Reactive Attachment Disorder

What is Reactive Attachment Disorder?

Reactive Attachment Disorder (RAD) is a serious disorder affecting social functioning in children who have experienced abuse and/or neglect. There are two subtypes: an Inhibited Type (thought to be very rare) in which children are emotionally withdrawn, fearful or “hypervigilant” and unpredictable in their social responses and a Disinhibited Type (called Disinhibited Social Engagement Disorder in DSM-5) in which children are indiscriminately friendly and do not recognise social boundaries. Children with RAD (whether Inhibited or Disinhibited) have difficulties developing intimate relationships and this can have a profound effect on their ability to settle into a foster or adoptive placement and on their friendships.

Frequency

In materially deprived populations, about 1% of pre-school and early school-age children have RAD and this prevalence is much higher in children in the care system. The great majority of children with RAD have a complex presentation with at least one other psychiatric diagnosis, often ADHD or conduct disorder. We do not know the prevalence in the teenage years or in adulthood, but indiscriminate friendliness can persist into adult life.

Causes

RAD is believed to be caused by abuse and/or neglect but not all abused and/or neglected children develop RAD. There appear also to be genetic risk or resilience factors for RAD (in the context of abuse or neglect), but we do not yet know what these are.

Core symptoms

Either
• Emotional withdrawal
• Fearfulness/hypervigilance
• Unpredictable responses, especially on reunion

Or
• Indiscriminate friendliness
• Wandering off without checking back (in younger children)
• Cuddliness with strangers (in younger children)
• Attention seeking or asking personal questions of strangers (in older children

Other symptoms sometimes associated with RAD

Controlling behaviour 
Self-stimulating behaviour (e.g. rocking, headbanging)
Gorging or scavenging for food