The Signs and Symptoms of Reactive Attachment Disorder

Reactive attachment disorder (RAD) is a condition in which children fail to establish healthy bonds with their primary caregivers. It affects children who have received inadequate care from their parents or primary caregivers—typically their mothers before the age of 5. A child might have RAD if there’s nothing neurologically or medically wrong with them, but they still can’t properly form attachments. The child may have difficulties regulating distressing emotions and may have a flat affect (no smiles) during interactions with caregivers. When emotional care and nurturing is withheld from a child during their first few years, it can have a negative impact on the rest of their life. Reactive attachment disorder (RAD) is a condition in which children fail to establish healthy bonds with their primary caregivers, and it can have a negative impact on the rest of their life.

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Left untreated, RAD can have a negative effect on a child’s behavioral, emotional, physical, and social development. Children with RAD are typically at a higher risk for depression, low self-esteem, relationship challenges, learning difficulties, and oppositional behavior. And 2016 research in Scientific World Journal found that children who aren’t treated for RAD may develop personality disorders when they reach adulthood. Despite the serious effects on a child’s life, many families are either unaware of the problem or never seek help. This makes it difficult to accurately estimate the prevalence of RAD. However, a 2013 study in the British Journal of Psychiatry found that 1.4% of children in a deprived population experienced RAD.

WHAT CAUSES REACTIVE ATTACHMENT DISORDER?

Research shows that RAD can be caused by several factors, including:

• Disregard of a child’s basic physical needs: For example, a baby cries, and no one responds or comforts the child. Or an infant is hungry or wet and they aren’t attended to for hours.
• Persistent neglect of a child’s emotional needs: withheld affection and care: RAD can occur when infants and toddlers don’t get the nurturing they need. For example, if caregivers don’t look at, talk to, sing to, or play with a child, it can lead to attachment problems.
• Frequent shifting of primary caregivers: For example, if a child bounces around with parents, grandparents, guardians, institutional care, or foster care, it may increase problems developing healthy emotional attachments.
• Preterm birth or low birth weight: A 2020 study in Acta Paediatrica shows that preterm infants are at increased risk of developing RAD. Babies born at less than 32 weeks of gestation have 3 times the risk of being diagnosed with the condition, and babies that are less than 2.5 kilos at birth have twice the risk as normal-weight babies.

SYMPTOMS OF RAD

Children suffering from RAD may exhibit an array of emotional and behavioral symptoms, including one or more of the following signs and symptoms:

• Detached, withdrawn, or unresponsive
• Resists attempts to soothe or comfort
• Holds back or bottles up emotions
• Exhibits avoidant behaviors
• Sudden, unexplained outburst or irritability, fear, or sadness
• Moodiness
• Lack of smiling
• Inappropriately familiar with others
• Selective with attachment figures
• Difficulty experiencing positive emotion
• Trouble accepting physical or emotional closeness
• Reacting violently when held or comforted
• Unpredictable behavior
• Difficult to discipline

All of these symptoms may range from mild to severe. Research in a 2018 issue of Attachment & Human Development found that the longer a child was in institutional care before being placed in foster care or with families, the more prolonged and elevated their RAD symptoms were.

RAD, THE BRAIN, AND OTHER PSYCHIATRIC DISORDERS

Healthy emotional attachments are necessary for the brain to develop properly, and children with RAD may have abnormalities in the brain. A 2015 study in NeuroImage: Clinical found that children with RAD have 20% less gray matter volume in the visual cortex. The researchers suggest such abnormalities may be associated with the visual emotion regulation impairments seen in RAD. Additional evidence in The Scientific World Journal shows that children with RAD are more likely to have multiple comorbidities. In fact, 85% of those with RAD in this study had another diagnosis. Mental health conditions that may be seen with RAD include:

• ADD/ADHD
• Oppositional defiant disorder
• Conduct disorder
• Post-traumatic stress disorder (PTSD)
• Autism spectrum disorder
• Specific phobia
• Tic disorder

HOW IS REACTIVE ATTACHMENT DISORDER TREATED?

With proper treatment, it’s possible for RAD children to learn to trust others and have a healthy and fulfilling life. There are two main goals of treating RAD:

• Ensure that the child is in a safe environment.
• Help the child develop a healthy relationship with the primary caregiver.

Treatment for RAD often focuses on both the child and the caregivers. Play therapy, where a child can express their fears and needs in a safe place, is one possible treatment for RAD. Psychotherapy (for the child alone and/or family therapy), social skills interventions, special education, and parenting skills classes are other treatment options. Although there’s no medication to treat the core attachment deficits associated with the condition, medications for co-existing disorders, such as ADD/ADHD, may be beneficial. In addition, making sure the child is eating a healthy diet should be an integral part of any treatment plan, in addition to treating any micronutrient deficiencies with nutritional supplements. In order to ensure that the best treatment plan is put in place, a child (and the caregivers) can also benefit from brain SPECT imaging to identify any undetected head injuries or other types of brain dysfunction that may be contributing to RAD symptoms.

6 TIPS TO HELP RAD KIDS (AND THEIR PARENTS)

If you’ve noticed attachment difficulties in any children who are in your care, seek help right away. The best way to prevent the long-term symptoms of RAD is with early treatment. Typically, the sooner parents or other caregivers get help for their RAD children, the better their chances are for living healthy lives as adults. If you’re struggling with how to handle a family member with RAD, here are some practical strategies that can help.

1. Get help for your child. The best way you can assist your child with RAD is to recognize that you can’t do everything on your own. Consider getting help from an integrative psychiatrist who takes a whole-person approach to diagnosis and treatment. This can be a huge first step in supporting your child as love alone cannot fix trauma or attachment issues.
2. Seek help for yourself. Asking for help is a strength, not a weakness. If your child is struggling, or you’re having difficulty providing care, seek professional assistance to help you better understand your child’s unique challenges and learn how to help manage their symptoms. Getting guidance on how to handle your child during difficult moments can provide tremendous stress relief.
3. Provide a stable home. An effective way to help children with RAD is to provide a safe and secure home environment. Additionally, at least for the short-term, it might be a good idea to reduce the number of caregivers. Have the most stable, reliable, loving caregiver provide the child with the stability, consistency, and attention they need.
4. Create a safe environment. Make sure your child is in a place where they won’t be physically, mentally, or emotionally harmed. This includes removing sharp objects, or anything else that could lead to self-harm or harm to others in the family.
5. Get clued in. One way to respond to your RAD child’s needs is to observe their habits and reactions. Pay close attention to their behaviors for clues to possible triggers. Try to anticipate difficult situations before they happen.
6. Heal the brain. Having undiagnosed or untreated brain health issues can contribute to more severe symptoms of RAD. Adopting a brain healthy lifestyle can help heal the brain and minimize symptoms associated with RAD.

If you have a loved one who is suffering from any of the symptoms associated with reactive attachment disorder, the Amen Clinics method of integrative psychiatry is here to help. A full evaluation at Amen Clinics includes brain SPECT imaging, cognitive and psychological testing, as well as an assessment of the biological, psychological, social, and spiritual factors that may be contributing to RAD or co-existing conditions. Emotional attachment issues in children can’t wait. During these uncertain times, your mental well-being is more important than ever and waiting until life gets back to “normal” is likely to make symptoms worsen over time. Find out more by speaking to a specialist today at 888-288-9834 or visit our contact page here.