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Understanding Reactive Attachment Disorder (RAD) in Children | Symptoms, Causes, Treatment

Jerome Albert Ecker | MD

Medically reviewed by Jerome Albert Ecker | MD, Assistant Professor of Medicine, Duke University - Durham, NC on November 28th, 2023.

Key Takeaways

  • This condition exclusively affects children who experienced severe neglect or trauma before age 5, when critical brain attachment pathways are still forming—after this window, the diagnosis cannot be made.
  • Affected children exhibit a consistent pattern of minimal attachment behaviors across caregivers, including avoiding comfort when distressed, showing little positive emotion, and episodes of unexplained irritability or sadness.
  • The disorder stems from grossly inadequate care such as frequent caregiver changes (more than 3-4 primary caregivers), institutional care, or severe neglect during the first 2-3 years of life when attachment bonds typically form.
  • Evidence-based treatment focuses on creating stable, responsive caregiving relationships through specialized therapies like Dyadic Developmental Psychotherapy, which can take 1-3 years to show significant improvement.
  • Without intervention, approximately 80% of children continue to struggle with forming relationships into adulthood, often developing conduct disorders, substance abuse, or becoming involved in the juvenile justice system.

Reactive Attachment Disorder (RAD) is a condition that affects children who have experienced grossly negligent care and have not formed healthy emotional attachments with their primary caregivers, usually their mothers, before the age of 5. When a child's basic needs for comfort, affection, and nurturing are not consistently met, they may struggle to develop trust, regulate their emotions, and form healthy relationships later in life.

Symptoms of Reactive Attachment Disorder

Children with RAD may exhibit a range of symptoms that affect their emotional, social, and behavioral development. Some common signs of RAD include:

  • Lack of emotional responsiveness or expressing emotions inappropriately

  • Avoidance of eye contact and physical touch, especially from caregivers

  • Frequent tantrums, irritability, or disobedience

  • Unexplained sadness or unhappiness

As children with RAD grow older, their symptoms may manifest in two patterns: inhibited and disinhibited. Inhibited RAD is characterized by detachment, unresponsiveness, excessive inhibition, and withdrawal. Disinhibited RAD, on the other hand, involves indiscriminate sociability, inappropriate familiarity, and a lack of preference for primary caregivers.

Causes and Risk Factors of Reactive Attachment Disorder

RAD develops when the attachment between a young child and their primary caregiver is disrupted or fails to form due to grossly negligent care. This can happen for various reasons, such as:

  • Constant disregard of the child's emotional and physical needs

  • Repeated changes in primary caregivers, preventing stable attachments

  • Parental mental health issues, substance abuse, or criminal behavior

  • Prolonged separation from caregivers due to hospitalization

Understanding Reactive Attachment Disorder (RAD) in Children | Symptoms, Causes, Treatment

Diagnosing Reactive Attachment Disorder

Diagnosing RAD involves a comprehensive evaluation by a mental health professional, such as a child psychiatrist or psychologist. They will review the child's developmental history, observe their behavior, and rule out other conditions like autism spectrum disorder. While there are no specific lab tests for RAD, the doctor may order neuroimaging or blood tests to identify any underlying physical causes for the symptoms.

Treating Reactive Attachment Disorder

Treatment for RAD focuses on two main goals: ensuring the child is in a safe environment and helping them develop a healthy relationship with an appropriate caregiver. Therapy may include:

  • Counseling for caregivers to address issues affecting their relationship with the child

  • Parenting skills training to improve the caregiver-child relationship and foster attachment

  • Play therapy to help the child and caregiver express their thoughts, fears, and needs

While there is no specific medication for RAD, doctors may prescribe medication to manage severe behavioral symptoms, such as explosive anger or sleep problems.

Preventing Reactive Attachment Disorder

Preventing RAD involves recognizing attachment issues early and seeking help as soon as possible. Parents and caregivers can help foster healthy attachment by:

  • Engaging with the child through play, eye contact, and frequent communication

  • Learning to understand and respond to the child's cues and needs

  • Showing warmth, nurturing, and responsiveness during daily care routines

  • Attending classes or workshops to build skills in nurturing the child

Outlook for Children with Reactive Attachment Disorder

Without treatment, RAD can have a negative impact on a child's physical, emotional, behavioral, social, and moral development. Children with RAD are at higher risk for depression, aggressive behavior, learning difficulties, relationship problems, low self-esteem, and substance abuse. However, with proper treatment and support, children with RAD can learn to trust others and lead healthy, productive lives.

For more information on Reactive Attachment Disorder and child mental health, visit:

The Bottom Line

Early identification before age 8 is crucial since the brain's capacity for forming attachments decreases significantly after this point, making treatment less effective. Creating a consistent, nurturing environment with the same caregivers while working with attachment specialists offers the best chance for recovery. If you're concerned about attachment issues in a child who experienced early trauma, Doctronic can help connect you with appropriate resources and specialists.

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