What is Reactive Attachment Disorder?

Simply stated, attachment is the emotional bond that a child forms with his primary caregiver. The quality of this emotional bond directly effect a child's ability to self-regulate and emotionally connect with others.  Very young children who experience neglect or abuse, or who lack access to a dedicated caregiver with whom they can form an attachment, are at high risk for attachment-related developmental problems, including Reactive Attachment Disorder (RAD), specifically.  As a result, some children from overseas orphanages or the domestic foster care system are at a higher risk of developing attachment related issues. 

Children who have experienced early neglect or abuse often have tremendous difficulty navigating between healthy exploration of their world and refuge seeking in adult caregivers, even after a stable and loving caregiver becomes available to them. Practically speaking, these children often have severe problems understanding and regulating their emotions and interact with others in ways that are inappropriate, confusing, and exasperating.

Identifying of Reactive Attachment Disorder (RAD)

The key factor that underlies Reactive Attachment Disorder is severe emotional neglect and/or abuse, occurring at an early age and especially before the age of 2.  Emotional and behavioral problems appearing similar to RAD symptoms, but emerging later in childhood or without history of neglect or abuse, are likely better explained by other mood, anxiety, or impulse-control disorders such as Bipolar Disorder, Severe Mood Dysregulation Disorder, Posttraumatic Stress Disorder, Oppositional Defiant Disorder, and Intermittent Explosive Disorder or developmental disorders such as Autism or Apserger’s Disorder.

If you know or suspect that your child may have experienced a sustained period of neglect or abuse early in his development, then consider the following symptoms as potential signs of Reactive Attachment Disorder:

• Persistent attempts to be the boss and direct caregiver behavior
• Is demeaning or punishing of caregivers
• Tries to take care of caregiver’s physical or emotional needs
• Is overly familiar with strangers
• Displays emotions that are inappropriate to the situation
  (e.g., laughing when he should be sad)
• Lacks fear or wariness in dangerous or unfamiliar situations
• Moods shift abruptly and severely
• Avoidance of eye contact except when angry
• Superficial friendliness
• Lack of empathy or moral insight
• Allows physical contact and affection only on her terms
• Compulsive lying and hoarding

These symptoms are listed not because they are exhaustive, but because they tend to differentiate between RAD and other disorders. You are encouraged to seek professional help from a licensed clinical psychologist with specified training in attachment issues if you suspect that your child may have RAD.

Next steps if you suspect that your child has RAD

Children with attachment-related problems experience the world differently than children who were able to form stable attachments in their earliest years of life. As a result, parenting a child with RAD requires understanding the developmental adaptations that occur in a neglectful and unpredictable interpersonal environment.

Correct diagnosis and a comprehensive treatment plan are essential to reaching your child and helping her to form secure attachments. Concrete steps can be taken to make sure that your child gets the support that he needs to work through early neglect or abuse and fully enter into his new life with you.

• Browse Dr. Olrick's available webinars to educate yourself about RAD and its available treatments.
• Schedule a consulation to with Dr. Olrick to discuss your concerns and how to move forward.
• Send your questions to Dr. Olrick by signing up for an email session.