Psychologist: Reactive Attachment Disorder (RAD)

A brief overview.

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I have heard that many internationally adopted children are at risk for Reactive Attachment Disorder. What is this disorder and what are some of the signs that parents should look for?

Reactive Attachment Disorder (RAD) is a condition in which individuals exhibit markedly disturbed and developmentally inappropriate social relatedness. Children with RAD have considerable difficulty forming meaningful, affectionate relationships. Since prenatal experience (e.g. exposure to substances), birth trauma, inconsistent or inadequate day care, separation issues, abuse, and neglect are precipitating factors that may lead to RAD, internationally adopted children evidence this disorder at a significantly higher rate than the general population.

Since healthy attachment to a caregiver is necessary for cognitive, emotional, social, and behavioral development, individuals with RAD often experience difficulties in these areas. The bottom line is that problems with attachment during the early years of life may compromise the quality of an individual’s life– particularly when it comes to relating with others.

What are some of the signs that parents should look for?

In infants, we see a general lack of connectedness. There is an indifference to others, including the parents; a resistance to physical contact; a lack of cuddling (e.g. the infant may appear stiff); poor eye contact; a lack of reciprocal smiles; and, oftentimes, a delay in reaching developmental milestones. With older children we see a continuation of these behaviors, as well as a host of other problematic behaviors, including poor peer relationships, poor impulse control, depression, aggression, a lack of conscience, abnormal speech patterns, and what seems like a preoccupation with control issues.

What can parents do?

All children– but particularly children with RAD– need structure and consistency. It is critical that they observe you modeling good social skills and that they are reinforced for their good social choices.

Children with RAD will often require professional intervention in order to work through traumatic experiences that compromised early developmental bonding. However, it is important to recognize that not all mental health practitioners are trained or willing to address the challenge of a child with RAD. Speak with your pediatrician and find a child psychiatrist, psychologist, or social worker with experience in working with attachment problems and childhood trauma. With early intervention, children with RAD can become respectful, resourceful, and responsible members of society.

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