Help Us Help Others:

Reactive Attachment Disorder, or RAD for shot, is a condition seen in kids who have been subjected to abuse, neglect, foster care placement, institutionalized care, or abandonment very early in their lives. While the official diagnosis of RAD is very rare, many children with attachment injuries display the types of behaviors associated with reactive attachment disorder.

The definition of Reactive Attachment Disorder

The Diagnostic & Statistical Manual (DSM) produced by the American Psychiatric Association defines RAD as “markedly disturbed and developmentally inappropriate social relatedness in most contexts; symptoms begin before age 5 years and are associated with grossly pathological care.” (DSM IV-TR, 2000, p. 130)

Signs & Symptoms of Reactive Attachment Disorder

Reactive attachment disorder is generally divided into two different subtypes:

Inhibited type

These children react to their attachment injuries by building a wall between themselves and anyone who might love them, or by seeking affection and then reacting violently at the first hint of rejection. They are often moody, angry, defiant, and difficult to control. Some characteristics of inhibited RAD:

  • Angry and defiant behavior
  • Will defensively push others away out of self-protection to reduce feelings of hurt
  • Problems controlling their impulses
  • An inability to regulate moods and emotions
  • Prone to fits of violence or extreme tantrums
  • Uncomfortable with expressions of love and affection
  • Little empathy towards others
  • Alters between being extremely affectionate and extremely moody or distant
  • May be charming or flirty with strangers but defiant or disrespectful to primary caregivers
  • Poor peer relationships – they often have few friends, and those they list as friends may not actually like or are really just acquaintances
  • Lies or deceives others with no apparent motive or reason
  • Can be manipulative at times
  • The tendency to sabotage just about every good or positive thing that happens to them
  • They may punish themselves to punish you
  • Self-destructive behaviors such as destroying their own belongings or cutting
  • Automatically responds to adult direction with a “No” or “Why?” statement before even hearing or understanding what the command was

Disinhibited type

These children take precisely the opposite approach, doubling down on their efforts and becoming excessively affectionate, clingy and needy. They might try to reach out to anyone and everyone for love and affection, often in socially inappropriate ways. Some signs and symptoms of inhibited RAD:

  • Clinginess and separation anxiety
  • Poor understanding of social boundaries; lack of respect for personal space
  • Gives affection to strangers or has a tendency to wander off with them, even long after being adopted
  • Other kids may be afraid of strangers and have difficulty discerning between those who want to help them and those who mean them harm, which means they often misbehave more around strangers
  • Attention seeking behaviors
  • Sexualized affection
  • Poor impulse control
  • Excessively needy–they may ask for help even when they don’t need it or exaggerate their helplessness
  • Are eager to please, and may be cooperative to an unnatural or superficial degree
  • Are chronically anxious, always worried about who’s coming or going
  • Aren’t as disruptive as inhibited types, but they’ll often do a lot of little things wrong without ever doing anything really bad
  • May exhibit passive-aggressive behavior
  • Can come off as shallow or superficial to others

Rather than fitting into all of one category or all of the other, multiple studies have suggested that many children with RAD exhibit both inhibited and disinhibited behaviors. (Zeanah et al., 2004; Smyke, Damitrescu & Zeanah, 2002) As for the cause of these different patters, “Haugaard and Hazen (2004) describe the inhibited type of RAD as a pattern resulting from experience with caregivers who do not provide emotional support and comfort when needed,” says Lyons Hardy. “Because children who have been treated in this way expect to be rejected by others, they avoid social contact.” (Hardy, 2007, p. 31) The disinhibited type of RAD is believed to form when caregivers are not naturally responsive but can be coaxed and coerced into providing affection if kids are persistent enough.

The number of kids with reactive attachment disorder

RAD is a rarely diagnosed disorder, and so it’s hard to get a handle on precisely how many kids have it. Yet there’s evidence it may be going undiagnosed. One study found that 40% of toddlers in foster care meet the diagnostic criteria for RAD. (Zeanah et al., 2004)

Yet this vastly understates the overall problem of attachment disorders, which are much more common and lead to behaviors very similar (if not identical to) RAD symptoms. As Lyons T. Hardy states, “limiting the conception of attachment-related psychopathology to the narrow diagnostic criteria of RAD significantly understates the importance of other attachment related conditions and may limit the use of potentially effective interventions.” (Hardy, 2007, p. 31)

Effects & consequences of reactive attachment disorder

I consider RAD to be the most profoundly debilitating psychiatric diagnosis a child can receive, and I’m sure many other experts would agree. It can be both crippling and difficult (though not impossible) to treat. With the exception of callous & unemotional traits (i.e., a psychosis label for children which, not coincidentally, is most often seen in children with attachment injuries), I don’t know of any other condition that so profoundly wounds a child and leaves caregivers struggling to deal with them. In the worst cases it creates a psychological barrier that prevents them from getting the types of loving medicine that would help them get better.

That said, no child is a lost cause. If you think a child has reactive attachment disorder, our books Vulnerable Children and Disturbed Kids (www.keep/books-publications) will help you unlock the loving soul that exists beneath the scars.

Treatment for kids with Reactive Attachment Disorder

There are no medicinal treatments for RAD. Psychological therapies typically consist of cognitive behavioral therapy and parent-child interaction therapy. (See our section on attachment disorder therapies.)


Help Us Help Others: