Signs, Symptoms, & Causes of Reactive Attachment Disorder

The first step to getting help is recognizing the problem. If you’re concerned your child or teenager may be suffering from reactive attachment disorder, learn more about the signs and symptoms to watch for.

Understanding Reactive Attachment Disorder

Learn about reactive attachment disorder

Reactive attachment disorder (RAD) is a complicated mental health disorder characterized by problems in developing emotional attachments to others. This disorder is the result of infants and children not having the opportunity to establish healthy bonds with parents or other appropriate caregivers. When a child’s basic needs for comfort, affection, and nurturing are not met, and loving attachments to others are not developed, the end result can be reactive attachment disorder. This can permanently change a child’s brain development, hurting their ability to establish future relationships.

In order for children to develop a sense of safety and learn how to trust others, they must grow up in a supportive and stable environment. However, when these needs are not properly met, children will begin to feel untrusting and unsafe. These children will also come to expect that all interactions they have with another individual will result in the same hostility or rejection they received from their primary caregivers.

With proper treatment, children can recover from many if not all of the symptoms related to Reactive attachment disorder.


Reactive attachment disorder statistics

Due to the rarity of the disorder and the fact that it is scarcely seen in clinical settings, there are no accurate statistics on how many children suffer from it. It has been noted by psychiatrists that even within the population of children who have suffered from severe abuse and/or neglect, less than 10% have developed reactive attachment disorder as a result.

Causes and Risk Factors

Causes and risk factors for reactive attachment disorder in children and teens

Since reactive attachment disorder is so rare, there is a significant lack of research as to why some children go on to develop this disorder while others do not. What researchers do know is that the development is related to the attachment process, which relies on interaction between the parent and child. Some examples of causes that have been linked to possibly impacting the development of RAD include:

Genetic: Although there is no specific genetic link yet identified as a contributing factor, genetic influences have been documented as playing a role in the development of other attachment disorders. Because of this, some experts believe there might be genetic influences in the development of RAD as well.

Physical: Some studies have shown that emotional interactions between infants and their mothers (or other primary caregivers) have an effect on how the brain develops. If emotional interaction is lacking in infancy, this changes how development occurs, which can cause a change in an individual’s personality. This can then have an effect on how that child views and experiences other relationships.

Environmental: It is widely believed by professionals in the field that the onset of RAD is due primarily to the environment in which a child grows up. When children fail to receive a bonding experience with a caregiver, the way in which they develop will be significantly affected. Children who are raised in homes where they are abused or severely neglected may grow up inherently fearing others and become unable to trust others because they believe that they will be met with the same hostility. Additionally, children who are raised in the foster care system may not be able to establish meaningful relationships as they spend a majority of their lives moving from home to home, leading them to be unable to develop proper attachment to caregivers, which can result in RAD.

Risk Factors:

  • Living in or growing up in an orphanage
  • Extreme neglect
  • Living in extreme poverty
  • Postpartum depression in the baby’s mother
  • Suffering from physical, sexual, or emotional abuse
  • Frequent changes in foster care
  • Institutional care
  • Living in or growing up in an orphanage
  • Extreme neglect
  • Living in extreme poverty
  • Other experiences of traumatic loss or changes with a primary caregiver

Signs and Symptoms

Signs and symptoms of reactive attachment disorder in children and teens

Reactive attachment disorder begins before age 5, with symptoms sometimes presenting while the child is still an infant. The signs and symptoms of RAD will vary depending upon the age of the child and other child specific factors. The following are some examples of behavioral, physical, cognitive, and psychosocial symptoms that children suffering from RAD may exhibit:

Behavioral symptoms:

  • Participating in self-soothing behaviors (such as rocking back and forth or stroking arms)
  • Little or no eye contact
  • Failure to smile
  • Withdrawn
  • No interest playing with toys
  • Refusing to interact with peers
  • Calm when left alone
  • Turning or leaning away when someone tries to show affection
  • Avoids or dismisses comforting comments or gestures
  • Acts aggressively towards peers

Physical symptoms:

  • Failure to smile
  • Looking joyless
  • Failure to gain weight
  • Appearing sad and listless

Cognitive symptoms:

  • Developmental delays
  • Cognitive delays
  • Language delays
  • Delayed responsiveness to stimuli

Psychosocial symptoms:

  • Low self-esteem
  • Lacking trust
  • Chronic feelings of being unsafe
  • Feeling unwanted
  • Feelings of worthlessness
  • Feeling “empty” inside
  • Anxiety
  • Sadness
  • Anger
  • Lacking a sense of belonging


Effects of reactive attachment disorder in children and teens

The effects of reactive attachment disorder can be long-lasting and can often continue into adulthood. The following are some examples of the effects that can be the result of untreated RAD:

  • Control issues
  • Delayed learning or physical growth
  • Eating problems, leading to malnutrition
  • Depression
  • Anxiety
  • Academic problems
  • Unemployment or frequent job changes
  • Aggression
  • Delinquency problems
  • Inability to show genuine affection
  • Underdeveloped conscience
  • Inability to genuinely care about another person
  • Aversion to any kind of touch
  • Inability to develop or maintain significant relationships

Co-Occurring Disorders

Reactive attachment disorder and co-occurring disorders

  • Autism spectrum disorder
  • Depressive disorders
  • Anxiety disorders
  • Pica disorder
  • Rumination disorder
  • Pervasive developmental disorder