Reactive Attachment Disorder

Definition

Reactive attachment disorder (RAD) is a rare condition of emotional dysfunction, in which a baby or child cannot form a bond with its parents or caregivers due to early neglect or mistreatment. The symptoms of RAD can mimic other conditions, so it is important to have the affected child evaluated by a specialist in order to get the correct diagnosis and treatment. Without treatment, RAD may persist for years and have a permanent effect on the child’s emotional development and adult relationships.

Symptoms

Babies and young children with RAD appear sad, fearful, irritable, and listless, and don’t respond to being picked up or comforted. They withdraw emotionally, and are wary and watchful of other people because they lack trust and expect hostility or rejection. Children with RAD show no interest in playing games, interacting with peers or engaging in any type of social interaction. These children may have multiple disorders, display problem behaviors due to anger and control issues, severe anxiety, safety issues and very poor self-esteem. They may also experience developmental delays and have lower-than-average IQ scores.

Causes

Infants and children whose basic physical and emotional needs are neglected learn not to expect normal caregiving and comfort from their caregivers. Although most children can ultimately develop healthy, bonded relationships in spite of early neglect, some cannot. The risk of developing RAD is higher than average in babies and children who have a mother with postpartum depression, live in orphanages and other institutions, live in multiple foster-care situations, are separated from parents for an extended period, or who have inexperienced or neglectful parents or caregivers. 

One study found that RAD is associated with changes in the brain's gray matter stemming from early mistreatment. Using brain scans to compare the gray matter of children with RAD to typically developing children, the researchers found significantly reduced volume of gray matter in the area of the brain known as the left primary visual cortex. This is the area of the brain that regulates the stress response to emotional visual images. Researchers suspect that the underdevelopment of this system early in life may cause problems with emotional regulation that result in more severe psychological problems later on.

Treatments

A pediatrician or family doctor can refer you to another physician who specializes in diagnosing and treating RAD. More often than not, the symptoms of RAD lessen or disappear completely when the child is moved to a consistently supportive and caring family environment or to caregivers who are emotionally available to respond to the child’s needs. There are no therapies or treatments that can cure attachment disorders, but since children with RAD often have multiple issues, therapy and medical treatment may be advised to treat the co-existing conditions. In some cases, attachment-based family therapy (ABFT) administered by a licensed, experienced attachment–based family therapist can help children and adults heal damaged family relationships and strengthen the parent-child bond. Medication may be considered when psychotherapy alone is not effective. 

Note: Attachment-based therapy as described here should not to be confused with unconventional, unproved, and potentially harmful treatments that are also referred to as attachment therapy, which involve physical manipulation, restraint, deprivation, “boot camp” type activities, or physical discomfort of any kind.

References

Pritchett R, Pritchett J, Marshall E, Davidson C, Minnis H. Reactive Attachment Disorder in the General Population: A Hidden ESSENCE Disorder.

The Scientific World Journal. 2013. Article ID 818157.

Shimada K, Shinichiro T, Mizushima S, et al. Reduced visual cortex gray matter volume in children and adolescents with reactive attachment disorder. NeuroImage Clinical. 2015;9:13-19.

Zeanah CH, Gleason MM. Annual research review: Attachment Disorders in Early Childhood—Clinical Presentation, Causes, Correlates, and Treatment. The Journal of Child Psychology and Psychiatry. March 2015;56(3):207-222.

American Psychiatric Association. Understanding Mental Disorders: Your Guide to DSM-5. 2015. American Psychiatric Publishing.

Last reviewed 03/05/2018