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Reactive Attachment Disorder - RAD

Has your child been diagnosed with Reactive Attachment Disorder, or RAD? This article offers a definition of Reactive Attachment Disorder, includes signs and symptoms for RAD, and also offers treatment options for RAD. Find out if your children are at risk for developing RAD.

In a normal parent-child relationship that begins with the infants birth, the child's needs are met with appropriate responses and care. The repeated meeting of the baby's needs builds trust and attachment between the baby and the people who consistently provide what the baby needs, but there is a special bond between the baby and the primary caregiver or caregivers. Normal relationships serve the child as a model for their future relationships.

The attachment between caregiver and baby is promoted by biology. Most people instinctively feel care and concern for babies, and respond to their cries or other indications of need with attempts to supply their needs and comfort them. This type of caregiver also snuggles and pats the baby, coos to it, and responds to the baby's facial expression with mirrored expressions. When the caregiver and baby are separated, the baby becomes anxious, and is happy when they are reunited.

Unfortunately, not all parent-child relationships are normal, and when they aren't the strong attachment that should form between baby and caregiver may be disrupted. This attachment can be disrupted by a variety of behaviors that do not fit with the description given, including:

  • neglect of the baby
  • failure to respond consistently to the baby
  • abuse of the baby
  • switching of primary caregivers at least once

A child who has to remain in the hospital, whose mother experiences postpartum depression, who has parents who are mentally ill, or who is placed in an orphanage or other institution are at risk for RAD. Death or divorce occurring during the baby's infancy can also be a risk factor.

Reactive Attachment Disorder (RAD) is the name given by the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) to the disturbed attachment that results from the issues mentioned above.  This type of negative experience disrupts the bond and can result in an attachment disorder. Typical symptoms in babies include withdrawal, lack of response to smiles and being picked up, lack of interest in games or toys, not exhibiting typical anxiety when caregivers leave, appearing listless and sad, and rocking or other self-soothing behaviors.

The baby's experience may lead to a child who feels very alone and untrusting. Typical symptoms in children who are no longer babies include withdrawal, imperviousness to attempts at comfort, aggression toward peers, social awkwardness and/or discomfort and abstinence from social interaction. When the child with Reactive Attachment Disorder becomes an adolescent, he or she may abuse alcohol or drugs.

However, there are two types of RAD. Inhibited RAD describes the child who does not build attachments and often results from the loss of the baby's primary caregiver with no chance to establish a relationship with a replacement. Disinhibited RAD describes the child who attaches indiscriminately with anyone, including strangers, and children with this type of RAD will have somewhat different symptoms.

There have been a range of unacceptable treatments for RAD, which have been criticized by the American Academy of Child and Adolescent Psychiatry, the American Professional Society on the Abuse of Children, and the American Psychiatric Association. Acceptable treatment may include a combination of counseling, education, and medication, which may be used to treat co-existing disorders, such as depression.





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