Children with a history of maltreated or neglected attachment experiences can have difficulty forming and maintaining relationships. They often show a lack of emotional closeness, do not seek comfort or physical touch from their caregivers and may behave aggressively in response to being held, cuddled or comforted. This condition is called reactive attachment disorder criteria and affects up to 2% of children. Some of these kids experience repeated removals from their parents and placement in foster care and other institutions, which can exacerbate the problem.
In many cases, the signs and symptoms of RAD are misdiagnosed or overlooked by mental health professionals. They are often mistaken for symptoms of other behavioral health disorders, like oppositional defiant disorder and conduct disorder, or they might be attributed to other conditions, such as genetic or neurological problems or autism spectrum disorders.
A diagnosis of RAD is difficult to make and requires careful observation and evaluation. It’s important to consider the child’s entire life experience when assessing for this condition. A psychologist or psychiatrist can evaluate the child, preferably with the family present, and perform a thorough interview to determine the symptoms of the disorder. The provider can also take a detailed history of the child’s early life and observe the child’s behavior with different caregivers.
The child’s background and history are the main criteria for a diagnosis of RAD, but a professional also needs to consider whether the symptoms are caused by other factors. Some kids with RAD are the result of parental death and thus have not had an opportunity to form a normal attachment with their parent figure. Others spend years in institutions and are deprived of emotional closeness and physical contact from parental figures. Other children have been abused physically or sexually by caregivers, which can leave them with a deep distrust and a sense of insecurity about their safety.
While no one can predict what a child with RAD will become, experts agree that children can recover with proper therapy. A child’s therapist will work with the child and their family to help them build trusting, loving relationships. This can include family therapy, individual therapy and group therapies.
Behavioral therapy involves teaching the child how to communicate emotions more effectively and how to express them appropriately. It can also teach the child self-esteem, and help them develop more positive behaviors. Some children with RAD may have anger management issues. They may act out in ways that are hard to control and may hide their anger with manipulative or passive-aggressive strategies, such as lying or playing with a toy too hard.
There are several controversial treatments for RAD, including holding therapy, which involves a therapist or caregiver physically restraining a child to force them to relax. The American Academy of Child and Adolescent Psychiatry has criticized this type of treatment, which can be psychologically damaging and even deadly. Other controversial treatments for RAD include hypnotherapy and electroshock therapy, which have been linked to accidental deaths of children.