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Reactive attachment disorder

Reactive attachment disorder, or RAD, is usually linked to maltreatment in early childhood. It is unclear how many are affected but one study of children in a deprived area of the UK found 1.4% of 6 to 8 year olds to be affected.

The absence of emotional warmth during the first few years of life can have a negative lifelong effect.

What are the symptoms of reactive attachment disorder?

RAD can affect every aspect of a child's life and development. There are two types of RAD: inhibited and disinhibited.

Common symptoms of inhibited RAD include:

  • Detached
  • Unresponsive or resistant to comforting
  • Excessively inhibited (holding back emotions)
  • Withdrawn or a mixture of approach and avoidance

Common symptoms of disinhibited RAD include:

  • Indiscriminate sociability
  • Inappropriately familiar or selective in the choice of attachment figures

What causes reactive attachment disorder?

RAD occurs when attachment between a young child and his or her primary carer does not occur or is interrupted due to grossly negligent care. This can occur for many reasons including:

  • Persistent disregard of the child's emotional needs for comfort, stimulation and affection
  • Persistent disregard of the child's basic physical needs
  • Repeated changes of primary carers that prevent formation of stable attachments (for example frequent changes in foster care)

How is reactive attachment disorder diagnosed?

As with adults, mental health disorders in children are diagnosed based on signs and symptoms that suggest a particular condition. If symptoms are present, the doctor will begin an evaluation by performing a complete medical history and physical examination. Although there are no laboratory tests to specifically diagnose RAD, the doctor may use various tests (such as X-rays and blood tests) to rule out physical illness or medication side effects as the cause of the symptoms.

If the doctor cannot find a physical cause for the symptoms, he or she may refer the child to a child and adolescent psychiatrist or psychologist, mental health professionals who are specially trained to diagnose and treat mental illnesses in children and teenagers. Psychiatrists and psychologists use specially designed interview and assessment tools to evaluate a child for a mental health disorder. The doctor will base his or her diagnosis on reports of the child's symptoms, and his or her observation of the child's attitude and behaviour.

WebMD Medical Reference

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