Reactive Attachment Disorder, often referred to as RAD, is a rare condition that creates difficulty for a child to form healthy, loving relationships with others. My husband and I were foster parents for 8 years. During that time, we attended many trainings and seminars about topics such as attachment and trauma. I read books and did research. I had a lot of head knowledge when it came to Reactive Attachment Disorder. Nothing I read or heard could have prepared me for what it is like to live with it.
At that time, we were fostering babies and toddlers. We focused on attachment in our parenting and worked on trying to heal any attachment issues that were present.
While I’m thankful that I did have that head knowledge and wasn’t starting from square one, it was a shock when we later adopted older children internationally and they were diagnosed with Reactive Attachment Disorder.
On this page, I am sharing resources pertaining to Reactive Attachment Disorder. I have briefly summarized the information here and provided links that will allow you to go into further depth on any of the subtopics that interest you.
What is Reactive Attachment Disorder?
Reactive Attachment Disorder is listed in the DSM-V. It is a mental disorder that can even be applied to infants.
Attachment issues in children fall across a spectrum. Reactive Attachment Disorder is the most extreme end of that spectrum. Children with RAD feel unsafe attaching to a primary caregiver or parent.
These children were unable to form a healthy attachment due to neglect, early childhood trauma, insecure or disorganized attachment style in the parent, multiple placements such as foster care or multiple caregivers such as in the case of an orphanage or group home, or abuse.
You can read more about Reactive Attachment Disorder including a helpful analogy taught to us by a very wise woman by clicking here: What is Reactive Attachment Disorder?.
What causes Reactive Attachment Disorder?
The simple answer is that when a child determines at an early age that they cannot trust that their needs will be met by the adult who is supposed to meet them, the attachment cycle is disrupted and Reactive Attachment Disorder can result.
It generally occurs when attachment between a child and their primary caregiver doesn’t take place or is interrupted.
Why it occurs in one child and not in another when they have similar backgrounds is a bit of a mystery.
Here are some of the risk factors for RAD:
- loss of a parent at a young age
- early and lengthy hospitalization due to prematurity or health concerns
- severe postpartum depression in their mother
- living in an orphanage or institutional care
- bouncing around from one home/foster home to another
- physical, emotional, or sexual abuse
- early childhood trauma
What are the symptoms of RAD?
If you suspect that your child may have Reactive Attachment Disorder but aren’t sure, you can read here about Recognizing the Signs of Reactive Attachment Disorder.
While there is no perfect checklist of symptoms of RAD, if your child exhibits some of the signs, you will want to have them assessed by a professional. It is important to get a diagnosis in order to be access treatment for your child.One of the questions that struggling parents often ask me after they receive a diagnosis of Reactive Attachment Disorder for their child is where they should start.
I think the most important place to start is by getting a better understanding of what Reactive Attachment Disorder is and focus on taking care of yourself in order to best meet the needs of your child.
What is it like to parent a child with Reactive Attachment Disorder?
Parenting kids who have RAD is the hardest thing I have ever done in my life. It is often lonely and scary. I am stretched to the very edges of my comfort zone and skill level and beyond on a daily basis.
It is sometimes rewarding, especially when I look at the small wins and remember how far we’ve come.
There are a lot of the same challenges that come along with parenting other kids, but the frequency and severity of the behaviours is to the extreme.
It is certainly exhausting.
I second guess myself.
I go to sleep at night wondering if I could have done more.
I wrote the article below to try to help others understand what it’s really like to parent a child with this disorder:
What I Wish you Knew About Parenting a Child with RAD
What is the treatment for RAD?
There are many treatments for RAD. Often, it is recommended that a combination of treatments be used. The type of treatment varies depending on the child, the severity of symptoms, and any other diagnoses that exist in addition to the diagnosis of Reactive Attachment Disorder.
The treatment that we have found the most effective for our kids with RAD was TBRI (Trust Based Relational Intervention). It is based off this theory; “Our children were harmed in relationship and they will experience healing through nurturing relationships” ~ Dr. Karyn Purvis.
We use it in conjunction with some other treatments. You can read a full list of treatment options here.
There are professionals who specialize in treating attachment disorders and early childhood trauma. It is always best to find a qualified, experienced professional.
Is there a cure for Reactive Attachment Disorder?
The debate rages on when it comes to answering this question. I can tell you one thing though based on our personal experience. There is hope.
Read more about how we found hope to cling to even in the midst of Reactive Attachment Disorder and the transformations that have happened with our kids.
The Best RAD Books:
The Connected Child: Bring hope and healing to your adoptive familyParenting from the Inside OutThe Whole-Brain ChildAttaching in Adoption: Practical Tools for Today’s ParentsNurturing Adoptions: Creating Resilience after Neglect and TraumaAdopting the Hurt Child: Hope for Families with Special-Needs KidsBuilding the Bonds of Attachment: Awakening Love in Deeply Traumatized ChildrenThe Body Keeps the Score: Brain, Mind, and Body in the Healing of TraumaThe Explosive Child
What are the two types of Reactive Attachment Disorder?
Reactive Attachment Disorder is sometimes classified into two types, Inhibited and Disinhibited. Here’s where it gets tricky. These are no longer part of the DSM-V. They are now classified as Reactive Attachment Disorder (RAD) and Disinhibited Social Engagement Disorder (DSED).
I do feel that it can be beneficial just to know what the types were and to be able to identify them. One of our children who had been diagnosed with RAD was Inhibited so when another of our kids did not show those same signs and acted out differently, I was confused. When that child also got a diagnosis of RAD, I wasn’t sure of the accuracy of the diagnosis until I learned about the two types.
I was then able to realize that we have one child with one type and one child with the other type. The positive is that this makes me an unofficial expert on RAD (!) because I’ve experienced both kinds. The negative of course is that I’ve had to learn new strategies and do more research.
Children who have Inhibited Reactive Attachment Disorder exhibit signs such as being withdrawn, emotionally detached and distant. They are hypervigilant, but do not always seem to react. They can push others away and can be verbally or physically aggressive if they feel perceive a threat to their safety (which can include someone just trying to get close emotionally or physically).
Children who have Disinhibited Reactive Attachment Disorder can be indiscriminate (not showing a preference for their parent or primary caregiver over others, even strangers). They often act much younger than their age and can be very anxious. They will go for comfort and attention to pretty much anyone, usually snubbing their parent in the process. This can be painful for the parent or primary caregiver.
Additional Resources on RAD:
Karyn Purvis Institute of Child Development
Activities to Promote Eye Contact
Helping a Child Through Trauma
Helping Kids Understand Sensory Processing
Body Tracing Affirmation Exercise
To the Mom Whose Child Sabotages Mother’s Day
Why Kids Don’t Outgrow RAD (and what happens when they grow up without help)
Dear Teacher: An Honest Letter to my Reactive Attachment Disorder Children’s Educators
Bonding and Attachment in Maltreated Children: How You Can Help – Dr. Bruce Perry (great read for teachers particularly)
Am I Going Crazy? (a mom’s perspective)
Parenting in The Chaos and The Clutter (special needs parenting support including parenting RAD)