Reactive attachment disorder is a pattern of mood and behavioral problems in children who have experienced neglect or abuse during early childhood. They are unable to form healthy, secure relationships with parents or caretakers because of the emotional neglect and abuse they have suffered. Typically, RAD is accompanied by a variety of emotional and psychological difficulties such as anxiety and depression, dissociative symptoms, internalising disorders (e.g., PTSD), social problems (e.g., oppositional defiant and antisocial behaviour), relationship problems and hyperactivity.
Research has demonstrated a significant link between a child’s RAD DSM reactive attachment disorder and future behavior, social, emotional and relationship problems. It has also shown that a child with RAD, either inhibited or disinhibited, is more likely to experience psychopathology than other children. Specifically, it has been found that both inhibited and disinhibited forms of RAD are associated with internalising disorders and a greater risk for externalising disorders such as behavioural problems and relationship problems.
Generally, a child with RAD is emotionally withdrawn and exhibits an avoidance of social reciprocity, fear of other people and selective attachment to a parent figure. They often show little or no affection, are irritable and angry, refuse to acknowledge a caregiver and may exhibit a blatant disregard for their own safety. They are often prone to lying and have trouble coping with changes in their environment or life circumstances.
Adults who suffer from RAD are frequently self-destructive and may engage in behaviors such as drug and alcohol abuse or impulsive ‘acting out’, which can have serious consequences. They have a difficult time informing, sustaining and developing healthy, loving relationships with other adults and have a hard time maintaining employment or a stable living situation.
In the past, RAD was divided into two categories, inhibited and disinhibited. Inhibited RAD is characterised by a lack of trust and fear of other people, a selective attachment to a caretaker and the ability to recognise faces, while disinhibited RAD is marked by indiscriminately social engagement with strangers. The latter is also known as disinhibited social engagement disorder (DSED).
The underlying cause of a child’s RAD is the failure to form a secure bond with primary caretakers during their first three years of life. This can occur if a child experiences chronic emotional, physical or sexual neglect, or if they are placed in multiple foster care situations, often without the ability to attach to any one of them.
The good news is that the damage caused by a lifetime of maltreatment can be reversed with a multi-pronged approach, including parenting education, trauma-focused therapy and family psychotherapy. Parent education focused on positive, non-punitive behavior management strategies, ways to respond to nonverbal communication and anticipation and coping strategies for when triggers arise and parent-child psychotherapy can help nurture and facilitate the development of a secure parental bond. This is a long-term process and requires a great deal of love, patience and realistic expectations from both the parent and the child.