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Part II-Breaking down the RAD diagnosis

Part II-Breaking down the RAD diagnosis

Parents-if you’re reading this post, you’re likely curious about attachment disorders. Maybe you’ve heard that your child has “reactive symptoms” or “attachment problems”. The Reactive attachment disorder (RAD) diagnosis makes more sense with education about the diagnosis which will provide a better understanding of why your child approaches the world with anger, indifference, and isolation. These young children go to extreme lengths to protect themselves emotionally.


This protection comes in the form of ‘invisible walls’, rejection of love and affection, and resistance to physical touch- just to name a few.

RAD is very common among children who have been adopted. Now, the act of adoption does not create ‘attachment issues’, but the institutionalized process which lead up to the adoption (foster care, orphanages, treatment centers) contribute to the lack of consistent relationships for a child.


It’s also important to understand that unlike many other mental health disorders, RAD can be ‘cured’ to the point where all symptoms have completely disappeared and they never come back. There are literally thousands of success stories of patient and loving families who have bonded and attached to their child.

In order to understand attachment disorders and choose the right treatment for your child, it’s important to understand the requirements for an accurate diagnosis.

Let’s get started.

Diagnostic criteria

In order to receive a full and accurate Reactive attachment disorder (RAD) diagnosis there are 7 criteria.

1) Child must demonstrate a consistent pattern of inhibited, emotionally withdrawn behavior toward adult caregivers, manifested by BOTH of the following:

  • Child rarely seeks comfort when distressed
  • Child rarely responds to comfort when distressed

2) Child demonstrates TWO of the following emotional disturbances-

  • Minimal social and emotional responsiveness to others
  • Limited positive affect
  • Episodes of unexplained irritability, sadness, or fearfulness that are evident even during nonthreatening interactions with adults.

3) Child has experienced a pattern of extreme insufficient care as evidenced by at least one of the following:

  • Social neglect or deprivation in the form of persistent lack of having basic emotional needs for comfort, stimulation, and affection met by caring adults
  • Repeated changes of primary caregivers that limit opportunities to form stable attachments (e.g.,frequent changes in foster care)
  • Rearing in unusual settings that severely limit opportunities to form selective attachments (e.g.,institutions with high child to caregiver ratios)

4) The care listed in the 3rd requirement is responsible for the disturbed behavior listed in the first criteria. Simply put-the behaviors listed in the first two criteria happened after
inadequate or inconsistent care took place.

5) The criteria are NOT met for autism spectrum disorder. (Some of the behaviors and symptoms overlap with Autism Spectrum Disorder (ASD). It’s important to rule out ASD before diagnosing RAD)

6) The disturbance is evident before age 5 years.

7) The child has a developmental age of at least nine months.

Two additional specifiers of qualifiers for specific types of attachment disorder

*Reactive attachment disorder persistent- if behavior is present for at least 12 months.

*Reactive attachment disorder severe-when a child exhibits ALL of the symptoms of the disorder, with EACH symptom manifesting at high levels.


Children who exhibit signs of RAD need a comprehensive psychiatric assessment and individualized treatment plan. Parents of a young child who shows signs or symptoms of RAD should: seek a comprehensive psychiatric evaluation by a qualified mental health professional prior to the initiation of any treatment.


There is hope!

A lot of it actually. During this RAD series, I’m sharing success stories at the end of each post because I’d like to highlight the incredible work that parents and their RAD children have done. My hope is that these success stories will encourage those of you who may feel hopeless, to keep fighting.

This story comes from the Midwest from an aunt who took custody of her 5 year old niece and 8 year old nephew earlier this year. The children’s father passed away when they were very young and their mother simply couldn’t cope with the grief and loss of her husband and turned to alcohol and meth. It didn’t take long for the authorities to step in and remove the children from the home.

After a few years and several placements, the approval was given for the children to be placed with family. The niece transitioned well and fit right in. However, the nephew struggled in his new home and rejected the love and efforts to bond by his new family.

The young man purposefully attacked the family in ways that would be difficult to forgive. He kicked the family dog, destroyed presents he was given, said awful things about his cousins and ruined most holidays by acting out and by being defiant. The family felt like they couldn’t leave the house and that they were being held hostage by this new addition to the family. The young man seemed oblivious to the efforts and that the family was taking to reach out and love him. On two separate occasions, the family gave their notice to the state asking that the nephew be removed.

Each time within a few days, the family had a change of heart. They decided to approach the problem with education and professional help. In this case, the aunt and uncle began RAD training courses and attended a six week attachment conference on the weekends.

The more they learned about attachment disorder, the stronger their commitment became to this young man. They understood his reasons for pulling away, and instead of choosing to be hurt by his actions, they involved him even more in the family by giving him choices. He participated in choices such as what was for dinner, what vacations the family took, and which movies to watch on movie night. The more the family gave him choices, the more invested he became in the long-term success of the family.

The aunt and uncle realized that in the beginning they were showering him with love and affection, but were forcing him to join the family on their terms, being part of their family culture, and to function within their family dynamic. They have now created a new culture and family dynamic with his input, and his ideas.

Things aren’t perfect but they are manageable and the family feels that the positive addition he brings to the family is worth every tantrum and every anger outburst.

This new approach has created a monumental shift in the focus and happiness of the family.

Empathy leads to a change of heart

Institutionalized children carry emotional burdens that are nearly impossible to comprehend. They developed unhealthy coping strategies at a very young age to deal with their own rejection and lack of a consistent comforting caregiver when they needed it most. The rejection to affection and love is merely a defense mechanism.

Overcoming these emotional burdens requires patience and love, but there is hope. You know your child better than anyone else, but more importantly you love them more than anyone else.

Hang in there, keep fighting and don’t question your ability to love or your to be a good parent. You are just what they need.