What Is Reactive Attachment Disorder? Symptoms And Treatment


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Reactive attachment disorder or RAD is a condition in which infants and young children fail to establish healthy attachments with caregivers or parents. Babies usually develop the disorder when they do not receive basic emotional care, support, and comfort from their caregivers.

Infants with reactive attachment disorder may require treatments to creates table relationships with their parents, family members, caregivers, and others. Parent or caregiver education, psychological counseling, teaching positive child interactions, and creating nurturing and stable environments are some of the ways to tackle this condition.

Read this post to know more about the symptoms, causes, risk factors, complications, and treatment of reactive attachment disorder in infants.

Causes Of RAD In Babies

Babies need a caring and stable environment to develop trust and feel safe. Neglect, abuse, and lack of emotional response from caregivers or parents can cause RAD in some babies. Babies who face social and emotional neglect may have a higher risk of developing reactive attachment disorder than others. However, not all babies who face neglect develop it.

The lack of stable attachment and the subsequent risk of RAD could be higher in the following circumstances (1).

  • Babies in children’s home and institutions
  • Parenting issues due to parental mental health problems, criminal behavior, or substance abuse
  • Frequent changes in caregivers or foster homes
  • Prolonged separation from parents or caregivers in some situations, such as hospitalization
  • Mistreatment or abuse
  • Inability to meet the basic needs of the baby, such as not changing diapers, not responding to cries, or not feeding on time

Although many risk factors exist, some babies may develop RAD, and others may not. The exact cause is unknown and more studies are needed to determine the etiological factors.

Symptoms Of RAD In Babies

RAD symptoms usually begin in infancy and may persist during early childhood. There is not enough research on the persistence of RAD symptoms beyond early childhood. It is not clear whether RAD may develop in children older than five years or not.

Signs and symptoms of RAD in babies and toddlers could include (2):

  • Fear
  • Withdrawal without known causes
  • Sad appearance
  • Listlessness
  • Irritability
  • Not smiling
  • Not seeking comfort or not responding to comfort
  • Not showing arms to reach out while picking them
  • Lack of social interaction, although they observe others
  • Not crying or reaching out for assistance or support
  • Disinterest in interactive games, such as peekaboo

Young babies cannot explain what they feel or ask what they want. You may trust your parental instinct to analyze your baby’s reactions and emotions.

When To See A Doctor?

You may consider seeking an expert opinion if your baby has any signs mentioned above. Similar symptoms and signs may also occur in babies with other disorders, such as autism spectrum disorder.

Seek medical care to diagnose the exact cause. Evaluation by a pediatric psychologist or psychiatrist could determine the reasons for behavioral problems and prevent any complications.

Complications Of RAD

Untreated RAD that persists through early childhood may lead to lifelong issues. Some researchers suggest that children and adolescents who suffer from RAD could develop callousness, which is insensitive and cruel disregard for other people and animals.

Untreated RAD could affect a child’s attachment to others, and it is often linked to depression, anxiety, post-traumatic stress disorders, and many other psychological disorders in adulthood (3).

Children with unemotional traits may also show various behavioral problems. However, it is not clearly known whether the behavioral issues in late childhood and adulthood are related to reactive attachment disorder during infancy and early childhood.

Prevention Of RAD In Babies

The risk of developing RAD can be reduced by providing proper love and care to the infant. Parents must ensure that their baby’s emotional and physical needs are met continuously.

The following tips may help improve the relationship with your baby (1).

  • Engage with your baby by playing, smiling, and talking.
  • Make eye contact while feeding or doing any other activities.
  • Try to observe and understand your baby’s cues. You may be able to interpret the needs of your baby with their cry or facial expressions.
  • Respond to a baby’s feelings with verbal or nonverbal interactions, such as a change in tone of voice, touch, and facial expressions.
  • Interact with the baby during daily activities, such as bathing or changing diapers

It is essential to interact with the baby while completing tasks such as feeding, dressing up, or cleaning up a baby on time. Babies can be happier and more interactive and forge warm relationships when they know their parents or caregivers are there for them.

If you suspect a baby has already developed RAD, engaging with the baby may not be enough to improve the baby’s condition. Consult a doctor for diagnosis in such cases.

Diagnosis Of RAD

A pediatric psychiatrist or psychologist could evaluate the signs and symptoms of RAD. The diagnosis is not made before nine months of age. The following methods are used for the assessment (2).

  • Observation of a baby’s interaction with parents or caregivers
  • History of behavioral pattern and interaction with others
  • Examples of a baby’s responses in various circumstances
  • Questions for parents regarding residence and living conditions
  • Evaluation of a parent or caregiver’s skills and methods of care

The possibility of the following mental health disorders is usually ruled out before confirming the diagnosis of RAD.

  • Autism spectrum disorders
  • Depressive disorders
  • Intellectual disability
  • Adjustment disorders

If the baby meets the criteria mentioned in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) by the American Psychiatric Association, RAD is diagnosed. The criteria include:

  • Lack of emotional response to caregivers and not responding or rarely seeking comfort when distressed.
  • Presence of unexplained sadness, fear, irritability, and no response to other’s interactions.
  • History of frequent changes in caregivers or lack of opportunity for attachments, such as being in intensive care for a long time, in babies lacking emotional responses.
  • Other possible disorders are excluded.

Treatment Of RAD In Babies

Creating stable attachment with others is possible for all babies with reactive attachment disorders. However, their surroundings could hinder them from developing trust and attachment with those around them.

Regardless of the causes and circumstances, babies who receive early interventions are shown to have better outcomes. There is no specific treatment for RAD in babies. Parents or caregivers are involved in the treatment since the goal of the treatment is to create attachment.

The treatment options aim at creating a stable and safe living environment for the baby and a positive attachment with the caregivers or parents. The following strategies are used to develop positive outcomes (4).

  • Educating parents or caregivers about RAD
  • Providing positive responses and good care to nurture the baby
  • Not changing the caregivers frequently
  • Creating a stimulative and interactive environment for the baby
  • Meeting the medical, housing, and safety needs of the baby
  • Psychological counseling for the parents, caregivers, and other family members
  • Training to enhance parental or caregiver skills

The American Psychiatric Association and the American Academy of Child and Adolescent Psychiatry do not encourage controversial and coercive techniques to treat RAD. These methods include force or physical restraint to break causes of lack of attachment, such as giving food or water after letting the baby stay hungry or thirsty. These practices do not have any scientific evidence and often end up in fatalities (5).

Infants and children need a safe and caring environment for their proper mental and physical development. Always maintain eye contact and interact with babies while attending to them. No babies are born with a lack of attachment; the circumstances and experiences cause RAD. Providea loving, caring, and safer environment for the little ones.


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