Reactive Attachment Disorder in Children and Adolescents

ICD-10 Code: F94.1

Reactive attachment disorder (RAD) is part of a cluster of diagnoses called the trauma and stressor-related disorders.  Trauma and stressor-related disorders are a group of psychiatric conditions that include:

  • Posttraumatic stress disorder
  • Acute stress disorder
  • Reactive attachment disorder

These disorders are characterized by an adverse reaction to one or more traumatic or unusually stressful experiences.

The Diagnostic and Statistical Manual of Mental Disorders-5th Edition defines traumatic events as situations in which the individual experiences, is threatened with, or witnesses serious injury, death, or sexual violence.  Repeated exposure to extreme details of traumatic events as part of an individual’s employment (e.g., a police officer or social worker who regularly encounters details of child abuse) also qualifies as a traumatic event.   

PTSD and acute stress disorder are both characterized by a set of adverse cognitive, behavioral, and emotional changes that occur after experience of one or more traumatic events.  Both disorders are characterized by intrusive and upsetting memories of the traumatic event(s), adverse cognitive and emotional changes (e.g., very negative beliefs about the world; persistent dysphoria or anger), avoidance behaviors (including avoiding thinking about the event), and increased autonomic reactivity.   Acute stress disorder is diagnosed when the symptoms occur in the month following the traumatic event.  PTSD is diagnosed when the symptoms persist for one month or longer following the traumatic event.

RAD is diagnosed only in children and is characterized by inhibited and emotionally withdrawn behaviors toward the child’s caregiver(s), along with other social and emotional disturbances.  RAD is an adverse reaction to neglect, repeated changes in caregivers (e.g., frequent changes in foster care), or rearing in adverse circumstances (e.g., institutions with inadequate availability of caregivers).

What is Reactive Attachment Disorder?

RAD is a relatively rare psychiatric disorder that affects less than 1% of children and adolescents; however, incidence is significantly higher (up to 40%) among children who have been institutionalized or who have experienced extreme neglect.

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Understanding Reactive Attachment Disorder

RAD can vary in its severity.  In severe cases, RAD can lead to inability to form satisfying relationships with peers or adults and can cause impairment across a wide range of domains of the child’s life.  Little is known about the comorbidity of RAD.

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How is Reactive Attachment Disorder?

Few clinical trials have investigated treatments for RAD.  However, published treatment guidelines for RAD are provided by the American Academy of Child and Adolescent Psychiatry.  Note that safety considerations, including involvement of appropriate child service agencies as warranted by ethics and law, should be addressed before the treatment recommendations below are applied.

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