Children with reactive attachment disorder (RAD) have a hard time bonding with other people because of previous negative experiences.
If you’re caring for a child with RAD, building a strong relationship isn’t easy. But with the right support and treatment, it is possible.
What Is Reactive Attachment Disorder?
RAD is a condition in which children have trouble building positive relationships with or emotional attachments to others.
They may not be able to show or accept affection. They may seem moody, irritable, sad, or anxious. They may act out and be difficult to discipline.
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What Causes RAD?
RAD typically occurs in young children and is diagnosed between the ages of 9 months and 5 years. Often, it happens because of a child’s negative experiences early in life. Those may include:
- Physical or emotional abuse.
- Unavailable or inconsistent caregivers.
- Physically or mentally ill caregivers.
- Unstable living situations (switching households, foster care, orphanages, adoptions, and more).
While abuse and neglect can cause RAD, not all children who experience those situations develop it.
Signs and Symptoms of RAD
Many of RAD’s symptoms or warning signs are similar to other pediatric emotional or behavioral conditions. A pediatric mental health professional can determine through an evaluation if a diagnosis is appropriate.
Signs of reactive attachment disorder in babies
RAD can begin to develop in infancy. Signs include:
- Not smiling.
- Not cooing, making sounds, or interacting with caregivers or others.
- Avoiding eye contact.
- Rejecting soothing attempts or physical contact.
- Excessive crying, with consoling attempts not working.
- No interest in playing or bonding.
If your child exhibits signs of RAD early, seek help as soon as possible. Talk to your child’s pediatrician if your baby is showing signs of not connecting.
Signs of reactive attachment disorder in children
As a child begins to get older, they may show other symptoms of RAD. Those may include:
- Unexplained irritability.
- Anger, whether expressed through tantrums, acting out, or passive-aggressive behavior.
- Showing sadness or fear around caregivers.
- Lack of smiling or happy behavior.
- Aversion to touch or physical affection.
- Lack of affection toward caregivers.
- Lack of guilt, regret, or remorse after bad behavior.
- Lack of interest in others.
- Antisocial behavior.
- Not seeking or responding to comfort when upset.
Talk to your child’s pediatrician if you notice these or other symptoms.
Children with RAD may be at risk for other mental and behavioral conditions later in life. These conditions include developmental and physical delays, anger issues, anxiety, depression, eating disorders, and drug and alcohol abuse.
Diagnosing Reactive Attachment Disorder
Because RAD symptoms look like symptoms of other behavioral disorders, it’s important to get the right diagnosis.
According to The Diagnostic and Statistical Manual 5th Edition, a doctor should rule out these conditions before making a diagnosis of RAD:
- Autism spectrum disorders.
- Depressive disorders.
- Intellectual or developmental impairments.
How to Support a Child with Reactive Attachment Disorder
If your child has RAD, it may seem daunting. It may be more difficult to build a strong bond with your child. But there are ways you can help them.
1. Be understanding.
As difficult as the situation may be for you, recognize that your child is having problems, too. It’s important for you to stay calm and do your best to help your child through their problems.
2. Be patient.
Helping a child with RAD overcome their condition doesn’t happen overnight. It’s a long process and may include setbacks. But it’s important not to give up and to keep working toward a solution.
3. Be realistic.
Along the same lines, think of helping your child as a marathon, not a sprint. Set achievable long-term and short-term goals along the way.
4. Be positive.
It’s likely you’ll have ups and downs in your relationship with your child. That happens in every parent-child relationship — it just may happen more often in children with RAD. Keep a positive attitude and recognize that the end goal is worth it. If you get discouraged, your child may get discouraged, too.
When in doubt, a bit of humor may help, too.
5. Be firm.
Support is important for children with RAD. But you should also let them know that there are boundaries for bad behavior. Setting appropriate guidelines and sticking to them can help children with RAD recognize that actions have consequences.
6. Be loving.
Don’t forget how important it is to show love and support to your child. Even if they have trouble accepting comfort or affection, you should still offer it as much as you can. Try to help them understand you’re there for them.
7. Be aware.
Learn what can trigger your child’s symptoms and try to avoid situations that may cause them discomfort.
At the same time, try to find out what they respond well to. If certain words or actions comfort them when they’re distressed, recognizing and utilizing them as much as possible can help you help them.
8. Be consistent
Children with RAD often may not respond well to uncertainty. Setting and following a routine or schedule may help your child avoid situations that cause them anxiety.
9. Be willing to apologize.
It’s very possible you may lose your patience or your temper when dealing with your child. It happens. But do your best to make sure those instances are as few and as far between as possible.
If you do have a conflict and you’re in the wrong, apologize quickly and start working to move forward in a positive way. It can help your child learn ways to resolve conflict.
10. Be there.
Many children with RAD developed it because of an unstable living situation. One way to help them overcome it is by being there for them. It’s important to build trust in any way you can.
Play with them, listen to them, and talk to them. Set aside time that’s specifically for them. Don’t be emotionally or physically unavailable. Let them know you’re there for them, no matter what.
If you do have a conflict, make sure you’re there for them as soon as they’re willing to reconnect. Reinforcing that you’ll be available even in bad times can help you build that important bond.
Often, being a parent to a child with RAD can be difficult on you as well. If that’s the case, seeking out support — talking to a trusted loved one or visiting a therapist — is one way you can help yourself along the way.
Treatment for Children with Reactive Attachment Disorder
It’s possible — perhaps likely — that you’ll need to seek professional help for a child with RAD. If that’s the case, it’s OK; know that there are experts available to help with whatever you and your child are going through.
RAD treatment typically involves not just your child but the whole family. It may include:
- Individual therapy for both you and your child.
- Family therapy with you, your child, and the rest of your family.
- Parenting counseling to learn tips on how to help your child.
- Play therapy to help your child with social situations.
- Special education classes to help your child build academic and social skills, while also addressing any behavioral or emotional issues they’re experiencing.
In addition to professional services, a healthy lifestyle can help your child, as well. Try to have them follow a healthy diet, exercise regularly, and get the recommended amount of sleep. And you can set a good example by doing the same in your life.
The Behavioral Health Division at UPMC Children’s Hospital of Pittsburgh supports children, adolescents, and their caregivers with a variety of behavioral, emotional, or mental health conditions. For more information on what we treat and our approach to treatment, visit us online.
Editor's Note: This article was originally published on , and was last reviewed on .
American Academy of Child & Adolescent Psychiatry, Attachment Disorders. Link
American Speech-Language Hearing Association, Kid Confidential: What Reactive Attachment Disorder Looks Like. Link
Child Mind Institute, Quick Guide to Reactive Attachment Disorder. Link
Elizabeth E. Ellis, Musa Yilanli, and Abdolreza Saadabadi, StatPearls, Reactive Attachment Disorder. Link
Melinda Smith, MA, Lawrence Robinson, Joanna Saisan, MSW, and Jeanne Segal, PhD, HelpGuide, Attachment Disorders in Children: Causes, Symptoms, and Treatment. Link
From nutrition to illnesses, from athletics to school, children will face many challenges growing up. Parents often will make important health care decisions for them. We hope to help guide both of you in that journey. UPMC Children’s Hospital of Pittsburgh is a national leader in pediatric care, ranking consistently on U.S. News & World Report’s Best Children’s Hospitals Honor Roll. We provide expert treatment for pediatric diseases, along well-child visits, urgent care, and more. With locations across Pennsylvania, Maryland, and West Virginia, you can find world-class care close to home. We also work closely with UPMC Magee-Womens Hospital, a national leader in care for newborns and their mothers. Our goal is to provide the best care for your children, from birth to adulthood and beyond. Visit our website to find a doctor near you.