Reactive Attachment Disorder (RAD)

Reactive attachment disorder (RAD) is an uncommon but critical condition in which an infant/young child doesn’t form healthy and secure bonds with their primary caregivers. Children with this condition struggle to form connections with others, rarely seek comfort from caregivers and have trouble handling their emotions.

Babies bond with adults who provide them with constant, loving care and they recognize the adults who protect/calm them when they’re feeling stressed. In most cases, they develop healthy and secure attachments to their primary caregivers, such as their parents, daycare provider, or even grandparents. When babies struggle to form healthy relationships with a stable adult, they may develop a reactive attachment disorder, which can have profound effects on a child's growth and future bonds.


This disorder goes beyond behavior problems and in order to qualify for a diagnosis of reactive attachment disorder, a child must exhibit a regular pattern of inhibited, emotionally withdrawn behavior toward adult caregivers.

Some symptoms include the child: 

  • Rarely or minimally seeking comfort when distressed

  • Rarely or minimally responding to comfort when distressed

To meet the standards, they must also show two of the following symptoms: 

  • Minimal social and emotional responsiveness to others

  • Limited positive affect

  • Episodes of unexplained irritability, sadness, or fearfulness that are evident during non-threatening interactions with adult caregivers

In addition to displaying those symptoms, the child must also have a past of inadequate care as evidenced by at least one of the following:

  • Changes in primary caregivers that limit the child’s opportunity to form a stable attachment

  • Persistent lack of emotional warmth and affection from adults

  • Being raised in an unusual setting that severely limits a child’s opportunity to form selective attachments (such as an orphanage)

The symptoms must be present before the age of 5 and the child must have a developmental age of at least 9 months to qualify for a diagnosis of reactive attachment disorder.


Teachers, daycare providers, and primary caregivers are most likely to notice that a child with reactive attachment disorder exhibits emotional and behavioral issues. A thorough examination by a mental health professional can establish whether a child has a reactive attachment disorder. An evaluation may include:

  • Direct observation of the child interacting with a caregiver

  • A thorough history of a child’s development and living situation

  • Interviews with the primary caregivers to learn more about parenting styles

  • Observation of the child’s behavior


Reactive attachment disorder may result when children aren’t given proper care by stable and consistent caregivers. If a caregiver doesn’t respond to an infant’s cries or a child isn’t nurtured and admired, he may not develop a healthy attachment. If there’s a consistent disregard for a child’s emotional or physical needs, a child may be at risk for developing a reactive attachment disorder and a lack of stimulation and affection can also play a role.


The first step in treating a child with reactive attachment disorder usually involves ensuring the child is given a loving, caring, and stable environment. Therapy won’t be effective if a child continues jumping from foster home to foster home or if they endure living in a private setting with erratic caregivers.

It is important that the caregiver is educated about reactive attachment disorder and is given information about how to build trust and develop a healthy bond between them and the child. Sometimes, caregivers are encouraged to attend parenting classes to learn how to manage behavior problems.


There are several ways in which primary caregivers may be able to reduce the risk that a child will develop a reactive attachment disorder. These can also be helpful for coping with the symptoms of this condition and establishing healthy connections. Some examples include:

  • Educate yourself about child development: Learning how to respond to your baby’s cues and how to help reduce your child’s stress can be vital in developing a healthy bond.

  • Provide positive attention: Playing with your baby, reading to them, and cuddling with them can help establish a loving and trusting relationship.

  • Nurture your child. Simple everyday activities, like changing your baby’s diaper and feeding them, are opportunities to bond.


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