What Is Reactive Attachment Disorder?

Reactive attachment disorder is a serious condition that affects a child's ability to form bonds. Early intervention is key, so learn the warning signs.

January 17, 2025 · 8 min · 1655 words · Phillip Myers

Table of Contents

Table of ContentsView AllTable of ContentsWhat Is Reactive Attachment Disorder?SymptomsDiagnosisCausesPrevalenceTreatmentCoping

Table of ContentsView All

View All

Table of Contents

What Is Reactive Attachment Disorder?

Symptoms

Diagnosis

Causes

Prevalence

Treatment

Coping

Close

Reactive attachment disorder (RAD) is a rare but serious condition in which an infant or young child does not form healthy and secure bonds with their primary caregivers. Children with this condition struggle to form relationships with others, rarely seek comfort from caregivers, and have trouble managing their emotions.

Babies bond with adults who provide them with consistent, loving care. They recognize the adults who protect them and calm them when they’re feeling stressed. In most cases, they develop healthy,secure attachmentsto their primary caregivers, like their parents, daycare provider, or perhaps a grandparent who is very involved.

When babies struggle to form healthy relationships with a stable adult, they may develop reactive attachment disorder. This can have profound effects on a child’s development and future bonds.

Reactiveattachment disordergoes beyond behavior problems. In order to qualify for a diagnosis of reactive attachment disorder, a child must exhibit a consistent pattern of inhibited, emotionally withdrawn behavior toward adult caregivers. Children with reactive attachment disorder:

To meet the criteria, they must also exhibit two of the following symptoms:

The symptoms must be present before the age of 5. And the child must have a developmental age of at least 9 months to qualify for a diagnosis of reactive attachment disorder.

Teachers, daycare providers, and primary caregivers are likely to notice that a child with reactive attachment disorder exhibits emotional and behavioral issues.

An evaluation may include:

Sometimes, children with reactive attachment disorder experience comorbid conditions. Research shows that children with attachment disorders experience higher rates ofattention-deficit hyperactivity disorder (ADHD),anxiety disorders, andconduct disorders.

History of the Diagnosis

Reactive attachment disorder is a relatively new diagnosis. It was first introduced in the DSM in 1980.

In 1987, two subtypes of reactive attachment disorder were introduced; inhibited and disinhibited. In 2013, the diagnosis was updated again. The DSM-5 refers to the disinhibited type as a separate condition called disinhibited social engagement disorder.

Here are some examples of times when a child may not be able to form asecure attachment to a primary caregiver:

Any time there’s a consistent disregard for a child’s emotional or physical needs, a child may be at risk for developing a reactive attachment disorder. A lack of stimulation and affection can also play a role.

Since reactive attachment disorder is a relatively new diagnosis—and many children go untreated—it’s uncertain how many children may meet the criteria. In 2010, a study in Denmark found that less than 0.4% of children had reactive attachment disorder. A 2013 study estimated about 1.4% of children living in an impoverished area in the United Kingdom had an attachment disorder.

It’s estimated that children in foster care—and those who resided in orphanages—exhibit much higher rates of reactive attachment disorder. A 2013 study of children in foster care in Romania found that about 4% exhibited reactive attachment disorder at 54 months of age. A history of maltreatment and disruptions to a child’s care likely increases the risk.

The first step in treating a child with reactive attachment disorder usually involves ensuring the child is given a loving, caring, and stable environment.Therapy won’t be effective if a child continues moving from foster home to foster home or if they continue living in a residential setting with inconsistent caregivers.

Therapy usually involves the child as well as the parent or primary caregiver.The caregiver is educated about reactive attachment disorder and given information about how to build trust and develop a healthy bond.

Sometimes, caregivers are encouraged to attend parenting classes to learn how to manage behavior problems. And if the caregiver struggles to provide a child with warmth and affection, parent training may be provided to help a child feel safe and loved.

Controversial Therapies That Are Not Recommended

In the past, some treatment centers used several controversial therapies for children with reactive attachment disorder.

For example, holding therapy involves a therapist or a caregiver physically restraining a child. The child is expected to go through a range of emotions until they eventually stop resisting. Unfortunately, some children have died while being restrained.

The American Psychiatric Association and The American Academy of Child and Adolescent Psychiatry caution against holding therapies and rebirthing techniques.Such techniques are considered pseudoscience and there is no evidence that they reduce the symptoms associated with reactive attachment disorder.

If you consider any non-traditional treatments for your child, it’s important to talk to your child’s doctor before beginning treatment.

Prognosis

Without treatment, a child with reactive attachment disorder may experience ongoing social, emotional, and behavioral problems. This may put a child at risk for bigger problems as they grow older.

Researchers estimate that 52% of juvenile offenders have an attachment disorder or borderline attachment disorder. The vast majority of those teens had experienced maltreatment or neglect early in life.

Early intervention may be key to helping kids develop healthy attachments earlier in life. And the sooner they receive treatment, the fewer problems they may have over time.

There are several ways in which primary caregivers may be able to reduce the risk that a child will develop reactive attachment disorder. These can also be helpful for coping with the symptoms of this condition and establishing healthy connections

If you or a loved one are struggling with reactive attachment disorder, contact theSubstance Abuse and Mental Health Services Administration (SAMHSA) National Helplineat1-800-662-4357for information on support and treatment facilities in your area.For more mental health resources, see ourNational Helpline Database.

If you or a loved one are struggling with reactive attachment disorder, contact theSubstance Abuse and Mental Health Services Administration (SAMHSA) National Helplineat1-800-662-4357for information on support and treatment facilities in your area.

For more mental health resources, see ourNational Helpline Database.

9 SourcesVerywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.MedlinePlus.Reactive attachment disorder of infancy or early childhood.Ellis EE, Saadabadi A.Reactive attachment disorder.StatPearls Publishing.Minnis H, Macmillan S, Pritchett R, et al.Prevalence of reactive attachment disorder in a deprived population.The British Journal of Psychiatry. 2013;202(5):342-346. doi:10.1192/bjp.bp.112.114074Skovgaard, AM.Mental health problems and psychopathology in infancy and early childhood. An epidemiological study.Danish Medical Bulletin. 2010;57(10):B4193.Gleason MM, Fox NA, Drury S, et al.Validity of evidence-derived criteria for reactive attachment disorder: indiscriminately social/disinhibited and emotionally withdrawn/inhibited types.J Am Acad Child Adolesc Psychiatry. 2011;50(3):216-231.e3. doi:10.1016/j.jaac.2010.12.012Josefson D.Rebirthing therapy banned after girl died in 70 minute struggle.BMJ. 2001;322(7293):1014.AACAP.Attachment disorder.Moran K, McDonald J, Jackson A, Turnbull S, Minnis H.A study of attachment disorders in young offenders attending specialist services.Child Abuse Negl.2017;65:77-87. doi:10.1016/j.chiabu.2017.01.009Cleveland Clinic.Reactive attachment disorder: living with.Additional ReadingMayes SD, Calhoun SL, Waschbusch DA, Breaux RP, Baweja R.Reactive attachment/disinhibited social engagement disorders: Callous-unemotional traits and comorbid disorders.Research in Developmental Disabilities. 2017;63:28-37. doi:10.1016/j.ridd.2017.02.012

9 Sources

Verywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.MedlinePlus.Reactive attachment disorder of infancy or early childhood.Ellis EE, Saadabadi A.Reactive attachment disorder.StatPearls Publishing.Minnis H, Macmillan S, Pritchett R, et al.Prevalence of reactive attachment disorder in a deprived population.The British Journal of Psychiatry. 2013;202(5):342-346. doi:10.1192/bjp.bp.112.114074Skovgaard, AM.Mental health problems and psychopathology in infancy and early childhood. An epidemiological study.Danish Medical Bulletin. 2010;57(10):B4193.Gleason MM, Fox NA, Drury S, et al.Validity of evidence-derived criteria for reactive attachment disorder: indiscriminately social/disinhibited and emotionally withdrawn/inhibited types.J Am Acad Child Adolesc Psychiatry. 2011;50(3):216-231.e3. doi:10.1016/j.jaac.2010.12.012Josefson D.Rebirthing therapy banned after girl died in 70 minute struggle.BMJ. 2001;322(7293):1014.AACAP.Attachment disorder.Moran K, McDonald J, Jackson A, Turnbull S, Minnis H.A study of attachment disorders in young offenders attending specialist services.Child Abuse Negl.2017;65:77-87. doi:10.1016/j.chiabu.2017.01.009Cleveland Clinic.Reactive attachment disorder: living with.Additional ReadingMayes SD, Calhoun SL, Waschbusch DA, Breaux RP, Baweja R.Reactive attachment/disinhibited social engagement disorders: Callous-unemotional traits and comorbid disorders.Research in Developmental Disabilities. 2017;63:28-37. doi:10.1016/j.ridd.2017.02.012

Verywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.

MedlinePlus.Reactive attachment disorder of infancy or early childhood.Ellis EE, Saadabadi A.Reactive attachment disorder.StatPearls Publishing.Minnis H, Macmillan S, Pritchett R, et al.Prevalence of reactive attachment disorder in a deprived population.The British Journal of Psychiatry. 2013;202(5):342-346. doi:10.1192/bjp.bp.112.114074Skovgaard, AM.Mental health problems and psychopathology in infancy and early childhood. An epidemiological study.Danish Medical Bulletin. 2010;57(10):B4193.Gleason MM, Fox NA, Drury S, et al.Validity of evidence-derived criteria for reactive attachment disorder: indiscriminately social/disinhibited and emotionally withdrawn/inhibited types.J Am Acad Child Adolesc Psychiatry. 2011;50(3):216-231.e3. doi:10.1016/j.jaac.2010.12.012Josefson D.Rebirthing therapy banned after girl died in 70 minute struggle.BMJ. 2001;322(7293):1014.AACAP.Attachment disorder.Moran K, McDonald J, Jackson A, Turnbull S, Minnis H.A study of attachment disorders in young offenders attending specialist services.Child Abuse Negl.2017;65:77-87. doi:10.1016/j.chiabu.2017.01.009Cleveland Clinic.Reactive attachment disorder: living with.

MedlinePlus.Reactive attachment disorder of infancy or early childhood.

Ellis EE, Saadabadi A.Reactive attachment disorder.StatPearls Publishing.

Minnis H, Macmillan S, Pritchett R, et al.Prevalence of reactive attachment disorder in a deprived population.The British Journal of Psychiatry. 2013;202(5):342-346. doi:10.1192/bjp.bp.112.114074

Skovgaard, AM.Mental health problems and psychopathology in infancy and early childhood. An epidemiological study.Danish Medical Bulletin. 2010;57(10):B4193.

Gleason MM, Fox NA, Drury S, et al.Validity of evidence-derived criteria for reactive attachment disorder: indiscriminately social/disinhibited and emotionally withdrawn/inhibited types.J Am Acad Child Adolesc Psychiatry. 2011;50(3):216-231.e3. doi:10.1016/j.jaac.2010.12.012

Josefson D.Rebirthing therapy banned after girl died in 70 minute struggle.BMJ. 2001;322(7293):1014.

AACAP.Attachment disorder.

Moran K, McDonald J, Jackson A, Turnbull S, Minnis H.A study of attachment disorders in young offenders attending specialist services.Child Abuse Negl.2017;65:77-87. doi:10.1016/j.chiabu.2017.01.009

Cleveland Clinic.Reactive attachment disorder: living with.

Mayes SD, Calhoun SL, Waschbusch DA, Breaux RP, Baweja R.Reactive attachment/disinhibited social engagement disorders: Callous-unemotional traits and comorbid disorders.Research in Developmental Disabilities. 2017;63:28-37. doi:10.1016/j.ridd.2017.02.012

Meet Our Review Board

Share Feedback

Was this page helpful?Thanks for your feedback!What is your feedback?HelpfulReport an ErrorOtherSubmit

Was this page helpful?

Thanks for your feedback!

What is your feedback?HelpfulReport an ErrorOtherSubmit

What is your feedback?