Reactive Attachment Disorder of Infancy or Early Childhood

Reactive attachment disorder (RAD) is an uncommon but serious condition. It prevents babies and children from forming healthy bonds with their parents or primary caregivers. Many children with RAD have experienced physical or emotional neglect or abuse, or they were orphaned early in life.

RAD develops when a child’s most basic needs for nurturing, affection, and comfort haven’t been met. This stops them from forming healthy relationships with others.

RAD can take two forms. It can cause a child to either avoid relationships or to excessively seek attention.

RAD can have negative effects on a child’s development. It may stop them from forming future relationships. It’s a lasting condition, but most children with RAD are eventually able to develop healthy and stable relationships with others if they get treatment and support.

According to the Mayo Clinic, the symptoms of RAD will appear before the age of 5, often when a child is still an infant. The symptoms in infants may be more difficult to recognize than in older children and may include:

• listlessness
• withdrawal
• no interest in toys or games
• not smiling or seeking comfort
• not reaching out to be picked up

Older children will show more noticeable symptoms of withdrawal, such as:

• appearing awkward in social situations
• avoiding comforting words or actions from others
• hiding feelings of anger
• displaying aggressive outbursts toward peers

If RAD continues into the teen years, it may lead to drug or alcohol abuse.

As children with RAD grow older, they may develop either disinhibited or inhibited behavior. Some children develop both.

Disinhibited behavior

Symptoms of this type of behavior include:

• attention-seeking from everyone, even strangers
• frequent requests for help
• childish behavior
• anxiety

Inhibited behavior

Symptoms of this type of behavior include:

• avoiding relationships
• refusing help
• refusing comfort
• showing limited emotions

RAD is more likely to occur when a child:

• lives in a children’s home or institution
• changes caregivers, such as in foster care
• is separated from caregivers for a long time
• has a mother with postpartum depression

To diagnose RAD, a doctor must determine that the infant or child meets the condition’s criteria. The criteria for RAD include:

• having inappropriate social relationships before the age of 5 years that aren’t due to delays in development
• being either inappropriately social with strangers or unable to respond to interactions with others
• having primary caregivers who fail to meet the child’s physical and emotional needs

A psychiatric evaluation of the child is also necessary. This may include:

• observing and analyzing how the child interacts with the parents
• detailing and analyzing the child’s behavior in different situations
• examining the child’s behavior over a period of time
• gathering information about the child’s behavior from other sources, such as extended family or teachers
• detailing the child’s life history
• assessing the parents’ experience and daily routines with the child

The doctor will also need to be sure that the child’s behavioral problems aren’t due to another behavioral or mental condition. The symptoms of RAD may sometimes resemble:

• attention deficit hyperactivity disorder (ADHD)
• social phobia
• anxiety disorder
• post-traumatic stress disorder (PTSD)
• autism or autism spectrum disorder

After a psychiatric evaluation, the child’s doctor will develop a treatment plan. The most important part of the treatment is to ensure that the child is in a safe and nurturing environment.

The next stage is to improve the relationship between the child and their parents or primary caregivers. This may take the form of a series of parenting classes designed to improve parenting skills. Classes may be combined with family counseling to help improve the bond between a child and their caregivers. Gradually increasing the level of comforting physical contact between them will help the bonding process.

Special education services may help if the child is having difficulty in school.

In some cases, a doctor may prescribe medications such as selective serotonin reuptake inhibitors (SSRIs) if the child has anxiety or depression. Examples of SSRIs include fluoxetine (Prozac) and sertraline (Zoloft).

According to the National Institute of Mental Health, fluoxetine is the only FDA-approved SSRI for children ages 8 and older.

It’s important to monitor children taking these types of medications for suicidal thoughts or behavior. This is a potential side effect, but it’s uncommon.

Without appropriate and prompt treatment, a child with RAD may develop other related conditions, such as depression, anxiety, and PTSD.

You can reduce the likelihood of your child developing RAD by attending to your child’s physical and emotional needs appropriately. This is especially important if you’re adopting a very young child, particularly if the child has been in foster care. The risk of RAD is higher in children whose caregivers have changed often.

It may be helpful to talk with other parents, seek counseling, or attend parenting classes. There are plenty of books written about RAD and healthy parenting that may also be of help. Talk to your doctor if you’re having difficulty that may affect your ability to care for your child.

The outlook for a child with RAD is good if the child receives the appropriate treatment as soon as possible. There have been few long-term studies of RAD, but doctors know it may lead to other behavioral problems in later life if it isn’t treated. These problems range from extreme controlling behavior to self-harm.