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Reactive Attachment Disorder: The "Rare" Culprit That Stifles Traumatized Kids and Their Parents

Updated: Jan 12, 2023

Imagine if 40% of the population had a condition that was hardly covered in provider education. Therefore, it was rarely recognized or treated, and the individual and their families were left to suffer alone, trying to find help and feeling like they’re crazy because no one is recognizing their needs.

Surprise, it’s not fiction. It’s a sad reality when it comes to reactive attachment disorder (RAD) and attachment issues in general.

Real Life Parenting Struggles with RAD

When we took foster care training, attachment issues were glossed over for a few minutes. I associated reactive attachment disorder only with children from very depraved orphanages. No one told me that all kids with a history like our son’s should receive attachment-informed care. No one helped set us up with such providers.

Our son was 9.5 when he moved in with us. He had an extensive trauma and neglect history, and we were his second adoption. We immediately sought out a therapist claiming adoption was one of her specialties. Our son also saw a psychiatric nurse practitioner and other providers. But none treated him for attachment or involved us in his treatment, which now seems crazy. It wasn’t until he was 14 that anyone even mentioned reactive attachment disorder to us, and still there was no local expertise, and his insurance didn’t cover any specialized treatments.

The Importance of Attachment

The first few years of a child’s life are now widely understood to be critical. By the time a child is 5 years old, 85-90% of their brain is fully developed. The majority of a person’s physical, cognitive and social brain function is shaped by these first few years.

But what providers aren’t yet focusing on is the key piece in that brain development: attachment with primary caregivers. Caregivers who are consistently responsive, attuned and available help the child form a healthy attachment. Healthy attachments in turn enable the child to learn to regulate their emotions and trust their primary caregivers. Healthy attachments allow children to thrive and set a positive foundation for the rest of their lives.

If the caregivers change or are not consistently responsive to the infant’s needs—whether that’s due to addiction, mental illness, medical issues, abuse, neglect, stress or a number of other causes—the child may develop unhealthy attachment patterns, categorized as avoidant, anxious or ambivalent. As cited in the article Childhood Attachment by Corinne Rees in the British Journal of General Practice, 40% of the general population is categorized as having one of these insecure attachment styles. She states: “Dysfunctional childhood attachment is of major public health importance and underlies many of the difficulties of contemporary society. Its under-representation in medical training, practice and research needs to be rectified.”

I couldn’t agree more. It’s my opinion that any adopted child is likely to have some attachment issues, even if it’s not reactive attachment disorder. Think of it like a spectrum. And, as seen above, many non-adopted children also have attachment issues.

In “Born for Love” by the famous Dr. Bruce Perry and Maia Szalavitz, they write about the hormones involved in bonding as they relate to adopted children: “In children whose infancies involved normal parenting, oxytocin rose in response to being held by their mother—but this response wasn’t seen in orphanage children held by their adoptive mothers, even though they were tested approximately three years after adoption.”

Left untreated, attachment issues become a lifelong impairment, impacting all facets of a person’s life, especially their relationships and mental health.

Rees says, “If children reach adolescence without achieving stable parental attachment, the professional task becomes one of damage limitation, aiming to give as safe as possible a transition to independence, and to halt intergenerational perpetuation of dysfunctional attachment.”

In addition to attachment issues in general not being adequately recognized and treated, there’s also a major misconception that reactive attachment disorder is rare amongst traumatized children. But take this stat from the American Bar Association page on reactive attachment disorder, referring to this 2004 study: “While RAD is rare in the general population, it is common in abuse cases. In one study of toddlers in foster care who had been maltreated, 38-40% of the children met the diagnostic criteria for RAD. Many older children who have delayed disclosure of their early abuse also suffer from undiagnosed RAD.”

What Parents Do

Families are suffering and failing due to this lack of recognition and treatment. It seems to be up to us, the parents—along with a few supportive experts—to create a paradigm shift. That’s why RAD Advocates was started by fellow RAD parents: to support families as well as educate the general public and providers. We have a lot of work to do. The entire system—from social services to therapists and doctors and everyone in between—needs to recognize the importance of healthy attachments and the number of folks suffering from insecure attachment. They must aim treatments, education and supports accordingly.

Until then, it’s up to parents to share information and support one another. But it's happening more than ever. Every day, parents are doing more sharing of resources, more speaking up, and more demanding help. And there is empowerment—and change— in that choice and voice.

About the Author:

Micaela Myers and her husband adopted a pair of siblings from foster care in 2015, when the children were 9 and 13. Since then, she has become an advocate for foster care reform and the support and education of adoptive parents. Micaela earned her MFA in writing from Vermont College of Fine Arts and works as a professional writer and editor in Wyoming.

1 Comment

What does the phrase, "damage limitation" mean? I feel like that is where we are with our 15-year-old RAD. Adopted at 9 and then couldn't live with the family for a couple years and now back. People get upset that they don't seem me be cuddly and warm with her like I am with my other children and she enjoys playing the victim when given any opportunity. We are always on edge with what she might lie about next. Cameras all over, locked doors, constantly checking on her to make sure she isn't destroying, stealing, or maiming is exhausting. I dread school vacations, there's just no breaks. I got her a helmet and skateboard and make her go outside sometime…

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