Reactive Attachment Disorder

DisclaimerThis page is not here to be used as a self-diagnosis, self-identification, or promotion - it's simply here to be informational. Whether or not one self-diagnoses, self-identifies, and/or seeks a professional diagnosis is up to them.

**Reactive Attachment Disorder (RAD)** is a condition in which a young child doesn't establish healthy attachments with parents or caregivers. Children with RAD have trouble managing their emotions. They struggle to form meaningful connections with other individuals.

## Signs & Symptoms

Reactive attachment disorder usually starts in infancy. Symptoms of reactive attachment disorder are unique to each child.

Signs and symptoms may include:

* Unexplainable 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 peekaboo or other interactive games.
* Behavioral problems.
* Failing to seek support or assistance.

### Diagnosis

The DSM-5 gives the following criteria for reactive attachment disorder:

* The individual demonstrates a chronic pattern of being emotionally withdrawn and inhibited, which is demonstrated by rarely seeking or responsive to comfort when distressed.
* There is evidence of a chronic social and/or emotional perturbation characterized by at least two of the proceeding: social withdrawal and minimal responsiveness to others, negative affect, unfounded or inexplicable episodes of irritability, fearfulness, or sadness, or out of proportion reactions to normative stress.
* The individual presents a history of extremely insufficient care, entailing of one of the following: deprivation or social neglect of basic emotional needs for stimulation, comfort and affection by caregivers; the constant flux of caregivers, resulting in a destabilized home environment; growing up in an unusual setting which limits the ability to form selective attachments.
* The child cannot also meet the diagnostic criteria for autism as the two diagnoses are mutually exclusive.
* The behavioral perturbation should manifest prior to the age of five.
* The child must have a developmental age of at least nine months in order to qualify for the diagnosis.

## Causes

To feel safe and develop trust, infants and young children need a stable, caring environment. Their basic emotional and physical needs must be consistently met by caregivers. A child whose needs are ignored or who is met with a lack of emotional response from caregivers does not come to expect care or comfort or form a stable attachment to caregivers. While not as common, older children can also develop RAD.

It's not clear why some children develop reactive attachment disorder and others don't.

Children may be more likely to develop RAD if they:

* Have many different parental figures, like multiple foster care situations.
* Were taken away from their primary caretakers after bonding with them emotionally.
* Experienced several traumatic losses early in life.
* Have parental figures who didn't try to become emotionally close to them.
* Spent time in an institution where they didn't have a loving parent figure.

## References

https://www.mayoclinic.org/diseases-conditions/reactive-attachment-disorder/symptoms-causes/syc-20352939

https://my.clevelandclinic.org/health/diseases/17904-reactive-attachment-disorder

Ellis EE, Yilanli M, Saadabadi A. Reactive Attachment Disorder. [Updated 2022 May 8]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK537155/