Reactive Attachment Disorder (RAD): Diagnosis, Cause, And Treatment

At birth, humans are pre-programmed to bond with a significant person- a primary caregiver or parent. Attachment is the deep bond or relationship that an infant has with a primary caregiver. Being the first interactive relationship of a child’s life, it greatly affects the child’s development and determines how they relate with other people throughout their life. Inadequate or absent caregiving during infancy and early childhood may cause a child to develop attachment issues, such as reactive attachment disorder (RAD) or other mental health or attachment disorders. In this article, we’ll be discussing how RAD develops, is diagnosed, its signs and symptoms, and how it can be treated to ensure an individual can live a productive, healthy life.

What is reactive attachment disorder (RAD)?

Attachment issues may vary from mild problems, which can be easily corrected, to the more serious ones known as reactive attachment disorder, or RAD. RAD is a condition in which young children cannot consistently connect or form a healthy attachment bond with their primary caregivers (parents or guardians) due to being grossly neglected by them. The effects of attachment disorder go beyond early childhood as the quality of a child’s attachment experiences sets the foundation upon which their verbal and non-verbal communication rests. Children with attachment issues or social engagement disorders may exhibit callous/unemotional traits, feel unable to express their emotions, or have difficulty understanding other people's feelings. This, consequently, may limit their ability to build and maintain healthy relationships in their later years.

For children to feel a sense of safety and develop trust, their basic needs- emotional and physical- must be met. A young child that does not enjoy adequate care may begin to feel abandoned, unloved, and uncared for. While the situations that lead to attachment issues may be unavoidable, like foster care or adoption, the child is still too young to understand the circumstances and reasons these things happen. So, they may end up with an insecure attachment, feeling no one cares about them, believing they can’t depend on others, and that the world is a cruel and dangerous place.

Little children can quickly build a sense of trust and form healthy attachments with their caregivers when their basic needs are consistently met. They can feel loved and easily trust and connect with caregivers who promptly attend to their needs and make them feel comfortable and cared for. Children and adolescents with a secure attachment style can:

• Cultivate and build successful intimate relationships.
• Maintain emotional stability.
• Quickly rebound from disappointment, failure, discouragement, and hardship.
• Feel satisfied being by themselves and also enjoy the company of others.
• Be sensitive to the feelings of other people and treat them right.
• Enjoy a positive self-image.
• Live life to the fullest.

According to the Diagnostic and Statistical Manual of Mental Disorders, attachment issues such as reactive attachment disorder (RAD) are commonly found in children between 9 months to 5 years old who may have been neglected or abused physically or emotionally. Though not common, reactive attachment disorder can continue beyond early childhood to the child’s more senior years, which may sometimes be misdiagnosed as some other type of emotional or attachment problem or result in the child being diagnosed with autism spectrum disorder (ASD).

Reactive attachment disorder (RAD): Diagnosis

Children with RAD must be diagnosed by a professional who has been trained to recognize the signs and symptoms of the disorder. Often, an in-depth evaluation is carried out by a child psychologist, a psychiatrist, or another medical provider. The symptoms found in children with reactive attachment may also apply in cases of other mental health disorders, like autism spectrum disorder, so it can be important to avoid giving a child a label without first consulting a professional. Self-diagnosis can delay the treatment process and worsen the child’s prognosis. Psychiatrists and psychologists use specially designed assessment tools and interviews to evaluate the child’s behavior, and this evaluation may include:

• Review of development milestones
• Observation of the child’s interaction with caregivers, caregivers, and others
• A sampling of behavior in various situations
• Evaluation of the parent’s or caregiver’s styles and abilities
• Questions about the home and living conditions of the child since birth
• Details about the child’s behavioral pattern over time

Causes of reactive attachment disorder

Reactive attachment disorder can develop when a child’s basic needs for love, care, comfort, nurture, and affection are not met. The child may not establish a healthy relationship and stable attachment with their primary caregivers and thus begin to exhibit behaviors and traits of RAD. Some of the situations that may cause attachment issues in a child include:

• A baby who is left hungry, wet, or/and unattended for hours.
• When a child cries, and there is no one to respond or offer comfort.
• A young child who is abused continuously or mistreated.
• Lack of emotional response, negligence, or insensitivity to the child’s basic needs.
• A child who is not smiled at, touched, talked to, held, interacted with, affirmed, or comforted when in distress.
• An emotionally unstable or unavailable parent who is depressed, ill, or consumed by substance use.
• A child who gains attention only when they act up, throw a tantrum, or display extreme behaviors.
• Frequent disruptions and changes in primary caregivers- resulting from adoption, foster care, death of parents, etc.
• A child who has been emotionally or physically abused or neglected by parents, primary caregivers, or other adults may end up with insecure attachment.

Signs of RAD

According to the American Academy of Child and Adolescent Psychiatry, the symptoms of reactive attachment disorder (RAD) may vary from child to child. Some of the signs in infants and young children with RAD could include:

• Avoiding eye contact or not smiling
• Inconsolable cries and wailings
• Exhibits eating disorders
• Consistent withdrawal and fearfulness
• Not reaching out to be carried
• Not showing ’emotions of conscience’ like guilt, remorse, or regret
• Irritability, unhappiness, anger, throwing tantrums, rebellion, disobedience, arguing, and other behavior problems (beyond what is normal for the child’s age and the situation)
• Never seeking comfort and rejecting comfort when it’s offered
• Not seeming to care or notice when left alone
• Likes to be alone and doesn’t engage in social interaction with others
• Does not make sounds or coo
• Coldhearted and callous-unemotional traits
• Not showing expected emotions
• Conduct disorder traits

According to the Academy of Child and Adolescent Psychiatry, adolescents with RAD may exhibit symptoms that fall under these two categories:

• Inhibited Reactive Attachment Disorder: In this case, children are aware of what is happening around them. They are sometimes hyper-vigilant, but they do not respond or react typically. Children with these disorders tend to be callous, unemotional, and insensitive, may be extremely withdrawn, emotionally detached, and resist comfort even when offered it. They may choose to keep to themselves and rarely show or seek affection from their caregivers and other people. They are excessively inhibited, meaning they hold back their emotions on a regular basis. 
• Disinhibited Reactive Attachment Disorder: Children with this attachment disorder may be excessively friendly toward outsiders or strangers. The child might seem to seek and prefer the comfort and attention of outsiders or strangers to their parents. Children with disinhibited reactive attachment disorder may act much younger than their age, be extremely independent, and seek attention from just about anybody in an unsafe way.

Treatment for RAD

Children who have not experienced appropriate bonding in their early years may have a hard time accepting love and care, but with time, consistent efforts, and repetition, they can learn to trust again and welcome love into their life. While there is no quick fix for reactive attachment disorder, early intervention can be key. Treatment for RAD usually involves a combination of therapy with an expert in child and adolescent psychiatry, parental education, and counseling to help the child have a loving and safe living environment at home, develop healthy relationships and positive interactions with caregivers, and improve peer relations. This treatment, most of the time, involves both the child and the caregivers. Some of the treatment strategies for RAD include:

• Individual psychological counseling: Psychologists or therapists may have a session with the child alone—or while the parents are observing— to sample or monitor the child’s emotions and behavioral patterns. Then, they may work with the child to help change their negative beliefs and behaviors to encourage a healthier outcome. 
• Family therapy: Most times, attachment problems are carried out by both the child and the caregiver or parent. Engaging in therapy as a family unit can help both the caregiver and child learn how to improve the situation by gaining new tools and techniques for bonding.
• Play therapy: This allows the child and the caregiver to express their feelings, needs, fears, and thoughts in the safe confines of play. Play therapy is geared toward helping the child learn the appropriate skills needed to build healthy interactions with peers and handle social situations.
• Parenting skills training: This is done to educate parents and caregivers on attachment disorders and teach them needed parenting skills. Implementing these techniques into their parenting style can help their child overcome their attachment issues. 

Other treatment strategies for child and adolescent RAD can include:

• Deliberately providing a loving, positive, and interactive environment for the child.
• Identifying and encouraging actions that feel good to your child, which they may have missed out on in their earlier years.
• Provide warm, loving, and nurturing interactions with your child, like during feeding, bathing, etc.
• Helping the child to identify their emotions and express their needs.
• Showing genuine love and care and giving reassuring and encouraging words.
• Appropriately addressing and taking care of the child’s safety, housing, and medical needs.

Online counseling for support for RAD 

Regardless of the stage of reactive attachment disorder your child may currently be going through, attachment problems can be treated. As a parent of a child with RAD, you may be in need of support yourself as you try to find solutions for your child. With the help of verified pediatric psychiatrists or psychologists like the ones at Regain, you can learn how to boost childhood attachment, repair existing reactive attachment or disinhibited social engagement disorder, and help your family develop a healthy and loving relationship. Regain is an online counseling platform that can be accessed from anywhere you have an internet connection and a smart device. Parenting can take up a lot of time but Regain makes it convenient to get the assistance you need by offering flexibility and plenty of options to customize your care. It could be the right option for you, your children, and your family, regardless of what you might be going through.

The effectiveness of online counseling 

Researchers have set out to discover whether attachment plays a role in the effectiveness of therapy. In one study, they explored the efficacy of an online group psychotherapy intervention and compared participants’ attachment dimensions to the results. Outcomes from the study showed a reduction in the global severity of psychiatric symptoms, including depression, and an increase in self-esteem. Feelings of loneliness were also reduced, as were symptoms of anxiety and avoidance. Researchers discovered that attachment dimensions were not a predictor of the effectiveness of therapy, which may suggest that anyone, regardless of attachment issues, could benefit from online counseling interventions. While researchers did observe that there could be a favorable change in attachment dimensions during therapy, it was not shown to predict the success of the intervention. 

Takeaway

As a parent, it can be difficult to watch your child struggle with something like reactive attachment disorder (RAD). You may be coping with your own struggles in life, like substance abuse* or mental disorders and struggling to keep up with the demands of parenting. While RAD can certainly present challenges, there is support available. Working with a therapist, you can get the tools you need to support your child and improve your own mental health. Regain can connect you with a licensed family therapist to address any problems you may be experiencing and offer advice to guide you toward happier, healthier relationships both in and outside of your family unit. 

* If you are struggling with substance use, contact the SAMHSA National Helpline at (800) 662-4357 to receive support and resources. Support is available 24/7.