Reactive Attachment Disorder

Nature of Disorder

Reactive attachment disorder is characterized by the inability of a child to establish a healthy attachment to their parent or primary caregiver.

Attachment, the deep connection established between a child and their parent or primary caregiver, is incredibly important for early development of a child and can impact their relationships with others later in life. Thus, a child’s inability to establish a healthy attachment to their parent can cause difficulty connecting to others or managing their emotions as they age.

Infants and children whose emotional and physical needs are neglected at a young age have a much higher risk of developing reactive attachment disorder. The risk of developing RAD is also higher for children who live in orphanages, live in multiple foster-care situations, are separated from parents for an extended time, have a mother with postpartum depression, or have inexperienced or neglectful parents. Children with reactive attachment disorder withdraw emotionally and can lack trust in other people. These children may also experience other disorders as a result of anger and control issues, anxiety, and poor self-esteem.


The early signs and symptoms of reactive attachment disorder can often been confused with the early symptoms of ADHD and autism.

Children who suffer with reactive attachment disorder may feel as if no one cares and may feel unsafe in their surroundings. The earlier symptoms of attachment issues are identified, the better. Infants may avoid eye contact, do not reach to be picked up, or reject efforts to be calmed or soothed. Infants may also cry inconsolably or spend a great deal of time rocking or comforting themselves. Reactive attachment disorder can be harder to identify in older children and adolescents. Withdrawal and avoidance are common in adolescents with RAD. They encounter difficulty forming connection with peers and adults throughout life. Adolescents may also demonstrate an aversion to touch and physical affection, control issues, anger problems, or difficulty showing genuine care and affection.

With age, reactive attachment disorder may develop into either inhibited or a disinhibited pattern of symptoms. Children expressing inhibited symptoms of RAD are extremely withdrawn and emotionally detached. While they are aware of their surroundings, they do not respond. Alternatively, children expressing disinhibited symptoms of RAD seek comfort and attention from virtually anyone, and are extremely dependent.


An inability to form meaningful relationships with parents and others can impact children with reactive attachment disorder in many different realms of life.

They may experience low self-esteem and lack basic social skills. They may act distant or aloof, further isolating themselves from others. The multiple effects of reactive attachment disorder may also lead to sleep problems, academic issues, and even depression and other anxiety disorders. Other effects of reactive attachment disorder include:

  • Inability to engage in exploration and play
  • Peer rejection
  • Sense of fear
  • Hypervigilance, looking for danger
  • Self-soothing behaviors such as rocking, rubbing own arms, etc.
  • Substance use (primarily in teens, but can be seen in older children, too)
  • Masking feelings
  • Awkwardness and discomfort in any social context, including the classroom


Treatment for reactive attachment disorder typically involves a combination of psychotherapy for the child, family therapy, parenting training, and special education services.

The combination of treatments for reactive attachment disorder seeks to ensure that the child develops positive interactions with caregivers, has a safe living environment, and improves relationships with peers. The earlier help is sought out, the better it is for child development.