What is Reactive Attachment Disorder?


Few things make a parent happier than having an infant start laughing, smiling and squealing simply at the sight of them. But some children respond little or not at all, no matter what parents do. These children may have Reactive Attachment Disorder or RAD. It occurs when infants or young children do not establish healthy attachments with parents or caregivers.


RAD is usually caused by extreme, prolonged instances of insufficient care before the age of 5 years. Symptoms include:

  • Rare or minimal comfort seeking: The child rarely seeks comfort or consolation from others when very angry, upset or sad.
  • Rare or minimal response to comfort: The child finds little comfort when feeling very angry, sad or upset when someone says or does something nice for them.

Other behavioral indicators include:

  • Failure to smile or show emotional expression (hard to be excited, self-assured or cheerful)
  • Watching others closely but not engaging in social interaction (responds with very limited feelings)
  • Failing to ask for support or assistance
  • Failure to reach out when picked up
  • No interest in playing peekaboo or other interactive games
  • Withdrawal, fear, sadness or irritability that is not readily explained

Even among severely neglected children, most don’t develop RAD, so the exact cause is somewhat of a mystery. However, children with RAD usually have experienced one or more of the following:

  • Social neglect or deprivation in the form of the persistent lack of having basic emotional needs for comfort, stimulation and affection met
  • Repeated changes of primary caregivers that limit opportunities to form stable attachments
  • Rearing in unusual settings that severely limit the opportunities to form selective attachments

For a child to feel safe and develop trust, he or she needs a stable, caring environment. Basic emotional and physical needs must be consistently met. They need food, water, changing and love to instill healthy attachment. For instance, when a baby cries, his or her need for a meal or a diaper change must be met. As that need is met, the child will usually have an exchange with the caregiver that may include eye contact, smiling and caressing. Children whose needs are ignored or met with a lack of emotional response may regress in forming bonds with others and develop unhealthy attachments.

Most children are naturally resilient and even those who’ve been neglected, lived in orphanages or had multiple caregivers can develop healthy relationships. Various theories about RAD and its causes exist, and more research is needed to develop a better understanding and improve diagnosis and treatment.


Typical treatments for RAD and other attachment disorders often focus on both the child and parents/caregivers. Treatments include:

  • Family therapy
  • Individual psychological counseling
  • Play therapy/expressive arts
  • Special education services
  • Parenting skills classes
  • Sensory processing therapy
  • Speech therapy
  • Medication
  • Behavioral therapy

Further complicating a RAD diagnosis is that the child could have another disorder such as autism spectrum disorder. It’s important to have your child evaluated by a psychiatrist or a behavioral specialist who can assess your child for specific disorders.

Hannah Nail Coble is the lead clinical social worker with Cone Health Behavioral Medicine. Send questions to Sherri McMillen at sherri.mcmillen@conehealth.com.


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