What is Reactive Attachment Disorder (RAD)?
Reactive attachment disorder (RAD) is a complex, severe, and relatively uncommon condition in which infants and young children do not establish lasting, healthy bonds with parents or caregivers. While this condition is rare, it is serious. In many cases a child with RAD has been the victim of abuse, neglect, or abandonment or is orphaned. These children have never established a loving, caring attachment with anyone. Undeveloped attachments may permanently damage a child’s growing brain and hurt their ability to establish future relationships. Additionally, it can lead to controlling, aggressive, or delinquent behaviors, trouble relating to peers, and other problems.
Attachment is the deep connection between a child and his or her caregiver that is encoded into the brain of a young child during early years of development. Proper attachment has a profound impact upon every component of the human body. Attachment to a loving caregiver or parent who provides support, love, and guidance is one of our basic human needs.
Generally beginning before the age of 5, reactive attachment disorder is a condition that lasts a lifetime. However, children and adolescents who have reactive attachment disorder are able to learn to develop stable and healthier relationships with caregivers and parents through an effective treatment program.
Since reactive attachment disorder is rarely seen in clinical settings, the prevalence rate of reactive attachment disorder is unknown. Often this disorder has been found in children who have been exposed to extreme, severe neglect, however even in this population this disorder occurs in less than 10% of these children.
Causes and Risk Factors
Children are born naturally resilient and even children who have been neglected or lived in orphanages can develop perfectly healthy relationships with others. It is not understood why some children develop reactive attachment disorder and why others do not. A few hypothesis about this causes for development of this disorder include:
Physical: When a child’s needs are ignored or are met with physically abusive responses from caregivers that child learns to expect hostility or rejection. After a period of time that child becomes distrustful and begins to avoid social contact. These emotional interactions between babies and caregivers may affect the development in the brain, causing attachment problems, as well as affecting personality and relationships throughout the child’s life.
- Living in an orphanage
- Inexperienced parents
- Frequent changes in caregivers
- Institutional care
- Extreme neglect
- Prolonged hospitalization
- Physical, sexual, or verbal abuse
- Extreme poverty
- Removed from neglectful or abusive home
- Parents with mental illness, drug abuse, or anger management problems
- Mother who has post-partum depression
Even though some of the causes for reactive attachment disorder are unavoidable, the message to the child’s psyche is the same, “my needs don’t matter.” This hard-wired belief is very challenging for a child or teen to overcome – the belief that he or she doesn’t actually matter can impact nearly every facet of his or her life.
Signs and Symptoms of Reactive Attachment Disorder
Reactive attachment disorder can negatively affect all areas of a child or adolescent’s life and development. There are two main types of reactive attachment disorder: inhibited and disinhibited. Not much research has been done on the signs and symptoms of this disorder beyond early childhood, however as children grow older they may develop either inhibited or disinhibited behavior patterns. In some cases an adolescent will display symptoms of both types. Some common signs and symptoms may include:
- Unresponsive or resistant to comforting
- Shuns relationships with everyone
- Indiscriminate sociability
- Inappropriately familiar or selective in choice in attachment figures
- Seeks attention from anyone
- Displays inappropriate childish behavior
- Frequently asks for help doing things
- Violates social boundaries
Relationships: In relationships, a person who has RAD may be bossy, untrusting, manipulative, and controlling. They may have challenges giving or receiving genuine love and affection. Their unstable peer relationships are tenuous at best, as children and teens with RAD blame others for their mistakes or challenges.
Behavioral: Destructive, irresponsible, impulsive, and defiant behaviors. Children or teens with RAD may steal, lie, abuse others, start fires, behave cruelly to animals, or act in a self-destructive manner. They also may avoid physical contact with others, and engage in drug or alcohol abuse.
Moral: Teens with RAD may lack faith, compassion, and remorse for their actions.
Emotional: Children who have RAD may feel sad, moody, fearful, anxious, depressed, and hopeless. These children may display inappropriate emotional reactions.
Thoughts: Children and teens who have RAD may have negative beliefs about themselves, life, and other relationships. These children and teens are unable to understand the concept of cause and effect. Additionally, they may experience inattention and challenges with learning.
Effects of Reactive Attachment Disorder
The complications of reactive attachment disorder can continue into adolescence and into later adulthood, causing a number of long-term negative effects. Some of these effects may include:
- Poor self-esteem
- Delayed physical growth or learning
- Challenges in scholastic environment that may lead a teen with RAD to drop out of school
- Delinquent or antisocial behavior
- Temper or anger problems
- Relationship problems
- Eating problems leading to malnutrition
- Academic problems
- Substance and alcohol addiction
- Unemployment or frequent job changes
- Inappropriate sexual behaviors
Co-occurring Disorders and Conditions
There are a number of conditions that are associated with neglect and therefore often occur with reactive attachment disorder. Some of these disorders and conditions include:
- Cognitive delays
- Language delays
- Severe malnutrition
- Anxiety disorders