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Reactive Attachment Disorder
by Jenny Brackman

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What causes Reactive Attachment Disorder?

RAD is believed to be the result of "grossly pathogenic care" (by the parent or the primary caregiver) which falls into three forms.

1. Persistent disregard of the child's basic need for comfort, stimulation, and affection.

2. Persistent disregard of the child's physical needs.

3. Repeated changes in the primary caregiver that prevent formation of stable attachments (e.g, frequent changes in foster care).

The DSM-IV states that RAD always begins before age five, although most of the research suggests that the first year of life is most crucial.
DSM-IV, p. 116

Who is at Risk?

The Diagnostic and Statisitical Manual of Mental Disorders (DSM-IV) states that RAD always begins before age five. However, most of the research suggests that children are at the most at risk during the first year of life. The following children are the most likely to develop RAD:
  • Children adopted from foreign orphanages
  • Children who have experienced prolonged hospitalizations
  • Victims of severe child abuse or neglect
  • Foster children, especially those with multiple placements
  • Children living in extreme poverty

How common is Reactive Attachment Disorder?

The DSM-IV says that RAD is relatively uncommon, especially compared to other disorders such as ADHD (117). However, others argue that it is a "time bomb ready to explode" because of the increased amount of babies being born to neglectful or drug-addicted parents" (Levy 1).

What are symptoms of Reactive Attachment Disorder?

1. Superficially Charming and engaging.
2. Affectionate with strangers
3. Incessant chatter or nonsense questions
4. Intense Control Battles
5. Refuses, resists, or is uncomfortable with affection on parental terms.
6. Hoarding food.
7. Significant learning problems or lags.
8. Destructive to self or others.
9. Daily lying or lying in the face of the obvious.
10. Parents who feel like giving up or feel hostile towards the child.
11. Poor, underdeveloped, or no concience
(CASA, 4)


 References:

Barabeem Howard E., Marshall, William L. Hudson, Stephen M. The Juvenile Sex Offender. Guilford Press: New York, 1993.

Diagnostic and Statisitical Manual of Mental Disorders 4th ed. American Psychiatric Association: Washington, 1994

Karen, Robert. Becoming Attached: First Relationships and how they Shape our Lives. Oxford University Press: New York, 1998.

Levy, Terry M. Orlans, Michael. Attachment, Trauma, and Healing: Understanding Attachment Disorder in Children and Families. Child Welfare League of America Press: Washinton, 1998.

Reactive Atttachment Disorder. Arizona Supreme Court, CASA Division, 2002. www.supreme.state.az.us/casa/training/Attach/attach.html. 13 Dec. 2002.

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