Understanding Reactive Attachment Disorder in Children : Causes, Symptoms, and Care

Attachment to parents or caregivers is an essential part of every child’s development. When this attachment gets disrupted to an extreme level, through neglect or abuse, children develop Reactive attachment disorder. Let us read further to know more about reactive attachment disorder in children.

Reactive attachment disorder (RAD) is a rare condition experienced by children where they do not form an emotional bond with their caregivers. For most children, bonding begins in the mother’s womb. Research has shown that babies can hear the voices of their parents and the heartbeat of their mothers while being in the womb.⁽¹⁾ So, they are born with an attachment that has already begun in the womb, and it grows stronger in the early months of their lives. With time, secure attachment can form if these infants have caregivers who are physically and emotionally available for them and if their survival needs are being properly met.

However, not all children are born into ideal situations. Reactive attachment disorder (RAD) is a rare condition where children or infants do not form healthy emotional bonds with their parents or caregivers, often because of neglect or abuse at an early age. Children with reactive attachment disorder are less likely to seek comfort when they feel distressed. Such children have trouble managing their emotions well and struggle to form meaningful connections with others. They might show limited positive emotions, but they can show more fear, irritability, or sadness.

Reactive attachment disorder affects one to two percent of children. However, the risk of RAD is higher in children who have been in foster care.⁽²⁾ Research has shown that about 35% to 40% of maltreated children in foster care develop reactive attachment disorder. Although children often begin to show up with symptoms of RAD before they reach five years of age, they can however vary in severity.⁽³⁾

Reactive attachment disorder (RAD) can affect every aspect of children’s life and development. Below are some common symptoms experienced by young kids and older kids who are being affected by reactive attachment disorder.

• An antipathy to touch and physical affection: Children with reactive attachment disorder usually laugh, flinch, or even say, “Ouch” when touched, instead of producing positive feelings, affection and love are perceived as a threat in such children.
• Anger Issues: Anger might be directly expressed, or expressed in tantrums, or through manipulative, passive-aggressive behavior. Children with reactive attachment disorder often hide their anger in socially acceptable actions, such as giving a high-five that hurts or hugging others too hard.
• Control Issues: Most children with RAD go to great lengths to be in control and avoid feeling helpless. These children are often argumentative, disobedient, and defiant.
• An Underdeveloped Conscience: Children with reactive attachment disorder (RAD) usually act like they do not have a conscience and fail to show regret, guilt, or remorse after misbehaving.
• Difficulty Showing Genuine Care, Love, and Affection: Children with reactive attachment disorder often misbehave when they are shown affection or love. They display little or no affection towards their parents and often misbehave affectionately with strangers.

As children with reactive attachment disorder grow older, their symptoms tend to change into inhibited or disinhibited symptoms.

• Extremely withdrawn, resistant to comfort, and emotionally detached.
• Although the affected children are aware of things going on around them, they still do not react or respond to anything in their environment.
• These children with reactive attachment disorder often push others away, ignore others, want to remain alone, and even act aggressively if others try to come closer to them.

• Children with reactive attachment disorder do not seem to have a preference between their parents or strangers.
• They start seeking comfort in anyone without distinction.
• Children with RAD tend to act extremely dependent on others and are developmentally younger.

According to the American Academy of Child and Adolescent Psychiatry (AACAP), reactive attachment disorder forms due to negative experiences with adults in children’s early years.⁽⁴⁾ Research has shown that a lack of attachment in the infant stage can impact brain development.⁽⁵⁾ Without positive bonding experiences in children’s early stages, the pathways for bonding in later phases of their lives can be lost.

Reactive attachment disorder (RAD) results when children are not given proper and adequate care and love by caregivers.⁽⁶⁾ Children will not develop a healthy attachment if caregivers do not respond to their cries during their infancy. Apart from this, if caregivers are changed frequently, children might also suffer from RAD, since they cannot be connected to anyone in particular.

Some other risk factors for reactive attachment disorders include:

• If they live in a foster care or children’s home
• If parents have severe mental health issues or abuse drugs or alcohol.
• If parents take part in criminal behavior.
• If children are separated from their parents for a long or if parents are hospitalized.

If a child exhibit symptoms that the doctor suspect of reactive attachment disorder, they might have a complete medical history and physical examination, which also include a review of the child’s developmental milestones. However, there are no specific laboratory tests to diagnose reactive attachment disorder. But, various tests like neuroimaging, or blood tests be conducted to examine what might be causing the symptoms.

When a physical cause for the symptoms is not found, doctors will refer these children to a psychiatrist or psychologist who will asses them to rule out other causes for their unusual behavior (like autism spectrum disorder) and try to figure out the condition.

Children with reactive attachment disorder should be taken appropriate care. By following the tips mentioned below, children’s symptoms and behavior can be improved. It should be noted that children with RAD will not heal from their trauma overnight, however, with consistent try and appropriate treatment, they can recover from the misery associated with the condition.

Try to learn more about RAD from every possible source, including your family therapist, pediatrician, and other aware persons. You should also find books about childhood trauma and neglect and know ways to see the world through the eyes of your children. Share your knowledge with family and friends so that everyone can play a crucial role in your child’s life.

It is also important for you to join a support group, either locally or online that brings together caregivers of children with reactive attachment disorders. This way you can know more about the condition and also discover ways to take care of children with RAD.

Symptoms of Reactive attachment disorder in children can persist for a long. However, these symptoms can be improved when children with RAD are taken proper care of and placed in a nurturing environment. The primary thing that can be gifted to such children is love and care.

Make sure that children with RAD are given a healthy diet and have enough sound sleep at night. This is because, without proper sleep and diet, the symptoms of reactive attachment disorder worsen. Apart from this, children with RAD should be involved with physical activities or exercises, that help them release frustration and stress and improve their mood.

Apart from being physically present for them, you should also be present emotionally with them. Make sure you talk to them and spend quality time with them while giving your full attention to them. When they feel comfortable with you, they will become happier and healthier. Try and make them feel comfortable with your hugs, cuddles, and words of affection.

If your child with reactive attachment disorder is prone to self-harming behaviors or any sort of violence, make sure to prepare a safety plan and ensure that everyone in your house is aware of it. Include a list of emergency contact numbers, a locked cabinet for storing dangerous items like knives or scissors, and a first-aid kit.

Mood swings and aggressive behavior are commonly seen in children with reactive attention disorder. Sometimes, such children become extremely aggressive and disruptive and may turn violent. To balance their behaviors, you can try out some ways like establishing rules and rewards (praising them and rewarding them with their favorite chocolate or toy) for their good behaviors, and setting some consequences (like not allowing them to watch television or play video games if they become disruptive). However, ensure not to punish them hard which can make them feel isolated or alienated. All these can discipline your child without making them feel isolated or left out.

Self-care is highly essential for caregivers or parents who are trying their best to take care of children with reactive attachment disorder. Caregiving such children requires plenty of patience. Sometimes caregiving children with RAD can make you feel stressed out, anxious, and frustrated. However, it is important to take personal physical and mental care in the first place.

Manage your stress with some relaxation techniques like meditation, yoga, and deep breathing exercises. Moreover, try to maintain a healthy lifestyle by getting proper sleep or rest, healthy diets, and exercising regularly.

Also, ask for assistance from family members or friends whenever you feel drained out or completely stressed. You too need a break. So, seek out help from anyone possible. Joining a support group will also help you get enough mental and emotional support.

Treatment for reactive attachment disorder has two primary goals. The first one is to ensure that the children with RAD are in a safe environment and the second one is to help these children develop a healthy relationship with a good caregiver.

Often, the treatment for reactive attachment disorder in children focuses on the caregivers and family members. Below are some of the professional treatments that can be helpful to improve symptoms of RAD in the affected children.

Treatment for reactive attachment disorder in children primarily includes play therapy, which encourages parent-child or caregiver-child bonding through different games and plays. This technique allows children and caregivers to express their thoughts, fears and needs in the safe context of play.

Family therapy is also one of the most important things to consider while making a treatment plan for children with reactive attachment disorder. This therapy focuses on strengthening children’s bonds with parents and other family members. A therapist will guide the caregivers and children with RAD through various activities that improve communication, understanding, and trust.

Treatment for reactive attachment disorder in children often focuses on parents and caregivers. A parenting expert, counselor, or therapist helps the caregivers of children with RAD to identify the triggers that lead to problematic or disruptive behavior in children and then offer advice on various coping strategies. Parent education can also involve several lessons in areas like improving nonverbal communication and building empathy with children.

Behavioral management training or BMT involves creating a system of appropriate rewards and essential punishments for specific actions at home or school. This approach can be used to minimize problematic or disruptive behaviors.

There is no medication for treating reactive attachment disorder itself. However, doctors might sometimes prescribe medications to help manage severe behavioral symptoms, such as problems sleeping or explosive anger.

According to the National Institute of Mental Health, the only FDA-approved SSRI for children ages 8 years and older is fluoxetine.⁽⁷⁾ It is essential to monitor children taking these medications since there are some possible side effects associated with them.

Without appropriate treatment at the right time, children with reactive attachment disorder will experience ongoing social, emotional, and behavioral issues. All these can put them at risk of bigger issues as they grow older.

Research has estimated that 52% of juvenile offenders have an attachment disorder or borderline attachment disorder.⁽⁸⁾ The majority of those teens had experienced ill-treatment or neglect in the early years of their lives.

Recognizing a problem with attachment in children and getting quick help can prevent reactive attachment disorder. Although, it might not always be possible to prevent reactive attachment disorder, however, doing specific things can help stave off its development. Check below to learn about these specific things to prevent the development of reactive attachment disorder in children.

• Play with your infants or children quite often and spend quality time with them.
• Talk to them with a smile and listen to them when they share their things with you.
• Try to understand your baby’s cues, such as their different types of cries, and understand how they feel or what they want.
• Show love and warmth as you bathe your baby. or feed them, or even change their diapers. This way they can connect with you more.
• Respond to your children with a caring facial expression and warm tone of voice.
• Seek assistance from other parents or support groups.

Reactive attachment disorder in children is a rare condition in which they have difficulty forming attachments with their parents, caregivers, or other people in their lives. Early trauma like abuse or neglect can result in RAD. Without effective treatment, reactive attachment disorder can continue into adolescence and even adulthood. Such children, if left untreated and uncared, can experience serious mental health issues, such as depression or anxiety as they grow up and might find it difficult to handle any close relationship.

If you are a parent or a caregiver of a child with reactive attachment disorder, see them to a good doctor and treat them appropriately. Meanwhile, also take care of yourself and stay healthy.

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