Overview

Reactive attachment disorder (RAD) is a serious condition that occurs in infants or young children who fail to establish healthy attachments with parents or caregivers. This disorder may develop when a child's basic needs for comfort, affection, and nurturing are not met, and they are unable to form stable and loving attachments with others.

With appropriate treatment, children with reactive attachment disorder can develop more stable and healthy relationships with caregivers and others. Treatments involve creating a stable and nurturing environment and providing positive interactions between the child and caregiver. Parent or caregiver counseling and education can also be beneficial.

Symptoms of Reactive Attachment Disorder

Reactive attachment disorder usually begins in infancy and may include the following signs and symptoms:

• Unexplained withdrawal, fear, sadness, or irritability.
• Sad and listless appearance.
• Not seeking comfort or showing no response when comfort is given.
• Failure to smile.
• Watching others closely but not engaging in social interaction.
• Failure to reach out when picked up.
• No interest in playing interactive games.
• Behavior problems.
• Failing to seek support or assistance.

When to Seek Medical Attention

If your child displays concerning signs that persist over time, consider getting an evaluation. Some symptoms may occur in children without reactive attachment disorder or those with other conditions such as autism spectrum disorder. To determine whether the behaviors indicate a more serious problem, consult a pediatric psychiatrist or psychologist.

Causes of Reactive Attachment Disorder

Infants and young children require a stable and caring environment to feel safe and develop trust. When their basic emotional and physical needs are consistently met by caregivers, a stable attachment is formed. However, a child whose needs are ignored or met with a lack of emotional response from caregivers fails to expect care or comfort, leading to an unstable attachment.

The exact reasons why some children develop reactive attachment disorder while others don't remain unclear. Various theories exist, and further research is necessary to enhance understanding and improve diagnosis and treatment options.

Risk Factors

The risk of developing reactive attachment disorder may increase in children who:

• Live in a children's home or institution.
• Frequently change foster homes or caregivers.
• Have parents with severe mental health problems, criminal behavior, or substance abuse that affects their parenting.
• Experience prolonged separation from parents or caregivers due to repeated out-of-home placement, hospitalization, or death of a primary caregiver.

However, it's essential to note that most severely neglected children do not develop reactive attachment disorder.

Complications

If left untreated, reactive attachment disorder can persist for several years and lead to lifelong consequences. These complications may include issues with relationships, social interactions, mental and physical health, behavior, intellectual development, and substance abuse.

Further research is necessary to determine if problems in older children and adults are related to early childhood experiences of reactive attachment disorder.

Prevention

While it's not certain if reactive attachment disorder can be prevented, there may be ways to reduce the risk of its development. Infants and young children require a stable and caring environment, and their basic emotional and physical needs should be consistently met. The following parenting suggestions may help:

• Be actively engaged with your child through play, talking, eye contact, and smiling.
• Learn to interpret your baby's cues and respond quickly and effectively to their needs.
• Provide warm and nurturing interaction during feeding, bathing, or changing diapers.
• Offer both verbal and nonverbal responses to your child's feelings through touch, facial expressions, and tone of voice.
• Consider taking classes or volunteering with children to learn how to interact in a nurturing manner if you lack experience or skills with babies or children.