R.A.D
Reactive
Attachment
Disorder
Nicole Kramer &
Kathleen Miller
Handout
What is RAD?
 RAD is a complex psychiatric disorder that begins in
infancy or very early childhood.
 A markedly disturbed and developmentally inappropriate
social relatedness in most contexts, beginning before age
5 years (Hardy, 2007).
Hand Out
 Description of RAD:
 A child’s attachment to primary caregivers is normally created
during infancy and throughout the first few years of life. When
child fails to find those attachments it can result in attachment
problems and trust issues, which can cause in most severe cases
RAD (Shaw, & Paez, 2007).
 Older children and adolescents characteristics:
 Poor cause and effect thinking
 Little to no remorse for their actions
 Self-esteem is generally low- feeling worthless, unlovable, and
masked by anger
 Controlling and manipulative
Handout
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 Many of the children have been physically, emotionally, or
sexually abused, or may been received inadequate or even
neglectful care (Lake, 2005).
 Two distinct types:
 Inhibited- tend to no initiate or respond to social interactions at
all or in an appropriate ways.
 Symptoms: physical and emotional delays, poor hygiene,
poor motor development and coordination, and/or an
unfocused, blank or bewildered expression
 Disinhibited- socially indiscriminate (may be excessively friendly
with strangers)
 Symptoms: excessive familiarity or ‘Psychological
promiscuousness’ with unknown people
Handout
 Strategies/Interventions for RAD:
* Most effective therapies and treatments will differ from child to child.
 Child-focused therapies:
 Psychotropic medications
 Counseling
 Holding Therapy:
 Trying to recreate bonding cycle in infancy.
 Therapist holds the child’s head in his or her lap and maintains
eye contact with the child, while the other restrains the child’s
arms and legs.
 This goes on for 10 days with a total of 30 hours.
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 Rebirthing Therapy:
 More extreme form of restraint where the child is wrapped in a
blanket to simulate the womb. Pillows are pushed against the
child to simulate the contractions and the child must push their
way out through the end of the twisted blanket.
 Dyadic Developmental Psychotherapy (DDP):
 Emphasizes a positive relationship with the child
 Therapist would listen and reflect back the child’s experiences
Additional Information to share
 Children who are hard to calm, irritable or unresponsive,
because of temperament, illness, or a disability like autism or
attention deficit/hyperactivity disorder (ADHD), can have
harder time forming strong relationships
 Domestic violence, poverty, and/or war can all play into
effect of attachments being formed
 As much as 3 to 6% of the general population may be
affected by RAD.
 RAD symptoms tend to worsen over the years without
treatment
Information to share
 Symptoms of both types of RAD often persist into adulthood.
 Diagnoses are usually based on reports of symptoms,
observable behaviors, family history and the clinical course of
the disorder. This can be VERY tricky.
 Many symptoms of RAD mirror and overlap multiple other
childhood psychiatric disorders.
Information to share
 Key elements of effective interventions are to target the
underlying issues, not just the symptoms that accompany
RAD.
 Treatments should be designed to:
 Raise self-esteem levels could help improve functioning
 Social support
 Involve the parents as well as child
 Consistent and reflective in nature to provide structure
 Earlier the interventions happen the better; might help
prevent lifelong consequences.
Information to share
 By the time children with RAD reach adolescences, many
have accumulated comorbid disorders:
 ADHD
 Oppositional defiant disorder (ODD)
 Posttraumatic stress disorder (PTSD)
 Learning disabilities
 Anxiety disorders
 Depressive disorders
 Mood disorders
Information to share
 In school settings students are usually easy to pick out based
on their antisocial or violent behaviors.
 Many don’t believe they can succeed in school, which leads
to acting out
 Trouble learning from their mistakes and a poor sense of
reality
 Students with RAD need to feel as though they BELONG in a
classroom or school setting.
Any
Questions?