Adoption, Attachment, and the Red Flags We Didn't Understand — Until Our Son's Reactive Attachment Disorder Diagnosis
- Anonymous
- Apr 28
- 7 min read
Updated: May 1
My husband and I sat in a conference room surrounded by lawyers, therapists, caseworkers, Court Appointed Special Advocate (CASA) volunteers, and clinical decision-makers from the Department of Child Services. After nearly a decade of trying to keep our family safe through the challenges of developmental trauma, we hoped they’d finally come together to support us.
The state-funded psychologist produced a 15-page report that included our son Joe’s reactive attachment disorder (RAD) diagnosis. Although five independent professionals had already diagnosed him with RAD, this psychologist had different recommendations.
Instead of suggesting out-of-home specialized treatment like the others had, she told us to try family game nights. We were also advised to work on Joe’s coping skills and — shockingly — to tell our other children that their needs were not as important as Joe’s.
I left the meeting completely defeated. After years of seeking help through what we thought were temporary adoption and attachment struggles, I found myself asking: What did we miss? What if we had recognized the red flags of reactive attachment disorder sooner? Would we still be in this place, where the “help” wasn’t help at all?
Why Early Signs of Reactive Attachment Disorder Are Missed — Even in Adoption and Attachment Challenges
Reactive attachment disorder was never mentioned in our foster care and adoption training. We didn’t know the disorder even existed — let alone how to recognize it.
By the time Joe was diagnosed with reactive attachment disorder, the damage in our family was already done.
Most clinicians rely on the DSM-5’s criteria for RAD, which is generalized and open to interpretation (copied at the end of this article for reference). For years, it didn’t explain what we saw in real life.
After years of seeking help through what we thought were temporary adoption and attachment struggles, I found myself asking: What did we miss? What if we had recognized the red flags of reactive attachment disorder sooner? Would we still be in this place, where the “help” wasn’t help at all?
Julie Fox Evans, a licensed professional counselor experienced in RAD, confirms what I had come to believe: the signs of RAD are easy to miss — even for most professionals. “These children are often incredibly skilled at keeping others at a distance,” Julie says. “But they do so in ways that look like something else — defiance, hyperactivity, or even social awkwardness. Their true motivations are easy to miss unless you know what to look for.”
Julie emphasizes how often children with RAD are misdiagnosed with conditions like ADHD, autism, oppositional defiant disorder, or intermittent explosive disorder. “Crutches won’t help a wound that needs stitches,” she says. “Likewise, to treat reactive attachment disorder like attention deficit disorder, autism, oppositional defiant disorder, or intermittent explosive disorder won’t help the child.”
We experienced this firsthand. One therapist told us to use sticker charts and time-outs. Another praised Joe’s ability to “self-soothe” — while we watched him spiral at home. Well-meaning professionals weren’t seeing what we saw. And what they offered only made things worse.
Trauma, Adoption, and Attachment Issues: Not Every Child Develops Reactive Attachment Disorder
Joe and his two brothers were our first foster care and adoption placement. All three experienced trauma — but only Joe was diagnosed with reactive attachment disorder. That didn’t make sense to us for a long time.
Most children who’ve experienced trauma show similar behaviors: hyperactivity, emotional dysregulation, food issues, sleep troubles, lying, stealing, or sensory sensitivities. But one key difference stands out. Children with “just” trauma can eventually trust caregivers and feel safe in a secure attachment environment — and their behaviors typically lessen over time. Children with RAD don’t experience that trust. They continue to test, push away, and resist even when they are physically safe.
Crutches won’t help a wound that needs stitches. Likewise, to treat reactive attachment disorder like attention deficit disorder, autism, oppositional defiant disorder, or intermittent explosive disorder won’t help the child.
In retrospect, both of our other boys likely qualified for attachment issues. One no longer does. Joe, on the other hand, was later diagnosed with severe, persistent reactive attachment disorder by six different professionals. The difference likely stems from the severity or duration of traumatic experiences each of our boys had early on.
The Red Flags of Reactive Attachment Disorder We Missed in Our Adoption and Attachment Journey
As new adoptive parents, we wanted to believe in love and consistency — that those things are enough in adoption and attachment healing. But reactive attachment disorder isn’t healed by love alone. Here are some of the red flags we missed along the way for Joe:
Multiple early caregiver disruptions: Joe had three caregiver disruptions before the age of two. This early instability disrupted his ability to form healthy attachment or build trust.
Self-isolation: While his brother joyfully explored his new room upon his arrival in our home, Joe spent the weekend alone — vacuuming. Even when we visited the zoo on a class trip, he didn’t want to be with his classmates or me. He spent hours petting sharks. Alone.
Constant disagreeability: Joe often said no before I could even finish a sentence. Sometimes just opening my mouth — or looking like I might — was enough to spark a battle.
Inability to accept no: Although Joe loved using the word “no” himself, hearing it from us triggered hours-long rages. These weren’t tantrums. They were explosive, exhausting efforts to gain control.
Rage as a tool, not a cry for help: Joe’s rages stopped the moment he got what he wanted or sensed we were backing off. This wasn’t dysregulation. It was strategic — a survival skill to avoid vulnerability and attachment.
Discomfort with physical touch: Joe stiffened when hugged. He rarely allowed physical affection, even as time went on. And when I touched him to protect him or guide him, he began accusing me of abuse.
Lack of sleep: Joe slept very little from a very young age. Not with illness. Not with melatonin or medication. He sat cross-legged in his crib many nights, eyes wide open.
Indiscriminate use of the word “mommy”: Both older boys initially called every woman “mommy.” It wasn’t sweet. It was heartbreaking. They didn’t understand the word as something sacred or tied to attachment.
Unusual potty training and regression: Joe weaponized his bodily functions, soiling vents, hiding underwear, and threatening siblings. But in residential facilities, where attachment wasn’t expected, those behaviors disappeared.
A seeming lack of a learning curve: One day he’d know how to tie his shoes or recite the rules. The next day, it was as if he’d never heard of them. He sabotaged every effort to help him — unless it gave him more control.
Julie Evans explains that while other disorders may mimic aspects of RAD, a child's early history is key. "Reactive attachment disorder is always rooted in early neglect or abuse," she says. "That’s the red flag that should prompt deeper evaluation."
How Professionals Can Spot Reactive Attachment Disorder in Adoption and Attachment Cases
Julie points to four guiding questions that can help identify whether reactive attachment disorder could be part of the picture. “Whether you’re a parent or fellow therapist,” she says, “consider the following when a child presents with concerning behavior — especially when things don’t add up in adoption and attachment cases.”
Has the child experienced early physical or emotional neglect or abuse? “This is your first red flag,” Julie explains. “You might not know the full history, especially in foster care and adoption cases, so you’ll have to use your clinical judgment.”
Does the child go to their caregiver during emotionally difficult times? “Children with RAD usually avoid or even push away comfort from their primary caregiver,” she says. “They might act out, deny vulnerability, or respond with aggression instead of seeking healthy attachment.”
Are there emotional or social disturbances with caregivers or peers? “You might see lack of engagement during play, extreme mood swings, or a failure to connect even in emotionally safe situations.”
Has the child experienced a pattern of insufficient care or repeated caregiver changes? “Even very early transitions — like multiple foster homes — can rupture attachment,” she says. “When basic needs aren’t reliably met in infancy, the damage runs deep.”
What If We Had Known the Signs of Reactive Attachment Disorder Sooner?
I often wonder what would’ve happened if someone had connected the dots earlier. If any professional had asked not just what Joe was doing, but why he was doing it — through the lens of developmental trauma.
Because when professionals don’t understand reactive attachment disorder, the consequences can be devastating. Children get the wrong diagnosis. Families are judged or dismissed. And dangerous, destructive cycles continue — sometimes for years.
But when professionals do recognize RAD, it opens the door to the right kind of help.
“To correctly recognize reactive attachment disorder symptoms does not offer promise,” Julie says, “but it does give greater hope for effective help. And parents and their children deserve that chance, at the least.”
If you're a clinician, foster parent, teacher, or anyone working with children from hard places, please learn the signs of reactive attachment disorder. And if you’re a parent who sees yourself in these stories, you’re not alone. There are others who’ve walked this road — and who will walk it with you now.
Not sure where to turn for your child battling early trauma?
You’re not alone — it's different for every family and you don’t have to figure it out on your own. Connect with RAD Advocates to find real answers from those who’ve walked this path.
DSM-5 Criteria for Reactive Attachment Disorder
For those seeking a clinical definition, the DSM-5 outlines the following criteria:
A. A consistent pattern of inhibited, emotionally withdrawn behavior toward adult caregivers, manifested by both:
Rarely or minimally seeking comfort when distressed
Rarely or minimally responding to comfort when distressed
B. A persistent social and emotional disturbance characterized by at least two of the following:
Minimal social and emotional responsiveness to others
Limited positive affect
Episodes of unexplained irritability, sadness, or fearfulness during nonthreatening interactions
C. The child has experienced a pattern of extremes of insufficient care, such as:
Social neglect or deprivation
Repeated changes of primary caregivers
Rearing in settings with limited opportunities to form attachments
D. The care in Criterion C is presumed to be responsible for the behavior in Criterion A.
E. The criteria are not met for autism spectrum disorder.
F. The disturbance is evident before age 5.
G. The child has a developmental age of at least 9 months.