact with adults or peers. This detached behavior can become a barrier to developing relationships.

Bouts of negative emotions. Your child might show extreme negative emotions, such as irritability, fear, or sadness for seemingly no reason. They may frequently throw temper tantrums that leave you feeling perplexed and hopeless. Or they may sink into inconsolable sadness and want to isolate themselves from you and the rest of the family.

Aggression. Some children with RAD act out or even show violent behavior. They might bully their siblings or intentionally break items in the home. Or they might resort to more subtle forms of aggression, such as tightly hugging others to inflict pain. They might also engage in self-harm, such as banging their head. It's important to consider that these actions may be due to the child’s past exposure to physical abuse or a desire to experience some sense of control to counter their own helplessness.

Early warning signs

Symptoms of RAD can become noticeable during infancy. Here are some symptoms to look for in babies:

• Lack of or limited smiling and eye contact.
• Quiet, unresponsive demeanor and lack of cooing or other sounds.
• Excessive crying that doesn't subside when you console them.
• Little interest in playing and hesitation in bonding efforts.
• Resistance to being fed, leading to a lack of weight gain.

Diagnosis

You can seek a formal RAD diagnosis from a mental health professional if your child is at least nine months old. During the evaluation, a clinician will likely spend time observing how the child interacts with you. For example, they might take notes on how your child behaves when they’re picked up or when you leave the room. The clinician will also ask you questions about the child's history, including possible incidents of neglect or abuse.

Similar conditions

Without careful assessment, the symptoms of RAD can be overlooked or misdiagnosed. Some conditions that may appear similar to RAD include:

Autism. Both RAD and autism in children can present with impaired social skills, such as a lack of eye contact or smiling. However, autism has other distinguishing symptoms, such as special interests and sensory sensitivities. Additionally, a RAD diagnosis requires a history of neglect or trauma, while autism does not.

[Read: Does My Child Have Autism?]

Post-traumatic stress disorder (PTSD). Anxiety can be present in cases of PTSD and RAD. PTSD symptoms tend to be episodic, though, while RAD symptoms are more consistent.

Depression. RAD is also easily mistaken for depression. However, depression doesn't necessarily impair a child's ability to receive or ask for comfort from a parent.

Taking care of a child with RAD

Children with RAD tend to have difficulty accepting affection, and this can be especially challenging if your instinct is to shower a child with love and attention. While change is possible, you’ll need to proceed slowly and be consistent in your approach to caregiving. The following strategies can help increase your child’s sense of trust and security, strengthen their attachment to you, and minimize inappropriate behavior.

As you incorporate these tips, remember to set realistic expectations for progress. Some days you might notice an improvement in your child’s behavior, only to experience setbacks later. It’s important to remember that your child won’t heal from their trauma overnight.

Tip 1: Learn as much as you can about RAD

Maybe your child’s sudden mood swings leave you feeling confused, or perhaps you second-guess your parenting decisions when you don’t see the progress you expect? Becoming more knowledgeable on attachment disorders will help you provide the best care for your child. By studying up on RAD and attachment, you can also feel more confident in your own parenting decisions.

Talk to your pediatrician or a family therapist. They can often help you find resources, such as books about childhood trauma and neglect that help you see the world through your child's eyes. Foster care programs may also have resources to share with foster parents.

Involve the rest of your family. Share your knowledge and resources with friends and family—anyone who may play a crucial role in your child's life. The more informed they become, the more support they can offer both you and your child.

Join a support group. Look for local or online groups that bring together caregivers of children with attachment disorders. Not only can you benefit from the emotional support from other members, but you may also learn new parenting strategies and tips.

Tip 2: Be a consistent, nurturing caregiver

RAD symptoms can persist for years. However, research shows, in most cases, symptoms of RAD tend to ease once a child is in a nurturing environment. With that in mind, the most important thing you can offer your child is love and attentive care.

Tend to their physical needs. Make sure your child is eating a healthy diet and getting enough sleep at night. Poor diet and sleep habits may only worsen their behavior. Physical activity can help your child release pent-up frustration and stress while also improving their mood.

Tend to their emotional needs. Play with your child, talk to them, or just spend time relaxing with them. Whenever possible, limit access to potential distractions, such as your phone, so you can give your child your full attention. Offer them whatever level of affection they feel comfortable with, whether that includes hugs, cuddles, or simply words of affection.

Be predictable. Predictability fosters a sense of safety and security, so stick to a schedule whenever possible. Feed and bathe your child at the same time each day, and establish regular play times. Following an unpredictable schedule can often lead to stress for both of you.

Develop a safety plan. If your child is prone to self-harming behaviors or any level of violence, it’s wise to have a safety plan and ensure that everyone in the house is aware of it. A safety plan could include a list of emergency contacts and a locked cabinet to store potentially dangerous items, like scissors or knives.

Tip 3: Establish rules, rewards, and consequences

Children with RAD can have erratic mood swings. Your child may shift from sad and unresponsive to angry and disruptive. In severe cases, their behavior might even be violent or self-harming.

Feelings of helplessness can motivate your child to find some sense of control by disobeying you. They may argue with you, or run and hide when you try to enforce nap time, for example.

It can be a balancing act to find ways to discipline your child without harming your connection to them.

Model “good” behavior. Aim to be a good role model. Show your child examples of acceptable behavior and explain why those behaviors are beneficial. For example, as you tidy up the living room, brush your teeth, or say “please” and “thank you,” let your child know the reasoning behind your actions.

Set predictable consequences. If your child lashes out at a sibling, for example, you could decide that their punishment is no television or playing video games for the evening. Stick with this punishment in the future. When you set predictable consequences, your child won’t feel blindsided or mistrustful.

Try to avoid punishments that isolate or alienate your child, such as banishing them to time-out alone in their room. This can make them feel as if your love is inconsistent or conditional. Despite their behavior, your child needs to feel seen and reassured that their relationship with you is solid.

Reward good behavior and offer praise when necessary. For example, when your child puts away their toys without a fuss, allow them to enjoy an activity of their choosing for 30 minutes.

Tip 4: Practice self-care

Caregiving a child with RAD requires plenty of patience. You want to stay calm and firm, even when faced with a temper tantrum or cold shoulder. If you lose your cool, you risk scaring your child or damaging their trust in you. Of course, it’s not easy to keep a level head if you feel overwhelmed by stress, anxiety, and frustration. To be an effective caregiver, it’s important to make self-care a priority.

[Read: Caregiver Stress and Burnout]

Manage stress. Use stress-relieving strategies to unwind. You have plenty of options, including meditation, breathing exercises, or yoga. Healthy lifestyle choices can also help stabilize your mood, so aim to eat a balanced diet, get enough sleep, and exercise regularly. It’s not always easy to maintain these habits on top of caring for a child, but do your best to make time for yourself.

Ask for help. When you need a break, ask friends or family members to babysit while you take some time for yourself. Or seek out respite care to give yourself a break. A support group can also be a good source of emotional support. The other group members can really empathize with your struggles and make you feel heard.

Don’t take rejection personally. When your child seems to shut you out or retreat behind an emotional wall, you might blame yourself for their reactions. Remember that their attachment disorder is a complicated condition that's rooted in past trauma or neglect. Children with RAD are trying to protect themselves, and only time and care will build a sense of security.

Professional treatment

You don't have to feel alone in managing your child's RAD symptoms. Instead, plan to seek help from a pediatrician or mental health professional. An expert can develop a personalized treatment plan to address attachment issues. This treatment plan might include:

Family therapy. Attached-based family therapy will focus on strengthening your child’s bond with you and other family members. A therapist may guide you and the child through activities that improve trust, communication, and understanding.

[Read: Finding a Therapist Who Can Help You Heal]

Parent education. A parenting expert or therapist can help you identify the triggers that lead to problematic behavior and then offer advice on coping strategies. Parent education can also involve lessons in areas like improving nonverbal communication and building empathy with your child.

Play therapy. This approach encourages parent-child bonding through gameplay or the use of toys, such as puppets. For example, a simple game like tossing a balloon back and forth can result in positive interactions and build trust.

Behavioral management training (BMT). BMT could involve creating a system of appropriate rewards and punishments for specific actions at home or at school. This approach can be used to minimize problematic behaviors like bullying.

Whether you're a birth parent, adoptive parent, or foster parent, caring for a child with RAD can be a challenging experience. But it can also be extremely worthwhile and rewarding when you see how your love and efforts can lead to positive change in your child’s life. Remember to be patient with yourself as well as your child, and celebrate signs of progress.