Reactive Attachment Disorder

Reactive attachment disorder (RAD) is a severe disorder of social functioning caused by social neglect and mistreatment.

Behaviour Help is a registered NDIS provider.

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Definition of  Reactive Attachment Disorder

Reactive attachment disorder (RAD) is a severe disorder of social functioning caused by social neglect and mistreatment. This disorder stems from early childhood when a young child lacks the loving care and nurturing to be able to form a secure, healthy emotional bond and attachment with their parents or caregivers. In some instances, the disorder may develop if the basic needs of the young child, such as affection, healthy nurturing or comfort are not met or established leading to lack of stable, loving and caring attachments with those around the child and consequently with those around them (Cuyvers et al., 2020; Ellis et al. 2021; Pritchett et al., 2013 & Turner et al, 2019). 

 

Causes of Reactive Attachment Disorder

Attachment develops when a young child is continually calmed, soothed or comforted, cared for and nurtured, and when the care from the parent or caregiver constantly meets the child's needs. The absence of emotional warmth during the first few years of life can negatively affect a child's future. It’s therefore through attachment with a loving, nurturing, caring and protective parent or caregiver that a young child learns to love and trust others. Once the young child learns to love and trust then they can be sensitive about the feelings and needs of others, to manage their emotions as well as to be able to develop a positive self-image and healthy relationships and healthy attachments with others. When this safe and nurturing environment is lacking, the child may not be able to create healthy connections to form attachments with others.  

There are many examples of caregiving and safeguarding situations that may place a child at higher risk of developing this disorder. These situations include: 

  • When a baby is in distress, crying but repeatedly not attended to or comforted. 
  • When a baby is hungry and repeatedly goes for hours without being fed.
  • When a baby’s diaper is wet or soiled but repeatedly not changed for hours. 
  • When a baby is almost never held, touched, talked to or interacted with for many hours or a long period of time, hence missing the human connection. 
  • When a parent or caregiver is negligent of the child and not consistent in meeting the child’s needs.
  • When a child is exposed to frequent changes of caregivers or caretakers consistently change. 
  • Situations where the child is physically, emotionally and psychologically neglected or abused by the parent or caregiver, caretaker or others.

(Cuyvers et al., 2020; Ellis et al. 2021; Pritchett et al., 2013 & Turner et al, 2019)

 

Types of Reactive Attachment Disorders

There are two main types of reactive attachment disorder. These are: 

  • Inhibited reactive attachment disorder – this is when the affected child shows signs of inexplicable signs of being wary, watchful and overly vigilant. In most cases, such affected children may be aware or sensitive about what is going on around them but may not show any signs of interest in their environment or what is going on around them. 
  • Disinhibited reactive attachment disorder – this type of RAD exhibits itself when the affected child is overly and indiscriminately friendly to strangers, socializing freely with strangers without the normal child withdrawal to safety when around strangers and/or showing no need to be close to a parent or caregiver for safety. 

 

(Cuyvers et al., 2020; Ellis et al. 2021; Pritchett et al., 2013 & Turner et al, 2019)

 

Symptoms of Reactive Attachment Disorders

Some of the generally common signs and symptoms of reactive attachment disorder include: 

  • Those affected would show signs of chronic patterns of being emotionally withdrawn, keeping to themselves, looking sad, being afraid or showing fear or unfounded or inexplicable irritability. 
  • Those affected would appear sad and lethargic and fail to smile without a clear cause.
  • Some may not seek comfort even when in distress or may not even respond to comfort when it is offered. 
  • Not engaging in social interactions despite being in social environments with others. 
  • Failing to seek support or any form of assistance when one needs it.
  • Failing to reach out even when being picked up.
  • Showing no interest in playing fun games or other interactive games with others or themselves.
  • An affected child or person may not show or express conscience emotions such as regret, remorse or even guilt. 
  • Affected children or persons may avoid physical touch from parents or caregivers. 
  • Affected children or persons may avoid making eye contact with others.

(Cuyvers et al., 2020; Ellis et al. 2021; Pritchett et al., 2013 & Turner et al, 2019)

 

References

Cuyvers, B., Vervoort, E. & Bosmans, G. (2020). Reactive Attachment Disorder Symptoms and Prosocial Behavior In Middle Childhood: The Role of Secure Base Script Knowledge. BMC Psychiatry, 20, 524 (2020).

Ellis, E.E., Yilanli, M., Saadabadi, A. (2021). Reactive Attachment Disorder. NIH. https://www.ncbi.nlm.nih.gov/books/NBK537155/

Pritchett, R., Pritchett, J., Marshall, E., Davidson, C., & Minnis, H. (2013). Reactive Attachment Disorder in The General Population: A Hidden ESSENCE Disorder. The Scientific World Journal, 2013, 818157.

Turner, M., Beckwith, H., Duschinsky, R., Forslund, T., Foster, S. L., Coughlan, B., Pal, S., & Schuengel, C. (2019). Attachment Difficulties and Disorders. InnovAiT12(4), 173.

 

Behaviour Help

If you are supporting an individual with this diagnosis, please refer to our services and resources. They aim to help children, adolescents and adults achieve better communication, social, emotional, behavioural and learning outcomes. So whether you are wanting guidance on parenting, teaching, supporting or providing therapy, Behaviour Help is at hand.

Note: This is not an exhaustive list of all the possible causes, symptoms and types but some general information that can be further explored. Based on what you have read if you have any concerns about an individual, please raise them with the individual/s. The caregiver can then raise these concerns with their local doctor who can provide a referral to the relevant professional (e.g. paediatrician, psychologist, psychiatrist, allied health professional and learning specialists) for diagnosis and treatment if appropriate.

Which resources are right for you?

Apps

Based on the Taking CHARGE of Rainbow of Emotions Workbook this app helps children of all ages develop emotional regulation skills. The app guides the child to firstly, identify and express their emotion in appropriate ways. Then the child is guided to use emotional management tool/s from the CHARGE tool kit to manage their emotions in a healthy way.

The acronym CHARGE stands for the different categories of emotional management tools – Chat tools, Helpful thinking tools, Amusement tools, Relaxation tools, Good routine tools and Exercise tools.

Behaviour Help App - Using the evidence-based approach of Positive Behaviour Support (PBS), the Behaviour Help web-based app allows people supporting individuals with emotional and behavioural difficulties to complete a Functional Behaviour Analysis and put together a comprehensive Behaviour Support Plan (BSP). The BSP can then be used by everyone interacting with the individual to manage and prevent challenging behaviours and ultimately improve their lives, and the lives of those who support them.

Books

If you want to learn more about emotional and behavioural difficulties then we have a great range of books you can read on your Kindle or order from Amazon.

Coaching

Personalised and practical one to one help tailored specifically to your family.

Online Courses

Access these online courses anytime online to learn about a range of diagnoses, practical skills and strategies to help develop the individual’s emotional regulation skills. Also learn to utilise the positive behaviour support framework to address anxiety, aggression, ADHD, ASD and ODD.

SEL Educational Videos

Minimise or eliminate the occurrence of challenging behaviours by teaching children of all ages appropriate ways of communicating, interacting, managing their emotions and behaviours.

The SEL curriculum uses video modelling to provide direct, explicit and systematic teaching of the various skills by discussing the importance of the skill, modelling the skill so the child learns what the skill looks like? sounds like? feels like? and learn the skill in staged situations that simulate real life scenarios.

Therapy

Personalised and practical behaviour therapy tailored specifically to your family.

Webinars

Webinars discuss a range of practical strategies to guide your child learn positive ways of behaving and managing their emotions.

Workshops

Attend our practical and interactive workshops to learn about a range of diagnoses, practical skills and strategies to help develop the individual’s emotions, behaviours, social and communication skills in your learning environment.

Ask Dolly

Since you’re here, you probably have questions and concerns. I am Dolly Bhargava, am here to help. I am a NDIS registered behaviour support practitioner and speech pathologist.

I have worked in a number of settings for over 21 years so, how can I help?

Please tell me what is worrying you right now and I will do my best to recommend resources and/or services that will be most useful to you in your situation.

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