Reactive Attachment Disorder


Reactive attachment disorder (RAD) is a rare but serious condition in which a child fails to establish healthy attachments to parents or other caregivers. It is caused by chronic maltreatment, neglect or abuse early in life. For instance, children born to drug or alcohol addicted parents learn very early on that things do not feel good and are not safe for them. In severe cases, where children have been abuse or violence victims, they learn that adults are hurtful and cannot be trusted.

The good news is that with proper treatment, children who suffer from RAD may develop stable and healthy relationships with adults. Treatment options include positive child/caregiver interactions; a stable, nurturing environment; psychological counseling, and parent and caregiver education.

Symptoms of RAD

How can you spot reactive attachment disorder in a child? Look for these symptoms:

  • Withdrawal, fear, sadness or irritability that is not readily explained.
  • A constantly sad, listless appearance.
  • Failure to seek comfort or show response when comfort is offered.
  • Failure to smile.
  • Failure to ask for support or assistance.
  • Failure to reach out when picked up.
  • Lack of interest in playing interactive games, such as peekaboo.

A child with RAD may try to completely control their world, as they feel they would otherwise be in danger – because they have not developed the normal attachments to other human beings that allow them to trust, accept discipline, or develop cause and effect thinking, self-control or responsibility.

A child with RAD may:

  • Initially be very charming, making you wonder why they have been reported otherwise. Then, after some time, they will suddenly become openly defiant, moody, angry and difficult to handle.
  • Be highly unpredictable from one day to the next.
  • Be unable to make or keep friends and not function well in groups.
  • Not perform well in school, despite having above-average intelligence. This is due to a lack of problem solving and analytical skills.
  • Test poorly, because they have not learned cause-effect thinking.
  • Self-inflict injuries or seek attention for minuscule or non-existent injuries – yet avoid adults when they have real injuries or genuine pain. They have not learned to seek and accept comfort because their earliest experiences have taught them that adults don’t care.
  • Be in a constant battle for control of their environment. If they are in control, they feel safe. If they are protected by an adult, they are convinced they will be hurt.

What You Can Do

Work closely with the parents of children with RAD. Talk with them about what you see at school. Parents who are in counseling and therapy with their children will eventually open up to you – and then you can help your RAD students to get healthy.

  • Make it perfectly clear to children with RAD that you will take care of them. Remind them – unemotionally but firmly – that you make the rules. Stay as neutral as you can, using structure and control without threat. Constantly acknowledge good decisions and behavior.

It’s a long road to effectively treating RAD, but when you do, remember what a vital role you’ve played in providing hope, encouragement and the chance at a normal life for a child most in need of it.

To learn more as you build your school-based therapy career, read our related posts or contact the expert team at Cobb Pediatric Therapy Services today.

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