Reactive detachment is a severe form of attachment disorder. It occurs in infants and children who have experienced gross neglect or mistreatment from their primary caregivers, usually their mothers, before age 5. Healthy emotional attachments are important for a young child to learn how to love and trust others, to regulate his emotions, and to develop healthy relationships and a positive self-image.
Most babies and children develop their first attachments with their caregivers while they are still in the womb. During this time, babies can hear their mother’s voice and heartbeat. They can also feel their mother’s body and movement. Once they have been born, most infants and children form healthy attachments to their primary caregivers if those caregivers provide consistent comfort and caregiving. When a child is abandoned or mistreated, this can have lasting effects.
The risk of reactive detachment is higher for babies and children who suffer from postpartum depression, live in orphanages and other institutions, are separated from their parents for long periods of time, are placed in multiple foster-care situations, or have neglectful parent or caregivers. In addition, some children with a history of trauma and/or neglect may have other conditions, such as depression or anxiety disorders, which may contribute to the development of RAD.
Symptoms of RAD are often characterized by an inability to seek or accept physical closeness, difficulty regulating their emotions, frequent anger and impulsivity, and an inability to interact socially. The withdrawn or disinhibited form of the condition is more common than the over-eager, demanding or aggressive behavior that’s described in the disinhibited attachment disorder (DSED) section of the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition.
Inhibited RAD symptoms include extreme agitation and difficulty interacting with others, including an inability to respond to people who reach out for comfort. Children displaying these symptoms tend to ignore their surroundings and exhibit self-soothing behaviors, such as rocking or rubbing their own arms. Disinhibited RAD is more common than the inhibited form of the condition and occurs in children who have experienced abusive or neglectful environments.
Treatment for a child with a diagnosis of RAD typically includes psychotherapy for the child and family therapy, parental training, and special education services. Some children may be prescribed a selective serotonin reuptake inhibitor (SSRI) drug to help regulate their emotions.
When caring for a child with RAD, it’s important to find ways to take breaks and keep from getting burned out. It is especially helpful for families to be familiar with the disorder and have a trusted caregiver who can step in from time to time. Finding support groups for other parents of children with RAD can be helpful, too. It’s important to remember that while a child with RAD may have challenges in life, most can overcome them with the right treatment. A professional therapist can help you understand the root causes of your child’s behavioral problems, and develop a plan for moving forward.