Reactive Attachment Disorder

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KEY POINTS

• Reactive attachment disorder (RAD) is a rare condition in which infants and children are unable to trust or develop a healthy bond with parents or caregivers.
• Treatment may include play therapy, cognitive behavioral therapy, and family therapy. Medicines may be prescribed if your child is depressed, overactive, anxious, or violent.
• Parenting a child with RAD can be hard. Consider seeing a therapist for yourself or attending a support group.

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What is reactive attachment disorder?

Reactive attachment disorder (RAD) is a rare condition in which infants and children are unable to trust or develop a healthy bond with parents or caregivers. Children with this disorder may behave in frightening and sometimes violent ways.

What is the cause?

RAD is the result of abuse, neglect, or other parenting problems early in a child's life. Any child who lives through the loss of the primary caretaker, abuse, neglect, or multiple caregivers in the first 2 years of life can suffer from RAD. When a child’s basic needs for comfort, affection, and nurturing aren’t met, the child learns that he or she cannot depend on adults.

What are the symptoms?

Babies may:

• Never smile or respond to comforting
• Not look at people or reach out when picked up
• Not want to play with toys or play peekaboo
• Rock themselves when left alone

Toddlers and older children with reactive attachment disorder may:

• Be angry and unable to control impulses or be unable to express feelings of anger or discomfort
• Resist affection and withdraw from others
• Act aggressively
• Be on guard and on the go constantly
• Try to control everything and never ask for help or support
• Be demanding or clingy
• Refuse to eat, gorge, eat strange things, or hide food

How is it diagnosed?

Your child's healthcare provider or a mental health therapist will ask about your child's symptoms, medical and family history, and any medicines your child is taking. Your provider will check for a medical illness or drug or alcohol problem that could cause the symptoms. Your child may have tests or scans to help make a diagnosis.

How is it treated?

Children with RAD need to feel safe, be in a secure and stable home, and learn to trust a caregiver. They also need to learn to control their anger and accept rules. Treatments that may help include:

• Play therapy, which uses toys, games, and drama to help your child learn to deal with feelings. Play therapy helps your child express feelings without words.
• Cognitive behavioral therapy (CBT), which is a way to help your child identify and change views of self, the world, and the future. CBT can make your child aware of unhealthy ways of thinking. It can also help your child learn new ways to think and act.
• Family therapy is often helpful. Family therapy treats all members of the family rather than working with one person alone. It helps the whole family to make changes.

Medicines may be prescribed if your child is depressed, overactive, anxious, or violent. These medicines must be prescribed by a healthcare provider experienced with their use in children with this disorder.

Your child may need to spend some time in a hospital if your child is thinking about self-harm or hurting someone else.

There is no evidence that “holding therapy” or “rebirthing” are safe or effective. Talk with your child’s mental health therapist before you try an unproven therapy for your child.

What can I do to help my child?

• Help your child learn to manage stress. Teach your child to practice deep breathing or other relaxation techniques when feeling stressed. Help your child find ways to relax such as taking up a hobby, listening to music, watching movies, or taking walks.
• Take care of your child’s health. Make sure your child eats a variety of healthy foods and gets enough sleep and physical activity every day. Talk to your child about the risks of smoking, using e-cigarettes, drinking alcohol, and using drugs.
• Check your child’s medicines. Tell your child's healthcare provider and pharmacist about all the prescription and nonprescription medicines, natural remedies, vitamins, and supplements your child takes. Make sure that your child takes all medicines as directed. It is very important that your child take the medicine even when your child is feeling and thinking well. Without the medicine, your child’s symptoms may not improve or may get worse. Talk to your provider if your child has problems taking medicine or if the medicines don't seem to be working.
• Contact your child’s healthcare provider or therapist if you have any questions or if your child’s symptoms seem to be getting worse. Help your child keep appointments with the therapist.
• Learn all you can about RAD. This will help you know what behaviors to expect and what to do and say. When you are parenting a RAD child, it is easy to doubt yourself. Parenting a child who fights you every step of the way can be hard.
• Consider attending a support group. If you're a parent or caregiver of a child with RAD, you may feel frustrated and stressed. Talking with other people who face the same challenges can help you cope. It can help to see a professional therapist. You need to take care of yourself so that you can take care of your child.

Get emergency care if your child has thoughts of suicide or self-harm, violence, or harming others.