How To Find Effective Treatment For Reactive Attachment Disorder In Children
In the context of psychology, attachment refers to how a child connects with their primary caregivers and how their needs are met or unmet. When children struggle with attachment—whether due to trauma or another challenge—they may be diagnosed with an attachment disorder. Reactive attachment disorder (RAD) is one of these conditions that can affect young children and causes behavioral changes and social risks. Below, explore the symptoms of this condition, the basics of attachment theory, and treatment options for children with attachment disorders.
What is reactive attachment disorder and how is it diagnosed?
Reactive attachment disorder (RAD), sometimes called inhibited reactive attachment disorder, is a childhood attachment disorder listed in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Revised (DSM-5-TR). The DSM-5-TR classifies the condition as a trauma- and stressor-related disorder of early childhood most frequently caused by neglect, abuse, or maltreatment from caregivers or other adults in a child’s life. The symptoms and diagnostic criteria involved in getting reactive attachment disorder diagnosed include the following:
- A pattern of being emotionally withdrawn and afraid of relationships
- Social withdrawal and emotional perturbation with minimal responsiveness to others, including negative affect, irritability, or refusing to speak
- A history of insufficient care or neglect, as these children often live in foster care and/or have been abused by caregivers
- The child does not meet the criteria for autism spectrum disorder (ASD)
- The behavioral challenges arise before five years of age
- The child must be at least nine months to qualify for diagnosis
Children with RAD often avoid connecting with caregivers and other adults. They may spend a significant amount of time alone and prefer to be independent. When people try to help them or offer advice, they may react with anger or anxiety. They may struggle to form healthy emotional bonds or even open up with a mental health professional in therapy.
Can adults have reactive attachment disorder?
Like disinhibited social engagement disorder (DSED) and all other attachment disorders, RAD is a childhood condition. That means adults cannot be diagnosed with it or any attachment disorder. Instead, adults may experience insecure attachment styles, which are not disorders but unhealthy ways of approaching relationships. Attachment theory may help adults understand how they interact with others and why.
Understanding attachment: attachment theory & attachment disorders
Attachment theory was developed by John Bowlby and Mary Ainsworth in the 1950s and 1960s to explain how infants and children emotionally attach to their caregivers based on how their basic needs are met. Children with all their basic needs met were found to have a secure attachment style, meaning they would grow up to be able to communicate their needs openly, accept the needs of others, and develop healthy relationships. The researchers then developed the four attachment styles based on their findings, which can be used to understand how children and adults act in relationships.
Attachment disorders are also linked to this theory of how early caregiver bonds can affect a child socially and emotionally. In addition to RAD, researchers have also identified a condition called disinhibited social engagement disorder (DSED). DSED tends to cause the opposite symptoms of RAD. In this case, the child’s history causes them to be overly friendly and communicative with adults and others, often to the point where they trust freely and can get into dangerous situations. They may desire extreme physical or emotional closeness and struggle to form a healthy attachment.
What’s my attachment style?
To figure out your attachment style or risk factors for insecure attachment, you can take an online quiz. Or, you could talk to a mental health professional about your current behaviors in relationships and the emotions that arise for you when you attach to someone. Below are traits of each of the four attachment styles according to attachment theory:
- Anxious attachment: Anxiously attached people have a profound fear of abandonment and go through any steps they can to avoid it, often asking for frequent reassurance or affection from partners.
- Dismissive-avoidant attachment: Avoidantly attached individuals are afraid of commitment and attachment and avoid it as much as possible, preferring independence.
- Anxious-avoidant (disorganized) attachment: People with a disorganized attachment go back and forth between anxious and avoidant traits, wanting connection and fearing abandonment but struggling to accept and be comfortable when loved and taken care of.
- Secure attachment: People with secure attachment can set healthy boundaries in relationships, open up about their emotions, connect with others, and take space to themselves.
Treatment for reactive attachment disorder: finding options near you for your child
There are methods available to help get children with reactive attachment disorder treated. Parents or caregivers looking to support a child showing symptoms of RAD may consider the following options.
Therapy as a key treatment for reactive attachment disorder in a child
The therapeutic modalities most commonly recommended for RAD include cognitive behavioral therapy (CBT), trauma-focused cognitive behavioral therapy (TF-CBT), psychodynamic therapy, family therapy, and emotionally focused therapy (EFT). However, hundreds of therapeutic modalities exist, so consult a therapist before choosing the one that may be right for you and your child. Therapy can be a helpful tool for both the child and their caregiver(s).
A therapist who is a specialist with experience treating attachment disorders may be best, as they can offer unique advice for your child based on what has worked for other children with RAD. If you struggle to find a RAD specialist in your area, you might look into virtual care.
Medication for any co-occurring mental health disorders
Medication can sometimes be helpful for symptoms of any mental illnesses that may co-occur with RAD, such as depression or anxiety. There are currently no approved medications for attachment disorders specifically. Still, medication can sometimes reduce anxiety or depression symptoms enough to allow a client to participate more actively in therapy, especially if they are anxious about opening up to the provider. Do not start, change, or stop a medication without consulting your prescribing provider.
The BetterHelp platform is not intended to provide any information regarding which medication or medical treatment may be appropriate for you. The content provides generalized information that is not specific to one individual. Do not take any action without consulting a qualified medical professional.
Support groups for mental health
Some children with RAD may also benefit from joining a support group with other children or trying group or family therapy. A group setting can encourage social skills learning and teach children to value social connections. Online options might be available if there are no support groups in your area. You can also look for group therapy with a licensed provider, though it often comes with a cost and may not be covered by insurance.
The family’s role in improving attachment issues and mental health
Family often plays a significant role in helping children develop secure attachments and reduce anxiety. If you’re the caregiver of a child with RAD that you’re fostering or have adopted, or if you’re the parent of a child whose other parent abused them, there are a few steps you can take that may help your child develop a secure attachment. These include but are not limited to the following:
- Do not call them names or pressure them
- Model positive behaviors for them in your own relationships
- Teach them about emotions and the value of every emotion, including “negative” ones
- Tell them you love them and are always there for them and follow through on your promises
- Don’t displace them or move frequently if you can avoid doing so, as moving around or putting them back in foster care can be traumatic
- Ask them specific but gentle questions to prompt discussions about emotions and thoughts
- Teach them about the dangers of hyper-independence at a young age
- Get them professional treatment for their symptoms
- Be open about your own emotions and thoughts in an age-appropriate way and without asking the child to help you or fix your problems
Can children develop attachment disorders for no reason?
Sometimes, a child’s behavior may seem similar to symptoms of RAD even if they have not experienced abuse from their caregivers and have a “good” life. However, caregivers should be aware that children can be abused in other environments. Estimates suggest that 34% of sexual abuse cases are family members or someone a person knows. Incest is common as a crime against children and should be looked out for. In addition, children can experience trauma from extended family, teachers, counselors, clergy members, or other children who abuse or bully them. Below are some potential signs that a child might be experiencing abuse:
- They have strange bruises from unknown causes
- They are suddenly meek, quiet, and scared when they used to be full of light and joy
- They are asking for attention or reassurance more often
- They start lying frequently
- They start using substances
- They start hanging out with people who seem to be toxic
- They start to self-harm or talk about suicide
- They start to experience depression or anxiety
- They never want to visit certain relatives or engage with certain people in their lives
- They are afraid to go to school
- They start talking about sex, genitals, or sexual topics more often, especially if you have never had these conversations with them before
- They start drawing scary pictures or playing out concerning scenes with their toys
If you notice these signs or any symptoms of RAD in your child, it’s recommended that you reach out to a mental health professional as soon as possible. In addition, you might ask your child if someone in their life has hurt them and tell them you’ll believe them no matter what. If you have reason to believe your child has been sexually abused, you can typically bring them to the doctor to get an exam to see if any evidence is available. In that case, you may be able to press charges against the adult who harmed them.
If you are experiencing sexual abuse or have experienced assault, note that the Rape, Abuse, and Incest National Network (RAINN) has a hotline dedicated to supporting individuals experiencing sexual assault, harassment, or intimate partner violence. You can contact them anytime by calling 800-656-HOPE (4673) or using the online chat. If you’re a teen or child experiencing or witnessing abuse of any kind from a family member or caregiver, reach out to the Child Help Hotline at 1-800-422-4453 or use the online chat feature.
Will children with attachment disorders grow up to have another disorder as adults?
Children with attachment disorders may be at risk of several mental illnesses in adulthood, especially anxiety disorders, depressive disorders, post-traumatic stress disorder (PTSD), and personality disorders. Children with RAD may be more likely to develop narcissistic personality disorder (NPD) or antisocial personality disorder (ASPD) as adults, especially if they have conduct disorder (CD) in their youth. However, some children with attachment disorders do not develop a disorder at all and may only struggle with an insecure attachment style as adults. Research suggests that attachment styles can be changed in adulthood to become more secure, so there may be hope for those who struggle with attachment in any way.
How to find effective treatment options
Effective treatment for attachment disorders can be challenging to find, but it exists. You might look for therapists or psychiatrists who specialize specifically in attachment. However, it’s advisable to avoid “attachment therapy” practitioners who claim they can cure childhood attachment problems with “rebirthing” and other methods like these. This type of attachment therapy is not a real, research-based method and has led to the death of multiple children.
Instead, you might look for therapy options like CBT, trauma-informed CBT, mindfulness therapy, and trauma-informed therapy. Before starting sessions, consult the provider to learn about how they can support your child. You might also see if you can do sessions with your child or if the provider offers family or group options, which can help children with reactive attachment disorder develop social skills and bonds.
Mental health support options for parents and teens
Parents or caregivers may also benefit from mental health support when raising a child with an attachment disorder. A therapist can guide you through emotional regulation and tips to support your child’s mental health. If you’re not able to find an attachment specialist in your area, you might try getting matched with a provider through an online therapy platform like BetterHelp for adults or TeenCounseling for teens aged 13 to 19.
Through an online platform, individuals can meet with a licensed therapist remotely via phone, video, or chat. Platforms like BetterHelp and TeenCounseling also offer resources like journaling prompts and group sessions to help clients make the most of therapy. Studies suggest that online therapy can be effective in many cases, with some research suggesting that it may be especially effective for adolescents in families where one person has a severe mental illness.
Takeaway
Reactive attachment disorder is a childhood condition that can cause avoidance of connection with caregivers, adults, and other children. This avoidance can look like hyper-independence and difficulty responding to others. Children with RAD often benefit from therapy, sometimes in combination with medication and group support. For online support for parents or teens, virtual therapy is an available option.
Frequently asked questions
How do you treat RAD in adults?
Reactive attachment disorder, among a couple of other mental health conditions, is only offered as an early diagnosis for children. Older children (adolescents) and adults cannot be diagnosed with an attachment disorder and childhood mental health conditions. Instead, adults with attachment issues might be struggling with an insecure attachment style or another mental illness that causes emotional problems, such as borderline personality disorder (BPD) or bipolar disorder. Adult attachment issues are often treated with trauma-focused therapy modalities like EMDR, IFS, or CBT.
What therapy is best for RAD?
The best therapeutic modalities for RAD tend to be early intervention methods that target developmentally inappropriate social relatedness, according to the American Psychiatric Association. Cognitive-behavioral therapy is sometimes used, especially trauma-focused CBT. In addition, dialectical behavior therapy (DBT) may be helpful for children diagnosed with RAD because emotional disorders often cause intense feelings and difficulty with relationships, which DBT addresses immensely. In DBT, a child’s symptoms can be addressed head-on, and the child can learn to form meaningful connections and a consistent pattern of behavior to reduce emotionally withdrawn behavior or inhibition. Not all children benefit from the same modality, so consult multiple therapists to ensure the child’s basic physical and emotional needs are met.
What medication is used for reactive attachment disorder?
No medication is specifically approved to treat attachment disorders or the impacts of emotional neglect. However, some children with problematic behaviors may have co-occurring conditions like anxiety and depression. Medications may help them regulate their emotions and develop positive emotions and thoughts.
A child’s behavioral challenges are usually treated in behavioral therapy. Parent-child interaction therapy may also help in understanding reactive attachment disorder symptoms and a child’s medical history. Adopted children experience RAD at a higher rate than children who live with their biological parents. In addition, children who have been in foster placements develop RAD and other attachment disorders frequently. Foster parents and adoptive parents can learn more about adoption and foster trauma and how to treat these experiences to help their children get through difficult moments.
The BetterHelp platform is not intended to provide any information regarding which medication or medical treatment may be appropriate for you. The content provides generalized information that is not specific to one individual. Do not take any action without consulting a qualified medical professional.
Can you overcome RAD?
RAD is considered a childhood disorder. In adulthood, people who had RAD in childhood might develop another mental health condition, such as a personality disorder or mood disorder. Some people only struggle with an insecure attachment style, which can look like challenges in adult romantic and sexual relationships.
What are the two types of reactive attachment disorder?
The two types of attachment disorder in childhood are reactive attachment disorder and disinhibited social engagement disorder. These two conditions are opposites, with reactive attachment disorder causing withdrawn emotions and interactions and DSED causing intense and inappropriate socialization and lack of concern for one’s safety.
Can a child outgrow reactive attachment disorder?
Yes, children can overcome the behaviors and emotions related to attachment disorders. However, they may start to struggle with other mental illnesses or insecure attachment styles in adulthood. Common adulthood conditions that may occur after an attachment disorder could include cluster B personality disorders, depressive disorders, anxiety disorders, and eating disorders. People with attachment disorders may also be more likely to have post-traumatic stress disorder (PTSD) or complex PTSD (C-PTSD).
Which behavior is expected in a child with reactive attachment disorder?
Children with RAD have difficulty forming relationships with adults and other children. They are often hyper-independent and may avoid talking about emotions. As they grow up, they may start taking on more “adult” or mature activities and responsibilities without giving space to their emotions. They may form an avoidant attachment style in adulthood.
How does it feel to have reactive attachment disorder?
Children with RAD may experience a fear of connection with others, as they may distrust adults, and they often come from home environments with neglect and abuse where they were never shown love. They might not trust anyone around them and believe that their only safety is in themselves and their ability to care for themselves. They may become angry when people show them empathy or affection.
What activities are good for kids with RAD?
Children with RAD may benefit from activities that don’t pressure them too much but help them ease into social situations. For example, the following activities may be helpful:
- Creating art in silence next to a caregiver or therapist
- Exercising and team sports
- Group music creation, such as a choir
- Support groups
- Going for a walk with a pet
- Playing with pets together
- Connecting through music, such as singing together or watching music videos
- Journaling next to each other without talking about the entries
How can you communicate with someone with reactive attachment disorder?
If your child has RAD, you can communicate with them by being patient and avoiding pressuring them to be more affectionate or open than they are comfortable with. Let them start to trust you over time by respecting their physical and emotional boundaries. Continue to be vulnerable and open about your own emotions and thoughts, but don’t dump them all at once. One way to do so is to model positive emotional behavior by practicing certain behaviors next to or in front of the child, such as using your own journal or practicing coping skills they’ve learned in therapy to show them how they look with someone else.
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