Reactive Attachment Disorder

A child with reactive attachment disorder (RAD) has been subject to neglect or abuse. The child fails to establish the expected bond with primary caregivers. This results in irritability, sadness, fearfulness and difficulty interacting with adults or peers.

RAD: What Is It?

Normally a child becomes attached to their primary caregivers, they provide nurturing and soothing. Reactive attachment disorder (RAD) is a rare condition that occurs when infants and young children do not form this bond. This occurs to those who are subject to extreme neglect or abuse. A child with RAD, which is diagnosed from 9 months to 5 years of age, rarely seeks or responds to comfort when distressed, shows limited positive affect, and has unexplained episodes of irritability, sadness or fearfulness in contact with caregivers.

RAD has two subtypes: inhibited type, where the child will display wary, watchful, and hyper vigilant behaviors. Also disinhibited type, where the child displays indiscriminately friendly behaviors, engages socially with strangers, and shows no need to remain near the safety of their primary caregiver.

RAD: What to Look For

Signs of RAD in infants and toddlers include a withdrawn appearance, a failure to smile, and a failure to react when parents or caregivers attempt to interact with them. For instance, a child with the disorder may not reach out when picked up or respond to a game of peekaboo. He may seem unaffected by the movements of others, and uninterested in watching others as they move about a room. Instead of seeking nurturing from a parent or caregiver, these children will attempt to nurture and soothe themselves. When distressed, they may calm down more quickly without the attention of an adult.

RAD: Risk Factors

A child who has experienced abusive or neglectful care is at risk for reactive attachment disorder. However the great majority of children who have been abused or neglected or who have experienced chaotic episodes in there early childhood do not develop the disorder.

RAD: Diagnosis

To be diagnosed with reactive attachment disorder a child must have a pattern of inhibited or withdrawn behavior towards caregivers. This is characterized by rarely or minimally turning to caregivers for comfort when distressed or responding to comfort when offered. The child must have experienced neglect or abuse in which the child’s early caregivers failed to meet his physical or emotional needs, or repeated changes in caregivers that severely limited opportunities for the child to form selective attachments. In addition the child must not meet the criteria for autism spectrum disorder, and be between 9 months and 5 years old.

Treatment for reactive attachment disorder usually involves both the child who has been diagnosed and his current caregivers. Treatment may include psychotherapy for the child, family therapy, parenting training, and special education services. Because RAD can be a painful and confusing experience for a child’s caregiver, psychotherapy or counseling may be advisable for parents, too.

Dialectical Behavioral Therapy and RAD

DBT has in practice for over 30 years. It has been used primarily with borderline personality disorders. DBT‘s approach is ideal for dealing with many of the issues children with attachment disorders have. It’s broad terms, it is used to help individuals who have extreme reactions to situations and struggle to cope effectively.

DBT can teach children how to cope with their internal thought processes and develop strategies to deal with their reactions in stressful situations. To be successful with RAD kids they be able to understand their own triggers. The presence of any other learning disabilities can present a significant barrier to effectively using DBT skills.