Reactive Attachment Disorder Treatment
The attachment between parent and child is usually strong and lasts for a lifetime. But what happens if that attachment never forms?
Reactive attachment disorder (RAD) is a serious (but rare) mental health disorder that develops when a child’s basic needs – affection, comfort and more – aren’t met. Often caused due to neglect and abuse, RAD leaves children struggling to manage their emotions and form meaningful and safe connections with others, problems that last into adulthood.
Treating RAD early is critical – this is a childhood condition that has lifetime effects. Discovery Mood & Anxiety offers a robust adolescent program that helps treat RAD and other mental health disorders in children.
What Is Reactive Attachment Disorder?
RAD is a condition that results when healthy emotional bonds don’t develop between a child and their parent, parents or caretakers. It often results from experiencing abuse and emotional neglect during childhood.
For a baby, attachment begins while in utero when nourishment is needed from the mother’s placenta. For a mother, attachment begins immediately after birth. The attachment bond can become stronger throughout infancy and childhood with more physical touch and comfort.
Strong emotional and physical attachment to a parent is important for development during childhood, so that there can be secure relationships in adulthood.
What Causes Reactive Attachment Disorder?
While other conditions have a variety of causes, the causes of RAD are unfortunately well known. RAD is caused by a child’s basic emotional needs going unmet. This is most often due to severe abuse and neglect during early childhood. Also, inconsistent caregiving during this time is a cause of RAD.
Here’s an example: when young children cry or show distress, it’s often because they need comfort, safety, or food. When their cries are ignored, or met with indifference or abuse, they often stop expecting care and fail to develop trust.
Another important thing to consider is that not every child in these situations develops RAD. An individual child’s level of resilience, timing, and the severity of neglect and abuse all determine how RAD develops. In general, RAD is more likely when abuse and neglect occur before age five.
There are risk factors for RAD, however.
What Are Some Risk Factors for Reactive Attachment Disorder?
There are many early childhood risk factors for RAD. Unlike other mental health disorders, there isn’t a specific genetic factor for RAD, although some researchers think that genes may play an indirect role. The primary causes for RAD are largely environmental.
They include:
- Severe abuse and neglect
- Frequent changes in caregivers
- Parental mental health disorders or substance use
- Prolonged separation from caregivers
- Living in institutions such as an orphanage or group home
How Common Is Reactive Attachment Disorder?
RAD is somewhat rare. Studies have shown that in general RAD affects between one to two percent of the population.
However, it’s possible that more cases of RAD exist due to underreporting.
What Are the Symptoms of Reactive Attachment Disorder?
Diagnosing RAD isn’t always easy. The symptoms of RAD can resemble those of autism spectrum disorders (ASD), which is why only trained medical professionals can diagnose RAD in children.
However, research has shown that there are some distinguishing features between RAD and ASD that help professionals make accurate diagnoses.
That said, children with RAD have difficulty trusting others, forming meaningful relationships, and regulating their emotions. In general, symptoms of RAD include:
- Avoiding comfort or affection even from adults they’re familiar with
- A failure to respond or seek out nurturing actions or figures
- Having difficulty calming down when upset
- Having limited emotional expression, like rarely smiling or having a lack of interest in social interactions
- Unexplained irritability, sadness, or fear
It’s important to remember these symptoms and behaviors aren’t due to ASD or other developmental issues, despite their similarities.
Do Adults Have Reactive Attachment Disorder?
While reactive attachment disorder can only be diagnosed in childhood, its effects can linger into adulthood, particularly if it’s untreated.
Adults who struggle with RAD often experience:
- Trouble forming and maintaining relationships
- Intense mood swings
- Impulsive behavior
- Control issues
- Co-occurring conditions like post-traumatic stress disorder, anxiety, depression, and more
- Low self-esteem
- Low self-worth
It’s why diagnosing and treating RAD in childhood is so important – this condition can cause difficulties for a lifetime.
How is Reactive Attachment Disorder Diagnosed?
RAD is diagnosed very carefully by a pediatric psychologist or psychiatrist. Generally, they conduct a thorough psychological assessment which focuses on:
- The child’s behavior
- Their developmental history
- The environment around them
Typically, the pediatric clinician will also examine how the child interacts with any of their caregivers, including emotional withdrawal, social responses, or any lack of seeking comfort.
As is the case with other disorders, clinicians make use of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) to help them make the correct diagnosis.
Diagnosing Reactive Attachment Disorder
To make a correct diagnosis of reactive attachment disorder, clinicians look for a few behaviors in a child:
- Consistent Patterns: A child must show inhibited and emotionally withdrawn behaviors toward adult caregivers.
- Persistent Disturbances: Unexplained irritability, sadness or fright, limited positive emotions, and a minimal amount of reactions to others are all signs of RAD.
- Personal History: Clinicians also look for a history of insufficient care, such as neglect, abuse, institutional upbringing, or multiple changes in primary caregivers.
Diagnoses of RAD are not made before nine months of age. To be diagnosed, the symptoms listed above must be present before age five.
Clinicians also look for signs of:
- Autism spectrum disorders
- Mood disorders
- Anxiety disorders
- Post-traumatic stress disorder (PTSD)
- Any intellectual disabilities
This helps them rule out anything that can resemble RAD.
How is Reactive Attachment Disorder Treated?
Supporting Caregivers
Specific parenting patterns in conjunction with professional therapy are the first-line approach to helping a child cope with reactive attachment disorders. The three therapeutic ingredients for a child to develop new patterns of emotional attachment are:
- Security
- Stability
- Sensitivity
The primary caregiver must practice extreme patience and give ample time for the child to express his or her emotions. Boundaries must be set, but in a loving and empathetic fashion. A stable and repetitive everyday routine must be practiced for the child to regain trust and normalcy in their life.
The primary caregiver must also practice love and sensitivity even when the child acts out. It is important to attend to the child’s needs in the most sensitive manner possible. The reactive attachment disorder treatment process may take a very long time, even years.
Keeping a solid foundation of these three therapeutic ingredients will lead to a transition in emotions and behavior in the child.
Talk Therapy
Talk therapy, which is also known as psychotherapy, is a form of therapy that can be very useful in treating RAD. A talk therapy session is essentially a conversation between a patient and a therapist, who work together to achieve the patient’s goals.
Two forms of talk therapy used to treat RAD are:
- Cognitive Behavioral Therapy: Cognitive behavioral therapy (CBT) is a form of talk therapy that helps identify negative thought patterns that stem from RAD while helping the patient process trauma and build secure, healthy attachments.
- Dialectic Behavior Therapy: Dialectic behavior therapy (DBT) helps teach important skills like distress tolerance and emotional regulation. It also helps people build healthier relationships and communicate more effectively.
Measurement-Based Care
At Discovery Mood & Anxiety, we use a unique measurement-based care approach that carefully monitors 27 distinct wellness indicators in our patients. This helps us create truly personalized treatment programs that grow with our patients as they succeed and grow under our care.
How Can I Help a Loved One with Reactive Attachment Disorder?
Helping a loved one with RAD, whether it’s an adult or child, requires patience, compassion, and consistency. As hard as RAD can be to experience, you can help your loved one take their first steps to treatment and management.
- Calm and Structure: Do your best to create a calm and structured environment. It’ll help your loved one feel less anxious and more secure.
- Be Consistent: Instability is something many people with RAD fear. Establishing routines and boundaries will help them feel safe, too.
- Learn More: Learning as much as you can about RAD will help you understand what your loved one has been through and is experiencing.
- Don’t Take it Personally: RAD’s behaviors stem from trauma, not because they don’t like you. Try to be empathetic and validate their feelings even when you don’t understand them.
- Offer Support, But Carefully: Many people with RAD have trouble with praise or touch. Show you appreciate your loved one while respecting their boundaries.
- Seek Professional Help: Attachment-focused and trauma-informed approaches are very effective in treating RAD. Gently suggest your loved one participate in therapy and offer to drive them to appointments.
What Happens if Reactive Attachment Disorder Isn’t Treated?
If RAD isn’t treated, it will cause long-term emotional, relationship, and behavior issues throughout life.
For younger people, untreated RAD can lead to oppositional behavior, defiance, impulsiveness, and even aggression. This can cause serious difficulties during the school-age years and even cause legal trouble later in life.
Also, untreated RAD can also cause other mental health disorders, including depression, PTSD, and anxiety.
Finally, there’s the risk of substance abuse. Like other mental health disorders, people with untreated RAD often turn to substances to deal with emotional pain, stress, and isolation.
Struggling with Reactive Attachment Disorder? Discovery Mood & Anxiety Will Help
Whether you’re trying to help a loved one with RAD or struggling with it yourself, you know how isolating and painful RAD can be. It’s painful to have trouble creating new connections with others; it can hurt to try to reach out to someone struggling with RAD and have them shy away.
RAD is treatable. At Discovery Mood & Anxiety, we make use of effective, measurement-based care (including a robust adolescent program) to help people gain a better understanding of themselves and live lives where they’re the ones in charge, not RAD.
We offer care for:
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Clinically Reviewed by
Matthew Ruble, MD
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