There are many ways that this can negatively affect both young people and adults. Below, we’ll discuss how reactive attachment disorder manifests, its symptoms, and what kinds of treatments are available.
What Is Reactive Attachment Disorder (RAD) And What Causes It?
As mentioned above, reactive attachment disorder can occur when an emotional bond isn’t formed between a caregiver and a child. This situation can happen due to the absence of a stable caregiver, neglect, and abuse (either physical or emotional). These factors are sometimes referred to as pathogenic care, the general disregard for a child’s basic emotional needs, which can lead to severe cognitive and psychosocial dysfunction.
Below are a few possible scenarios that can cause RAD:
- Failing to feed a child or infant, even after they express their hunger
- Neglecting a crying baby
- Not interacting (such as talking and playing) with the baby, which results in loneliness
RAD can be more common among children in foster care, especially if they have to change homes frequently. It can also occur in children of parents with mental health conditions or substance use challenges.
Despite this, RAD is uncommon, and most children who experience neglect don’t develop the condition. According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), for a diagnosis of RAD to be made, a child must be at least nine months old, and the symptoms must be present by the age of 5.
Reactive Attachment Disorder Symptoms
At its core, RAD is a disorder that impairs social functioning, among other symptoms that can greatly interfere with a child’s ability to function with ease. Compared to those without the condition, individuals with reactive attachment disorder tend to display more behavioral and psychosocial concerns, which can manifest in childhood and adulthood. include the following:
- Problematic eating behaviors
- Delayed language and motor skill development
- Anxiety and/or depression
- Excessive self-monitoring
- Emotional lability
- Lack of empathy
- Problems with concentration and attention
- Oppositional behaviors
- Maladaptive behaviors, such as destroying property, lying, and stealing
- Suicidal or homicidal ideation
A person experiencing reactive attachment disorder may have difficulty showing affection and experience challenges with their anger. They may dislike being touched and have a lack of remorse for negative behavior.
Additionally, reactive attachment disorder can present as two sub-types: inhibited and disinhibited. Inhibited RAD might be described as hypervigilance. Children with this type may be more wary and watchful than usual. Those with the disinhibited type may interact freely with strangers and disregard the need to stay near the safety of their caregivers. This kind of behavior can also be known as indiscriminate friendliness.
Some of these reactive attachment disorder symptoms may only be apparent past the age of 5, but there are warning signs that can sometimes be observed in infants. Even though they cannot speak coherently, infants typically show many cues to express how they are feeling. However, an infant with RAD may:
- Not smile
- Avoid eye contact
- Reject being picked up
- Cry frequently
- Not want to play with toys or games
If left untreated, the symptoms of RAD can carry over into adulthood. They can have serious implications and consequences.
Reactive Attachment Disorder In Adults
Some of the symptoms listed above can be present in reactive attachment disorder in adults and can affect interpersonal relationships. There is also some supporting evidence that shows that RAD in childhood is associated with different personality disorders, such as borderline personality disorder, later in life. Symptoms of RAD may include the following:
Adults with RAD who have difficulty adjusting to social situations and making safe connections may also experience challenges with forming relationships. This can include social relationships with friends or colleagues as well as intimate relationships.
Beyond relational challenges, RAD in adults can also lead to criminal behavior, such as vandalism, arson, homicide, and cruelty to animals. In the worst cases, the individual may show no remorse for criminal behavior and may repeat such actions. Social isolation and a sense of hopelessness can also lead to substance use problems and other addictions, such as gambling or sex addiction.
Treatment For Reactive Attachment Disorder
RAD can be difficult to diagnose, and research into the condition is ongoing. Researchers have yet to agree on a standardized treatment intervention, but some methods have shown promise, including behavior management training (BMT). BMT assists caregivers by providing psychoeducation about their child’s behavioral challenges while teaching them parenting skills that encourage healthy behavior. BMT typically involves 10 steps (broken down into 10 sessions) that deliver training to the child’s caregivers. In one study, BMT was highly successful at treating the symptoms of RAD, and researchers recommended it for broader clinical testing.
Other types of treatment, such as play therapy and art therapy, have demonstrated some effectiveness in the treatment of other attachment disorders, but few clinical trials have been carried out to measure their effectiveness with RAD. However, spending time engaging a child in these activities can be supplemental in forming attachments between a caregiver and a child because they encourage bonding. Additional parenting strategies can include teaching the child about emotions and consequences and reassuring the child that they are safe and loved.
Treatment for RAD in adults can be different since they are legally independent and there is a chance that their former caregivers are unavailable. An adult with RAD may choose to bring a friend to therapy sessions so that trust can be formed. If no friends are available, treatment may focus on the development of social skills and the formation of a secure attachment with a therapist.
Therapy Can Help With Reactive Attachment Disorder
If you are concerned that your child is showing symptoms of reactive attachment disorder (RAD), it may help to make an appointment with a qualified healthcare provider or mental health professional. If the challenges of parenting make it difficult to visit a therapist’s office, you might consider online therapy. With online therapy, you can get support as a parent from the comfort of home at a time that works for your schedule. You can connect with a therapist via phone, live chat, or videoconferencing—or a combination of these methods.
A growing body of evidence shows that online therapy is an effective option for mental health treatment. For example, a study published in Clinical Child and Family Psychology Review explored the efficacy of telehealth for family therapy. The review reported that research supports telehealth-delivered therapeutic sessions as an effective delivery of family therapy services. Furthermore, the study concluded that evidence shows equivalent efficacy for mental health and child behavioral outcomes between remote and in-person delivery.
With an online therapy service like BetterHelp, you can receive support from a licensed online therapist if you have a child who is displaying symptoms of reactive attachment disorder. Likewise, if you are an adult who has difficulty forming meaningful relationships with others, treatment is available to you, too.
Below are some reviews of BetterHelp therapists by other people who have sought help through online therapy:
“Mary helped me to overcome my terrible childhood which still affected me. She helped me trust my judgment, build confidence, and gave me the knowledge to identify toxic people before they affect my life, I am forever grateful for that.”
“Keisha is an amazing counselor and has helped me with issues regarding my career, childhood, and relationship with my father. She is kind, responsive, and extremely knowledgeable. Keisha was able to help me look at my problems from another perspective and shine a light on positive thinking.”
If you have a child with reactive attachment disorder, or if you yourself have experienced challenges related to insecure attachment, know that you’re not alone. With BetterHelp, you can be matched with a therapist who has training and experience with reactive attachment disorder or any other specific concerns you’re facing. Take the first step toward getting support and contact BetterHelp.
What happens to kids with RAD when they grow up?
Reactive attachment disorder (RAD) can lead to challenges in adulthood, such as:
- Depression and anxiety
- Personality disorders
- Substance use disorders
- Trouble forming stable attachments
How severe these effects are may depend on factors like:
- Professional treatment
- The child’s history
- Exposure to a nurturing environment
- Emotional support from caregivers
- Opportunities to form healthy bonds with others
That said, reactive attachment disorder, treated early by a specialist in child and adolescent psychiatry, can be managed in adulthood.
What age is reactive attachment disorder?
Reactive attachment disorder tends to form during early childhood, but it can have effects on older children and adults. According to the DSM-5, a child must be at least nine months old to be diagnosed with RAD, and they must show symptoms before age five.
Is reactive attachment disorder similar to ADHD?
Reactive attachment disorder and ADHD may give similar symptoms, such as trouble concentrating and hyperactivity. That said, they are two separate conditions.
What are the two expressions of reactive attachment disorder?
Childhood attachment disorders can take two forms: inhibited and disinhibited. The inhibited type can make a child withdrawn, resistant to affection, or reluctant to express their emotions. The disinhibited type, also known as disinhibited social engagement disorder, can make a child overly friendly to others, including people they don’t know.
Is reactive attachment disorder a form of PTSD?
Like PTSD, reactive attachment disorder is considered a trauma and stress-related disorder. A child with RAD may also have PTSD, but they are not the same thing.
Do people with reactive attachment disorder have empathy?
Emotional neglect, one of the risk factors for reactive attachment disorder, can lead to challenges with empathy. This can affect how the child interacts with others and make it hard to manage relationships. That said, reactive attachment disorder, diagnosed and treated early enough, may not always lead to challenges with empathy.
Does reactive attachment disorder look like autism?
Reactive attachment disorder and autism spectrum disorder may give some similar symptoms, such as social challenges and trouble forming relationships. That said, these are separate diagnoses with different causes. The causes of autism spectrum disorder are still being studied, but according to the American Psychiatric Association, there may be a genetic component. RAD, on the other hand, tends to be caused by outside factors in early childhood. These may include neglect of the child’s physical or emotional needs, an absent primary caregiver, or other forms of trauma.
Can reactive attachment disorder lead to narcissism?
Reactive attachment disorder and narcissistic personality disorder can sometimes have similar symptoms, like trouble feeling empathy, but they are separate disorders. Some children with RAD may go on to develop narcissistic personality disorder, but this is not always the case.
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