Reactive Attachment Disorder

Healthy attachments are formed when a child is able to “ask” for care from adults in the form of crying, talking, or other communication and when adults are able to provide care for a child.

If a child is missing either of these components (lacks the ability to “ask” for care or adults are not providing appropriate care), the child may not be able to form healthy attachments and may have RAD.

RAD is classified into two types:

1. Emotionally Withdrawn/Inhibited Type: A child has extremely emotionally inhibited behavior in social interactions with others. When distressed or upset, these children do not try to obtain comfort or nurturing and may resist offers of comfort.
2. Indiscriminate/Uninhibited Type: Children are very unselective when they choose caregivers or others to provide them comfort. They tend to lack a preference for primary caregivers and to lack an appropriate wariness of strangers. These children may wander from caregivers without checking back and often approach or seek nurturing from total strangers rather than from caregivers they know.

Evaluation and Diagnosis

The emotional and social problems associated with RAD can continue to have an impact throughout childhood. RAD is usually diagnosed before age five. Diagnosis of RAD is based on an evaluation of both the caregiver and the child, as well as the interaction between the two.

Treatment

A key component of treatment of RAD includes making sure the child has safe, consistent, and familiar caregivers. Treatment focuses on creating appropriate and secure attachments with caregivers by working with the child and caregivers individually and possibly as a group. Treatment options include parent–child interaction psychotherapy and skills building.

Learn more about mental health treatment