Reactive Attachment Disorder- An Alarm for Parents

Introduction: Reactive Attachment Disorder

Reactive Attachment Disorder as the name suggests is a condition causes primarily due to attachment-related problems among children. Reactive Attachment Disorder is also known as RAD is a condition among infants where the child is unable to form a secure and healthy relationship with the primary caregiver such as parents.

But before we understand what Reactive Attachment Disorder is, we need to understand what attachment means for children and how this can affect the overall future wellbeing of the child.

Attachment is a unique and emotional bond shared between two individual. Attachment is a very important aspect of an infant’s life because even before birth it is shared with the mother. Attachment during infancy and pre-school is mainly focused on the relationship between parents as primary caregivers and children.

Attachment for children is related primarily towards satisfaction of basic needs. On the other hand, research done by psychologist Harry Harlow on monkeys suggests that children need warmth, care and comfort along with food, water and shelter. Also, another view by psychologist Bowlby, suggests that attachment among infants is primarily related to the need for safety and security.

But when the primary caregiver i.e. parents are not available for providing safety, comfort and care through actions like soothing the crying child, giving attention to the child when in need, cleaning and feeding the baby when necessary can lead to such disorders.

What is Reactive Attachment Disorder?

RAD could be said as emotional dysfunction, mainly caused due to early neglect/ mistreatment by parents or caregivers. This condition can lead to an inability in managing emotions, fear about forming intimate relations, lack of trust and self-worth among children. This could be observed in their behaviour such as being aloof, irritable, getting angry easily and always feel the need to be in control. But does this occur in all children?

In Whom does Reactive Attachment Disorder Occur?

This condition isn’t very common among children of all age groups. Specifically, this condition can be seen in children from 9 months to 5 years..

RAD can be developed among children who-

Didn’t get proper care from caregivers.
The caregivers were unavailable when the child was in need.
The caregivers were inconsistent, for example, the nanny for the child changed frequently.
Children who have faced multiple traumatic losses early in their life.
Children who have lived in a foster home or orphanage.
Sometimes this disorder can be misdiagnosed as ADHD or Autism. Hence, when the below discussed behavioural changes are seen, please seek help from a mental health professional.

Does Gender has any effect on the occurance?

It is usually observed that the attachment style is common for both genders during infancy. Hence, we can infer that the occurrence of this disorder is independent of gender.

ICD-10 & DSM-5 Classification

DSM-5 diagnostic criteria for Reactive Attachment Disorder – Code 313.89

This includes 6 diagnostic criterions such as emotionally withdrawn, inconsistent care from a primary caregiver, frequent change in caregivers, rearing in an unusual setting, etc. can lead to this condition. The most important criteria here is that the pattern of behaviour is consistent for at least 12 months.

ICD 10 Diagnostic Criteria- Code F94.1

This states that the condition is characterized by disruption in emotional response in a changing social environment which is a result of severe parental neglect.

Why Does Reactive Attachment Disorder Occur?

As discussed in the introduction, we primarily can say that this disorder occurs due to the inability to form an emotional bond which happens when there is parental neglect or mistreatment.

There are some common reasons which can cause such condition, such as-

The child’s nappy wasn’t changed for a long time and this occurred frequently
The child wasn’t fed when the child was hungry and this also occurred frequently.
The child wasn’t comforted or put to ease when is distress or irritable.
The child was left to cry for a long time and wasn’t soothed.
The child didn’t have a consistent safety and security from parents.
There could be situations where there are some serious issues or the parent himself/herself is suffering from some mental health condition due to which nursing the child isn’t possible. But the child is very small and immature to understand this and hence develops a feeling that I am not being cared. Also, if the child has suffered from abuse by caregivers it can develop this disorder.

Early Signs: Reactive Attachment Disorder

What are the behavioural changes that can be a sign for parents that it is time for them to seek help?

Avoiding eye-contact
Don’t want to be touched by parents.
Excessively friendly with strangers.
Don’t want to be soothed when in need.
Cry inconsolably
Angry, irritable and excessively argumentative.
Avoid interactive games.
Constantly soothing themselves by rocking.

Symptoms: Reactive Attachment Disorder

As mentioned above they avoid touch because it is perceived as a threat. For example, the child might shout, say “ouch” even when you hold the hand or run away when being touched or cuddled by parents.
These children like everything in their control. They feel secure only when things are in their control because when security was needed it wasn’t provided by caregivers. For example, they might argue on small issues like their preference of clothes but these arguments are intense and severe from the child’s side.
These children do not show genuine care or affection and also fail to perceive the same from their parents. For example, if the mother is unwell, then the child might not bother to ask the mother rather would neglect her and be self-engrossed.
Lack of conscience is seen in these children because they fail to understand and accept guilt, regret or remorse. This is the result of the uncertainty faced earlier which causes them to become self-sufficient and this restricts them from thinking empathetically.
These are some of the common symptoms seen in children with RAD.

Types of Reactive Attachment Disorder

RAD is mainly classified into 2 types-

Inhibited – These children are emotionally withdrawn, they inhibit comfort from others. These children are aware of the actions happening around but don’t react to them.
Uninhibited – These children on the other hand are excessively friendly towards strangers while avoiding caregivers. They also have acute anxiety issues and always act to be young than their actual age to gain attention.

How do you distinguish between RAD and other disorders?

Let us understand the difference between RAD and ADHD with research. This research was carried out on young school children, some of them were diagnosed with ADHD while some with RAD and a few were regular students. On the basis of the assessment done, it was seen that the distinguishing character is- the nature to cling to strangers seen among children with RAD.

Treatment available for Reactive Attachment Disorder

These children are normal and in spite of the emotional instability are capable of forming a good relationship if treated early. There is no standard therapy for treating this disorder but it is important that the work is done collectively with the child and mother.

The child needs safety and security; hence the main objective of the treatment is to provide a soothing, comforting and safe environment to the child. The caregiver has to be nurturing and addressing the child’s need, which in turn will help in developing a positive relationship.