Children are born into all kinds of situations and not all of them are ideal. We hope that our children and others that we know have happy and healthy lives- a home that they can grow and thrive in. This means food, clothing, safety, love, among other basics. Maybe they can have a little more. Unfortunately, not all children have even those basics, by no fault of their own.

These events can lead to damaging, even traumatic consequences. Some issues can fade  (but not entirely disappear) with time, therapy and changes to the child’s life. Some are permanent, no matter what changes are made. One of these issues that children can face is reactive attachment disorder, which can start as soon as infancy.

What is attachment? 

It is the deep connection between you and your child that affects their ability to connect with others and express emotions later in life.

When Needs Are Not Met

Babies need a lot- food, cuddles, diaper changes and so on. When they are not met in a short amount of time, or by someone that is not gentle with them, or at all, the baby learns not to trust others. This can begin a lifetime pattern of not being able to trust others, but not knowing exactly why (at least not for a long time). This can impact their ability to form healthy and trusting relationships.

Some examples are:

  • A baby is in foster care due to issues within her biological home, but her foster parents are not responsive to her needs. She cries to be fed, but her foster mother takes up to a half hour to come to her to do so. She learns through this that she can not rely on others to help her.
  • The child of a single mother that is a drug user cannot form a strong bond with his mother. She is not very, if at all, responsive to his needs.
  • A child has moved around between family members. She is not in a stable home long enough to form secure bonds with anyone.
  • A child’s needs are met inconsistently- they don’t know what to expect.
  • A child is being abused- physically, sexually or emotionally.


The Emotional Toll

These children have difficulties expressing emotions- they even have a hard time smiling. They don’t want to show that they are hurting (either emotionally or physically) and rarely seek comfort when they are. They don’t think anyone will help them. It is very common for them to be withdrawn from others. They also have a feeling of low self-worth, feelings of anger, may not like getting close to anyone, and feel a need for control.

Some early signs of RAD are:

  • Doesn’t reach out to you
  • Doesn’t seem to care about being left alone
  • Doesn’t seem interested in games or toys
  • Avoids eye contact
  • Spends a lot of time self-soothing

Note: Some of the signs can be similar to the early signs of autism, so the child needs to be seen by a mental health professional to rule this out.

To meet the criteria for Reactive Attachment Disorder (RAD), a child must have at least one of the following before age 5:

  • Changes in primary caregivers that severely affect the child’s ability to form secure attachments
  • Persistent lack of warmth from adults in the child’s life
  • Being raised in an unusual setting that prevents the child from being able to form secure attachments (ex. group home, etc)

There are no exact numbers on how many children have RAD, due to the newness of the diagnosis. It is known that children in foster care, have been abused or have been taken away from their primary caregiver after forming a bond are more likely to be diagnosed with RAD. Many children with RAD are also developmentally delayed.

Getting A Diagnosis and Finding Solutions

In many situations, either preschool or kindergarten teachers are among the first to see symptoms of RAD. They can sometimes see the things that parents and other family members don’t. In other cases, it may be the family or other caregivers like daycare providers.

A mental health professional can make the diagnosis after completing an evaluation containing:

  • An observation of the child with a caregiver
  • History of the child’s development and living situation
  • Interviews with the primary caregiver
  • Observation of the child’s behaviors

The mental health professional will need to rule out any other disorders before diagnosing RAD.

Treatment for RAD includes the child and their main caregiver. It can’t be effective if the child is constantly moving from place to place so the child will need to be in a consistent, if not a permanent home. During therapy, the caregiver is educated about RAD and how to make their home secure and loving for the child. They are also taught on how to build trust with their child and how to show love in a healthy way.

Parents of children with RAD need to find support and take care of themselves- it does go a long way in helping their children. Patience and realistic expectations also help because attachment is a process. It does not change overnight.

Some parents may need classes on how to manage behavior issues, depending on the situation. There have been some controversial therapies attempted in the past, like “rebirthing”, in which one child died. Physical restraints are also discouraged. Without treatment, however, a child is at risk for ongoing behavior and/or emotional issues in the future, potentially life-long.

Preventing Reactive Attachment Disorder

There are ways to prevent this from affecting your child or a child close to you.

  • Learning about child development. This can help with knowing what to expect during infancy, the toddler years and beyond.
  • Providing positive attention. Playing with, cuddling and other activities can help establish a bond with your child.
  • Learn about attachment issues. If you are raising a child with attachment issues, learn about them and what you can do to help. It may take time but it will be well worth it.


This disorder can be a heartbreaker, but with enough love and work, there is a possibility of a good ending.

For more information:

Help Guide

RAD information