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Reaction Attachment Disorder


The definition of reactive attachment disorder has been provided in this paper followed by a brief introduction to the symptoms of the disorder. The positive and negative outcomes and their impact on relationships has been put forward. The causes of the reactive attachment disorder amongst infants and adults have been tackled. Finally, the various treatment strategies as addressed by empirical research have concluded the paper.


This is a severe uncommon disorder that affects children. The disorder is characterized by poor or inappropriate social interactions or excessive interactions depicted by children even with strangers. In most cases the child appears to be disturbed in terms of making the normal social interactions from all contexts. During early childhood, it is expected that the child develops attachments to the caregiver with the normal socialization models. The care giver in this case could even be the mother or any other person charged with the responsibility of taking care of the child. However with the disorder such an attachment is not achieved because of a number of factors ranging from child abuse, neglect, genetic, environment or even separation from the child in the early stages of development. (Cappelletty, Brown,&Shumate,2005).

Children with Reaction Attachment Disorder (RAD) have social interaction models that appear to be grossly disturbed and can be the main cause of future behavior problems later on in life. The symptoms of the disorder vary from behavior problems to socialization problems as depicted by researchers. (Fairchild, 2006).


Behavior problems

Children with RAD are clearly noticed with aggressive and oppositional behaviors at their young age.Most research findings have demonstrated that   RAD children are not affectionate to their parents and they lack eye contact on parents. Such children can be indiscriminately attracted to strangers unlike in the normal cases.

They also tend to be very destructive on their self and other kids. For instance they are always in trouble and prone to accidents than other children.

In most cases, they would want to be given more attention than anybody else.  They are also prone to vices such as stealing and lying. Such can tell lies even for the obvious things.

Evidence from empirical studies also indicate that RAD children often like asking non sense and annoying questions to their friends and their care takers.

In terms of knowledge and learning, researchers have indicated that the children normally lag behind in language and other cognitive skills.

In cases where the children have been left with pets and other animals, they have tended to display a cruel behavior towards the animals. From empirical studies, children with RAD display a variety of symptoms that are unusual and clearly reflect their disturbed attachments. (Shaw& Paez,2007).

Negative outcomes of the disorder

Undesirable behaviors are part and parcel of children who have Reaction Attachment Disorder. In some cases the children have depicted erratic mood swings. The unpredictable behavior can be in the form of clinging to hanging and swearing. In studies where the children with the disorder have been assessed, the results have shown that the children stated concerns about being mad and crazy. In some cases, psychiatric analysis has pointed pointed out that the child here’s a voice instructing to do a particular undesirable activity. Research has also shown evidence of children not showing affection to their parents as a result of the disorder. Bad behaviors such as stealing unnecessarily and lying can be quite a common thing amongst the children with the disorder. (Schechter& Willheim,2009).

Delayed social and cognitive development.

Children with Reaction Attachment Disorder can experience delayed development in their cognitive abilities. In most cases the children find difficulties and are completely unable to accomplish cognitive tasks assigned to them in school or by the caregivers. Delayed cognitive development can be indicated in such cases with mild mental retardation. In terms of social development affected children can depict immature socialization and inappropriate behaviors. The behavior of the children can also be indiscriminate social interaction with lack of abilities to regulate emotions such as anger. The children can also show lack of attention and concentration while in the company of caregivers and other children. Language deficiency is also associated with the children with the disorder. Affected children can experience difficulties in receptive and expressive skills. The child may be unable to undertake comprehension and articulation exercises. (Schwartz, Davis&Andrew,2006).

Positive outcomes

The interruptive and controlling behavior of children with Reaction Attachment Disorder can be made useful in terms of leadership. This is in light of the fact that they have tendencies of believing that they are more powerful than the rest. The children therefore do not find it comfortable to be led or influenced by others. In their ability to have control over what others are doing, RAD children can end up being chosen as young leaders. This is also achieved positively because they are able to make others focus on what they do. By this they easily manage to influence and lead others. In future such an  ability can grow and develop into future leaders in business and in the corporate world.

Growing up and developing independently is a positive outcomes of RAD. In most cases children develop attachment to their parents at a very tender age. Most of them are unable to live independently without the affection from the parents.  With or without parents, RAD children would still continue living and achieve education and other important goals. The reduced attachment and dependency on parents should therefore be viewed as a strength because the children cannot break down in case something happened to the care givers. In future such children could also develop into powerful people in the society who are self driven and highly motivated. A good historical example was provided by Adolf Hitler who suffered the disorder in his early childhood.

The ability of the RAD children to depend on themselves is a very important positive outcome. This is because they can easily confront the challenges that come in their way without involving other children or care givers.  This can make such children develop talents and other skills that can benefit them in their future lives. For instance independent thought and decision making can be greatly developed in such children more than their counterparts who are so much dependent on caregivers and colleagues.

Causes of Reaction Attachment Disorder (RAD).

Child abuse

Abuse has become a common threat amongst young children and it has been blamed by most researchers to be a cause of this severe disorder. Abuse can be physical, emotional and even sexual. Psychologists argue that when the child is subjected to abuse in any form, the risk of developing an attachment disorder is very high. In most cases, child who have been subjected to abuse by their caregivers, siblings or parents often are impulsive towards the people who caused the problem. Later own this can be transferred to other people hence a reaction attachment disorder. (Fairchild, 2006).


In normal situations, it is expected that a parent should take care of the child to ensure that all the needs are met as the child undergoes growth and development. Child neglect is a common problem among teenage mothers and other cases. Research has indicated that children who have been neglected lack the love and affection of parents or primary care givers. The children struggle on their own and they fail to develop the necessary attachment to their parents. In such cases , the children are forced to socialize on their own and this can greatly interfere with their different aspects of development.

In some cases, the symptoms of the disorder have been noticed in children who have been separated from the primary care givers. If the mother was the source of primary care for the child when the mother is separated from the child due to factors such as death or any other separation, the child might fail to initiate attachments with other people. This has been mentioned by sociologists and they argue that it is a common case during early adolescence.

Foster parents who have adopted children who have pasts full of abuse and neglect have experienced behaviors in the children that are associated with the disorder. The most common behavior in the aggressive behavior that has been witnessed by most of the foster parents. (Guttmann-Steinmetz & Crowell, 2006).

Genetic constitution of the infant.

The genetic constitution of the child can also predispose the child to RAD. This is still under the aspects of poor maternal care and its impact on the child’s development. Infants are normally born with different genetic profiles some which can result in the attachment and behavior disorders. There is a strong growing body of evidence from animal and clinical studies that suggests that the infant’s genetic constitution is very important in the reaction towards pathogenic environments. In the genetic makeup of the child , there are genes that are in charge or releasing the neuronal hormones that shape the child’s attachments to the mother or primary care giver. From this point of view, it is more likely that some children become susceptible to disturbed attachment depending on the nature of their genes. In light of this issue, several genes have been cited to have an effect on attachment and detachment of the child. For instance vasopressin and serotoninergic have been implicated in studies of attachment disorders. (Hardy, 2007)

Maternal Ambivalence

This involves the various reactions and processes the expectant mothers go through which might affect the developing child. It is vital to mention that in some communities, cultures can exert a lot of pressure on the mother. The way the mother responds to the cultural pressures determines the risk to attachment disorders. In some cases the mother is supposed to deal with stressful situations such as uncooperative husbands or separation issues and they all affect the relationship with the child. In cases where mothers have responded with mixed reactions on the child chances of forming stronger ties with the child even after birth become slim hence making the child to develop RAD symptoms. (Hardy, 2007)


A number of  studies have pointed out the role played by poor motherhood in the occurrence of RAD in infants. It is vital to mention that emotional and cognitive aspects of the mother can predispose the child to the attachment disorder. There are studies which have been done on primate mothers have indicated that mothers have the potential of influencing the future behavior of their children in relation to the disorder. Specifically they have concluded that nonhuman mothers who were abused at infant stage are more likely to abuse their children hence leading to the development of the disorder in their off springs. This was observed in both the children raised by their biological mothers as well as those raised by their non biological mothers. Maternal anxiety and other emotions in relation to bad behavior of the child has also been indicated by research to affect the child. Children who have behavior problems and are difficult to manage can trigger anxiety amongst mothers and if it is not handled carefully, it can result in the disturbed attachment in the infants of 4 years.

The goodness of fit in the mothers environment has also been associated with triggering factors of the disorder. Sociologists argue that the mother has to be well equipped with the right attitudes and skills that can control the external environment of the child. This is applicable to infants who are unresponsive and quiet and also those who are irritable and repulsive. With such a control, the mother is able to reduce the risk of the environment in triggering symptoms of the disorder. (Hardy, 2007)


Therapy and management of reaction attachment disorder requires a lot of patience from the people involved. Immediate success upon commencement of the therapy should not be anticipated. Infants and adolescents are often oppositional and aggressive and can test the limits of external controls and rules. The therapists must therefore be prepared for little appreciation from the patients while at the same time expects the negative feedback in terms of behavior of the patients. (Hoffman,  Marvin, Cooper & Powell, 2006).

Empirical studies have identified various treatments for reactive attachment disorder. One of the most common strategy has been psychotherapy and has taken different dimensions while utilizing theories such as that of attachment. Becker-Weidman has articulated the Dyadic development psychotherapy. The researcher argues that symptoms of the disorder have declined to a great extent in cases where the method has been applied effectively. The therapy is based on the attachment theory and it is founded on the premise that the current situation of the child is the most essential in reducing the symptoms while at the same time the experiences of the child should be looked into. Building a relationship with the child is a key aspect of this treatment. The proponent argues that it is through the knowledge of the child’s background and experiences that workable relationships can be built with the care giver. In an environment where there is safety of the child, the therapist models healthy attachment modes. The RAD child is given a chance to re-experience the traumatic situations and in the event new feelings are triggered and expressed. (Becker-Weidman, 2006).

Cycle of security therapy

This is a strategy that uses the secure and non secure attachment designs. The process is led by a therapist who addresses the children and the care givers. One of the goals of the therapy is to develop a secure working environment between the children and the caregiver. The goal then shifts to the attention and sensitivity and responsibility that looks into the attachment needs of the child. The ability to recognize the verbal and non-verbal cues is enhanced by the methods. (Hoffman, Marvin, Cooper & Powell, 2006).

Another therapy that has been put forward through empirical research is known a eye desensitization and reprocessing. Such a therapy in founded on the assumption that traumatic episodes are trapped rather than processed by the brain. Each and every aspect of the negative experiences continue to be reactivated every now and then and they have an impact on the victim of the disorder. Children who suffered abuse and neglect continue to visualize these bad experiences and it interferes with their abilities to form relationships with their caregivers. This therapy has the potential of diminishing the unfortunate experiences of abuse and neglect and replaces them with positive feelings such as those of happiness and hope. The RAD infants are therefore able to continue with a normal life that is full of excitement and positive attitude towards others hence attachments. (Newman, 2007).

Medications for other conditions that might be affecting the child with RAD has also shown positive results according to empirical research. Studies have continued to point that conditions such as anxiety and depression might be very influential towards the behavior of adolescents. In cases where these conditions have been kept at bay, reactive attachment disorder symptoms have reduced tremendously.


Individual psychological counseling can be of great help to children suffering from the attachment disorder. In this case, the therapist who can be the parent or care giver should seek psychological counseling on how to bring back attachment relations with the affected child.  The caretaker can also attend the counseling sessions with the affected child for the psychologists to have a first- hand experience with the patient. Empirical studies have shown that RAD children who are given medicine by the psychologists would show diminishing behavior problems with application of therapy. In these studies the patients were enrolled in a three year program. During the three years counseling was applied and it resulted in positive results with changed behavior in the children. Specifically the patients developed attachments with their adopted mothers and they showed a diminishing trend in the oppositional and aggressive behavior. (Haggard& Hazan, 2006).

Play therapy

This form of therapy makes use of a number of important aspects in forming attachments between the caregiver and the child. The balance of structure, nurturance and play are key in this case in the formation of attachments. As recorded by Weir (2007), modifying theraplay is a crucial step towards helping the child with attachment problems. The approach is applicable to children of upto 12 years. The sessions are designed to last for one hour per week and should last between 10 to 20 weeks. The facets that are key towards better attachments include structure, challenge, stimulation and nurturing as mentioned by Pzybylo (2002). Structure in theraplay refers to the groundwork in which times rules are set and reviewed for the sake of establishing the structure. The challenge pertains to the scenario where the participation of parents and children is required whether they like it or not. Participation of these two important stakeholders ensures that the required tasks are completed as set to realize the objectives. Engagement has to be undertaken in the therapy so as to attract the children and ensure they are in the process of changing their behavior. Nurturing has been considered to be a very important aspect of play therapy by the research. It is through nurturing that the desirable bonds are established between the care giver and the child. A sense of security is very essential for the child. Empirical research had provided evidence that affirms that the more secure the environment formed by the caregiver, the stronger the attachments that are established between the child and the care giver. (Newman, 2007).


Reactive attachment disorder manifests itself in different behavior problems and has an impact on the relationships between infants and their care givers. It is vital to understand the symptoms of the disorder before choosing the appropriate therapy. Empirical research has shown the success that has been achieved by various treatment methods  that have been discussed in the paper.


Becker?Weidman, P. A. (2006). Treatment for children with trauma attachment disorders:  Dyadic Developmental Psychotherapies. Child and Adolescent Social Work Journal , 23 (2), 147?171.

Cappelletty, G. G., Brown, M. M., & Shumate, S. E. (2005). Correlates of the Randolph  Attachment Disorder Questionnaire (RADQ) in a sample of children in foster placement. Child and Adolescent Social Work Journal , 22 (1), 71?84.

Fairchild, S. R. (2006). Understanding attachment: Reliability and validity of selected attachment measures for preschoolers and children. Child and Adolescent Social Work Journal , 235?261.

Guttmann-Steinmetz S, Crowell JA (2006). "Attachment and externalizing disorders: a developmental psychopathology perspective". J Am Acad Child Adolesc Psychiatry 45 (4): 440–51.

Hardy, L. T. (2007). Attachment theory and reactive attachment disorder: Theoretical perspectives and treatment implications. Journal of Child and Adolescent Psychiatric Nursing, 27?39.

Hoffman, K. T., Marvin, R. S., Cooper, G., & Powell, B. (2006). Changing toddlers' and preschoolers' attachment classifications: The Circle of Security intervention. Journal of Consulting and Clinical Psychology , 1017?1026.

Haugaard, J, J.; Hazan, Cindy.(2006).Recognizing and Treating Uncommon Behavioral and Emotional Disorders in Children and Adolescents Who Have Been Severely Maltreated: Reactive Attachment Disorder. Child Maltreatment, Vol 9(2), May 2007. pp. 154-160.

Mukaddes, N Motavalli; Kaynak, F. Nimet; Kinali, Gulsevim.(2005). Psychoeducational Treatment of Children with Autism and Reactive Attachment Disorder. Autism The International Journal of Research and Practice, v8 n1 p101-109 Mar 2005.

Newman L, Mares S (2007). "Recent advances in the theories of and interventions with attachment disorders". Curr Opin Psychiatry 20 (4): 343–8

Schwartz, Eric; Davis, Andrew S.. (2006). Reactive attachment disorder: Implications for school readiness and school functioning.Psychology in the Schools, Apr2006, Vol. 43 Issue 4, p471-479, 9p; DOI: 10.1002/pits.20161.

Shaw, S. R., & Paez, D. (2007). Reactive attachment disorder: Recognition, action, and considerations for school social workers. Children and Schools , 69?74.

Schechter DS, Willheim E (2009). Disturbances of attachment and parental psychopathology in early childhood. Infant and Early Childhood Mental Health Issue. Child and Adolescent Psychiatry Clinics of North America, 18(3), 665-687.

Weir, P. K. (2007). Using integrative play therapy with adoptive families to treat reactive attachmentdisorder: A case study. Journal of Family Psychotherapy , 18 (4), 1?16.

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