Reactive Attachment Disorder
Reactive Attachment Disorder Jan 10, 2024

Reactive Attachment Disorder (RAD) is a term that describes a complex set of challenges faced by some children in forming healthy connections with their caregivers. This condition can profoundly affect a child’s emotional and social development, making early intervention crucial. In this article, we will explore the definition and prevalence of RAD, the signs and symptoms to watch for and delve into the essential role of therapy, particularly attachment-focused therapy, in the treatment of this disorder.

Understanding Reactive Attachment Disorder:

Reactive Attachment Disorder (RAD) is a psychological disorder that primarily affects children. It is characterized by significant difficulties in forming and maintaining healthy emotional bonds and connections with caregivers or parents. Children with RAD often struggle to develop a sense of trust and security in their relationships.

The disorder typically stems from early experiences of neglect, trauma, or inconsistent caregiving during a child’s formative years, particularly in the first few months or years of life. These early disruptions in a child’s attachment can have profound and lasting effects on their emotional and social development.

RAD shows itself through a bunch of signs and problems. The most important one is that the child struggles to make emotional bonds. This means they might feel unsafe or uncomfortable around the people who are supposed to look after them. They might also find it challenging to share their feelings or ask for help when needed.

Another sign is trouble with social things. The child might stay away from others, not look people in the eye, or avoid physical touch. Making friends becomes complicated, and they might feel like they don’t belong with others.

Behavioral issues are also part of RAD. Difficulties forming bonds often lead to behaviors like being aggressive, not handling emotions well, or not responding when someone tries to help or comfort them. These behaviors are like signals, telling us that the child is struggling deeper in building and keeping relationships.

Reactive Attachment Disorder (RAD) is not classified within the autism spectrum. It is a distinct psychiatric disorder that falls under the category of Trauma- and Stressor-Related Disorders in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). 

While both RAD and some conditions within the autism spectrum involve challenges in social interaction, they have different origins and characteristics. RAD is primarily associated with disruptions in early caregiving experiences, such as neglect or trauma, and it specifically involves difficulties in forming emotional attachments. Autism spectrum disorders, on the other hand, are neurodevelopmental conditions characterized by challenges in social communication and behavior, often present from early childhood.

It’s essential to recognize the distinctions between various disorders to ensure accurate diagnosis and appropriate interventions for affected individuals.

In simple terms, Reactive Attachment Disorder is not just about misbehaving – it’s a sign that a child needs exceptional help to build the strong and healthy connections they missed out on when they were little. The goal is to give them the proper support so they can grow up feeling safe, loved, and able to make strong bonds with the people around them.

Recognizing the Signs:

Identifying Reactive Attachment Disorder (RAD) involves paying attention to specific behavioral and emotional signs that indicate a child is facing challenges in forming secure attachments. One key aspect is the child’s struggle to trust and connect with their caregivers, which can manifest in various ways.

Social withdrawal is a common sign seen in children with RAD. They may keep to themselves, avoid engaging with others, and appear distant or isolated in social settings. This withdrawal can extend to difficulties forming connections with peers, making it challenging for the child to engage in typical social interactions.

Avoidance of eye contact is another noticeable indicator. Children with RAD might find it difficult to make eye contact with their caregivers or other people. Eye contact is a fundamental aspect of human connection, and avoiding it suggests a more profound struggle in establishing emotional bonds.

Resistance to physical touch is a significant manifestation of RAD. The child may not be comfortable with hugs, cuddles, or other forms of physical affection, even from those supposed to provide care and comfort. This aversion to touch reflects their challenges in forming a sense of security and trust.

Behavioral manifestations further highlight the difficulties associated with RAD. Aggressive behavior is one common way these challenges surface. The child may act angrily, displaying aggression towards others or themselves. Difficulty regulating emotions is another notable sign that the child may struggle to manage their feelings appropriately, leading to emotional outbursts or numbness.

A lack of responsiveness to comfort from caregivers is a crucial indicator. In typical situations, children seek comfort and reassurance from their caregivers. However, children with RAD may not respond positively to these attempts at comfort, creating a noticeable disconnect in the caregiver-child relationship.

Risk Factors:

Several risk factors increase the likelihood of a child developing RAD, and understanding these factors is vital for early detection and intervention.

Early neglect or trauma is a significant risk factor. If a child experiences neglect or trauma during their early years, especially during the critical period of forming attachments, it can disrupt the normal development of emotional bonds.

Extended periods in institutionalized care also pose a risk. Children who spend significant time in institutions without consistent and individualized caregiving may face challenges forming secure attachments.

Inconsistent caregiving is another risk factor. When caregivers are not consistently available or responsive to the child’s needs, it can create uncertainty and hinder the development of trust and emotional bonds.

Recognizing these risk factors helps professionals and caregivers identify children who may be at a higher risk of developing RAD. Early detection is crucial for implementing timely interventions that address the underlying issues and support the child in developing healthier attachment patterns.

Treatment Approaches:

When it comes to treating Reactive Attachment Disorder (RAD), attachment-focused therapy takes center stage. This therapeutic approach is about helping the child build trust, establish secure connections, and work through the core issues that make it hard to form healthy attachments with caregivers. The main goal is to create a safe and supportive environment that encourages the child to develop stronger bonds with those who care for them.

In addition to attachment-focused therapy, social skills development is a crucial component of treatment. This aspect focuses on improving the child’s ability to communicate effectively and positively interact with peers. Since RAD often impacts a child’s social interactions, working on these skills becomes vital in helping them navigate relationships outside the family unit.

Therapeutic Techniques:

Several therapeutic techniques are employed within the context of attachment-focused therapy to achieve positive outcomes:

  1. Play Therapy:

Play therapy is a powerful method where children use play to express their emotions and thoughts. Therapists can observe how the child interacts through activities and games and gain insights into their feelings and struggles.

Play therapy creates a comfortable space for the child to communicate without the pressure of direct conversation. It helps them express themselves in a way that feels natural and non-threatening.

  1. Cognitive-Behavioral Therapy (CBT):

CBT is another valuable tool in treating RAD. It focuses on addressing negative thought patterns and helping the child develop healthier ways of thinking and responding to various situations.

CBT aims to reshape the child’s perceptions, emotions, and behaviors by identifying and challenging distorted thought processes. This is particularly important in cases where RAD has led to negative beliefs about themselves, others, or relationships.

  1. Coping Skills Development:

Teaching coping skills is an integral part of therapy. Children with RAD may struggle to manage their emotions or healthily deal with stress. Therapists work on equipping them with practical coping strategies that they can use in their daily lives.

Coping skills may include self-regulation, emotional expression, and problem-solving techniques. These skills empower the child to navigate challenges more effectively.

By combining attachment-focused therapy with these therapeutic techniques, professionals aim to create a comprehensive and tailored approach to address the specific needs of each child with RAD. It’s not about fixing behaviors; it’s about helping the child build a foundation for healthy relationships and emotional well-being. The ultimate goal is to empower them to successfully form meaningful connections and navigate the complexities of social interactions.


In conclusion, understanding and addressing Reactive Attachment Disorder requires a multifaceted approach. Early intervention, the cornerstone of effective treatment, is supported by attachment-focused therapy and social skills development. While challenges exist, success stories underscore the transformative power of therapeutic interventions. As research continues to evolve, so does our understanding of RAD, offering hope for improved treatments and outcomes in the future. For now, the emphasis remains on early identification, intervention, and the unwavering support of caregivers in helping children overcome the challenges posed by Reactive Attachment Disorder.

"Attachment is not a connection between two objects, but a bond between two human beings." - Edward John Mostyn Bowlby
About author

Karuna Kaul is psycho socio clinical psychologist, who works with all age group people. Her profession motivates her to serve people who are facing behavioral issues. She has over 8 years of experience and has successfully established credibility in the areas of counselling and wellness. Assessment and behavioral analysis and training and coaching. She has been an active advocate of mental health awareness. And all her endeavors in the field are primarily focused on educating more and more people about Mental Health concerns and promoting Holistic Wellbeing. She has done master in clinical psychology PG Diploma in counselling and guidance and certified in drug addiction counselling Also she has done neuro medicine psychology from London University, Kent College of United Kingdom. With an experience of six years, she had worked with various organization which provides mental health services.