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Reactive Attachment Disorder


What is reactive attachment disorder?

Reactive attachment disorder (RAD) means your child has trouble forming bonds with people who take care of him. A child may become frightened and frustrated if no one responds to his needs, or if response is inconsistent. He may not be able to trust that he is safe and will be given what he needs. Your child may not form bonds with his parents or other caregivers he sees regularly. He may instead be openly affectionate or cling to strangers but not respond to known people.

What are the signs of RAD?

Signs of RAD develop fully by the time a child is 5 years old. You may start to notice signs when your child is about 1 year of age. As he gets older, you may notice the following:

  • Not responding to someone who tries to talk to or play with him
  • Not being easy to comfort, or not seeking comfort from a caregiver
  • Being open with or seeking attention or comfort from strangers, or not being afraid of strangers
  • Trouble understanding emotions of others
  • Listlessness, or looking sad
  • Acting frightened or watchful
  • Lack of fear when separated from a regular caregiver
  • Taking risks or doing dangerous things such as running into traffic
  • Being destructive or lying often

What increases my child's risk for RAD?

  • Physical or emotional abuse or neglect
  • Adoption, or lack of care at an institution such as a foster home or hospital
  • Frequent changes in caregivers, or loss of a caregiver he was close to
  • Postpartum depression or mental illness in his mother
  • A parent was neglected or abused in childhood, or did not learn how to care for a child
  • His parents were too young to put a child's needs ahead of their own

How is RAD diagnosed?

Your child's healthcare provider will check for any developmental delays, such as autism, that can cause symptoms of RAD. He will also check your child's physical development and overall health. Healthcare providers may give you questionnaires to fill out with what you notice about your child's attachment to his caregivers. Your child may be given toys to play with while healthcare providers observe. He may be asked to make up a story about people in his life. Healthcare providers will look for the following:

  • Social cues include facial expressions and body language. A child with RAD may not show any change in facial expressions, or he may not react to his caregiver's facial expressions. Social cues help your child trust he will be cared for. He will also use social cues to develop relationships throughout his life.
  • Reciprocity means your child gives and receives attention. For example, children often smile and laugh as they play with a caregiver. They may ask for a hug or reach out to be picked up. A child with RAD may not react when he is touched or hugged, or he may pull away. He may say it hurts to be touched. As your child reads the social cues of his caregivers, he should be able to respond appropriately. The caregiver should also be able to respond to the child's needs.
  • Secure base means your child sees his caregivers as protective and safe. Children usually crawl or walk away from a parent or caregiver but then turn around and come back. A child with RAD may not come back. Healthcare providers will also watch what happens when the child and parent or caregiver are separated, and when a stranger enters the room. A child with RAD may not be upset when his parent or caregiver leaves. He may not be afraid when a stranger comes in.

How is RAD treated?

Healthcare providers will first make sure that your child is living in a safe environment and that he is not being abused. A therapist can help your child's parents and caregivers learn to respond to his needs and bond with him. The therapist can teach you ways to manage your child's behavior problems in a positive and productive way. Therapy may include helping parents or caregivers talk about their own childhoods and relationships with caregivers. This may help develop a responsive relationship with your child. Parenting classes are also available. Ask your healthcare provider for more information on classes in your area.

What can I do to help my child?

  • Respond to your child's needs. Respond the same way each time. Children learn to trust when they receive consistent care and attention. Do not force attention on your child or force him to hug you. Offer attention and be willing to accept if he offers attention to you. You may have to build trust before you can hug him.
  • Do not try to discipline your child if he will not respond. An attempt to force your child to respond may make the behavior worse. Therapists can help you learn when discipline is appropriate and how to be strict without making your child feel unsafe.
  • Be interactive with your child. Give your child eye contact and smile when you speak with him. Give him your full attention when he speaks to you. Talk to your younger child while you are giving him a bath, changing his diaper, or feeding him. Ask your older child about his day at school. Eat meals together, and encourage him to talk with you. Remember that he is learning to understand body language. He may misinterpret if you seem hurried or tense. Be patient as he learns to pick up cues and body language. It might be helpful to tell him why you are stressed. This will help him understand that it is not because of him.
  • Limit the number of people who take care of your child. He will have a more difficult time bonding if several people take care of him regularly. It may be helpful to find someone you trust to care for your child for short periods of time. This will allow you time to rest and come back to your child feeling calm and positive.
  • Talk to your child's teachers and school officials. Your child may have trouble making friends. He may act out in class. His teachers or classmates may not want to include him in activities. It is important for your child to feel accepted and supported at school and at home. Your child's teachers may be able to help him in the classroom. His school may have programs to help him.

When should I seek immediate care?

  • Your child tries to harm himself or another person, or he threatens harm.

When should I contact my child's healthcare provider?

  • You have questions or concerns about your child's condition or care.

Care Agreement

You have the right to help plan your child's care. Learn about your child's health condition and how it may be treated. Discuss treatment options with your child's healthcare providers to decide what care you want for your child. The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.

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Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.