What is Reactive Attachment Disorder?

Reactive Attachment Disorder (RAD) is a relatively rare condition that impairs the natural social development of a child. While the disorder may not be immediately detectable in the child's earliest years, Reactive Attachment Disorder will usually manifest as a pattern of social relations that are out of alignment with a proper developmental path.


RAD can cause a child who possesses it to repeatedly fail at proper social initiation and responses. The child's hindered ability to maintain developmentally appropriate social relations may be classified as an "inhibited form" or "disinhibited form" of RAD; the former indicates a failure to begin or participate in developmentally appropriate social interactions, and the latter is a case of excessively high sociability that shows no regard for a lack of familiarity with strangers.

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Though the emergence of attachment disorder symptoms may be attributed to both environmental and biological variables, the condition has largely been linked to insufficient or abnormal attachment paradigms developed with a child's earliest caregivers.

Naturally, a child's failure to develop a healthy attachment to a primary caregiver can range from a variety of circumstances. In some cases, the inhibited form of RAD might be the directly linked to abuse or neglect; however, not all inappropriate attachment development patterns are caused by one caregiver's aggression or incompetence.

Between the ages of six months and three years, if a child is abruptly separated from their caregiver for any reason, they could suffer the lack of an opportunity to form normal attachment models in their most critically formative stage.

In addition to abuse, neglect, and abrupt separation, RAD can also be the cause of too many changes in caregivers over time. Without any significant amount of time spent with any caregiver over the others, the child may develop a disinhibited form of RAD from being unable to differentiate the relationship between familiarity and closeness.

It is important to note that while there are a multitude of unusual caregiver arrangements can result in RAD, none of them are guaranteed to result in the development of inhibited or disinhibited forms.

Diagnosis Criteria

Whether inhibited or disinhibited, the onset of RAD must come before the child has reached five years of age. The child must show a significant lack of developmentally appropriate social relation skills, such as excess affection for strangers and indifference to caregiver attention. There must be a demonstrated history of neglect and the lack of a primary caregiver that the child can be identified as preferring. The diagnosis is only possible if the symptoms don't meet the criteria for developmental delays or pervasive developmental disorder.


A variety treatment approaches have been suggested and enacted to resolve RAD, one of the most actively discussed being Attachment Therapy. Attachment Therapy implementation has been controversial, as its criteria for diagnosis are not shared with the DSM-IV-TR or attachment theory behavioral models. Because there haven't been many longitudinal studies on the outcome of RAD, there is not yet a consensus on what the most effective approaches to the disorder may be.