reactive attachment disorder


Summary: Markedly disturbed and developmentally inappropriate social relatedness that begins before age 5 and is associated with grossly pathological child care. The child may persistently fail to initiate and respond to social interactions in a developmentally appropriate way (inhibited type) or there may be a pattern of diffuse attachments with nondiscriminate sociability (disinhibited type). (From DSM-V)

Top Publications

  1. Minnis H, Marwick H, Arthur J, McLaughlin A. Reactive attachment disorder--a theoretical model beyond attachment. Eur Child Adolesc Psychiatry. 2006;15:336-42 pubmed
    Despite its importance in public health, reactive attachment disorder (RAD) is an under-researched and little used clinical category...
  2. Gleason M, Fox N, Drury S, Smyke A, Egger H, Nelson C, et al. Validity of evidence-derived criteria for reactive attachment disorder: indiscriminately social/disinhibited and emotionally withdrawn/inhibited types. J Am Acad Child Adolesc Psychiatry. 2011;50:216-231.e3 pubmed publisher
    ..the validity of criteria for indiscriminately social/disinhibited and emotionally withdrawn/inhibited reactive attachment disorder (RAD)...
  3. Minnis H, Reekie J, Young D, O Connor T, Ronald A, Gray A, et al. Genetic, environmental and gender influences on attachment disorder behaviours. Br J Psychiatry. 2007;190:490-5 pubmed
    ..Behaviours suggestive of attachment disorder can be differentiated from common childhood emotional and behavioural problems and appear to be strongly genetically influenced, particularly in boys. ..
  4. Buckner J, Lopez C, Dunkel S, Joiner T. Behavior management training for the treatment of reactive attachment disorder. Child Maltreat. 2008;13:289-97 pubmed publisher
    b>Reactive Attachment Disorder (RAD) is a childhood disorder characterized by extremely inappropriate social relating across a variety of interactions that must be present by age 5...
  5. McGoron L, Gleason M, Smyke A, Drury S, Nelson C, Gregas M, et al. Recovering from early deprivation: attachment mediates effects of caregiving on psychopathology. J Am Acad Child Adolesc Psychiatry. 2012;51:683-93 pubmed publisher
    ..Security of attachment mediated this relationship. Interventions for young children who have experienced deprivation may benefit from explicitly targeting caregiver-child attachment relationships. ..
  6. Smyke A, Zeanah C, Gleason M, Drury S, Fox N, Nelson C, et al. A randomized controlled trial comparing foster care and institutional care for children with signs of reactive attachment disorder. Am J Psychiatry. 2012;169:508-14 pubmed
    ..signs of emotionally withdrawn (inhibited type) and indiscriminately social (disinhibited type) reactive attachment disorder in Romanian children enrolled in a randomized trial of foster care compared with institutional care and ..
  7. Chaffin M, Hanson R, Saunders B, Nichols T, Barnett D, Zeanah C, et al. Report of the APSAC task force on attachment therapy, reactive attachment disorder, and attachment problems. Child Maltreat. 2006;11:76-89 pubmed
    ..The report reflects American Professional Society on the Abuse of Children's (APSAC) position and also was endorsed by the American Psychological Association's Division 37 and the Division 37 Section on Child Maltreatment. ..
  8. Minnis H, Green J, O CONNOR T, Liew A, Glaser D, Taylor E, et al. An exploratory study of the association between reactive attachment disorder and attachment narratives in early school-age children. J Child Psychol Psychiatry. 2009;50:931-42 pubmed publisher
    To explore attachment narratives in children diagnosed with reactive attachment disorder (RAD)...
  9. Zeanah C, Scheeringa M, Boris N, Heller S, Smyke A, Trapani J. Reactive attachment disorder in maltreated toddlers. Child Abuse Negl. 2004;28:877-88 pubmed
    To determine if Reactive Attachment Disorder (RAD) can be reliably identified in maltreated toddlers in foster care, if the two types of RAD are independent, and to estimate the prevalence of RAD in these maltreated toddlers...

More Information


  1. Hall S, Geher G. Behavioral and personality characteristics of children with reactive attachment disorder. J Psychol. 2003;137:145-62 pubmed
    The authors compared behavioral and personality characteristics of children with reactive attachment disorder (RAD) with non-RAD children...
  2. Boris N, Zeanah C. Practice parameter for the assessment and treatment of children and adolescents with reactive attachment disorder of infancy and early childhood. J Am Acad Child Adolesc Psychiatry. 2005;44:1206-19 pubmed
    This parameter reviews the current status of reactive attachment disorder with regard to assessment and treatment...
  3. Sadiq F, Slator L, Skuse D, Law J, Gillberg C, Minnis H. Social use of language in children with reactive attachment disorder and autism spectrum disorders. Eur Child Adolesc Psychiatry. 2012;21:267-76 pubmed publisher
    Children with a diagnosis of reactive attachment disorder (RAD) appear to show difficulties in social understanding. We aimed to compare the pragmatic language functioning of children with (RAD) and autism spectrum disorder (ASD)...
  4. Kočovská E, Puckering C, Follan M, Smillie M, Gorski C, Barnes J, et al. Neurodevelopmental problems in maltreated children referred with indiscriminate friendliness. Res Dev Disabil. 2012;33:1560-5 pubmed publisher
    ..including Attention Deficit Hyperactivity Disorder (ADHD), Post-Traumatic Stress Disorder (PTSD) and Reactive Attachment Disorder (RAD) and one third exhibited the disorganised pattern of attachment...
  5. Adams K. Falling forever: the price of chronic shock. Int J Group Psychother. 2006;56:127-72 pubmed
    ..The ability to recognize subtle dissociative states is a valuable tool in the repertoire of the group psychotherapist. ..
  6. Velderman M, Bakermans Kranenburg M, Juffer F, van IJzendoorn M. Effects of attachment-based interventions on maternal sensitivity and infant attachment: differential susceptibility of highly reactive infants. J Fam Psychol. 2006;20:266-74 pubmed
  7. Bailey H, Moran G, Pederson D, Bento S. Understanding the transmission of attachment using variable- and relationship-centered approaches. Dev Psychopathol. 2007;19:313-43 pubmed
  8. Harden B. Safety and stability for foster children: a developmental perspective. Future Child. 2004;14:30-47 pubmed
  9. Kuhn J, Lenz A. [Coping in children of parents with schizophrenia--strikingly deceptive strategies]. Prax Kinderpsychol Kinderpsychiatr. 2008;57:735-56 pubmed
    ..Our findings confirm the necessity of increased social support to children of parents with mental disorder by extending the cooperation between institutions and by supporting social networks. ..
  10. Rees C. Thinking about children's attachments. Arch Dis Child. 2005;90:1058-65 pubmed
    ..The current under-representation of attachment in paediatric education, practice, and research needs to be rectified. ..
  11. Herrmann A, Huber D. [The influence of patient- and treatment-related factors on the success of inpatient psychotherapy]. Z Psychosom Med Psychother. 2013;59:273-89 pubmed
    ..Furthermore, regular occupational activity has a positive effect on symptomatic treatment outcome, while a younger age has a positive effect on interpersonal treatment outcome. ..
  12. Svanberg P, Mennet L, Spieker S. Promoting a secure attachment: A primary prevention practice model. Clin Child Psychol Psychiatry. 2010;15:363-78 pubmed publisher
    ..Methodological shortcomings, however, mean that these findings should be regarded as tentative. ..
  13. Madigan S, Bakermans Kranenburg M, van IJzendoorn M, Moran G, Pederson D, Benoit D. Unresolved states of mind, anomalous parental behavior, and disorganized attachment: a review and meta-analysis of a transmission gap. Attach Hum Dev. 2006;8:89-111 pubmed
    ..26* .34 = .09). Other factors yet to be uncovered must mediate the influence of unresolved states of mind on infant disorganized attachment; thus, further exploration of infant, parental, ecological, and genetic factors are warranted. ..
  14. Bernier A, Meins E. A threshold approach to understanding the origins of attachment disorganization. Dev Psychol. 2008;44:969-82 pubmed publisher
  15. Rich P. From theory to practice: the application of attachment theory to assessment and treatment in forensic mental health services. Crim Behav Ment Health. 2006;16:211-6 pubmed
  16. Zimmermann P, Scheuerer Englisch H. [Differences in attachment and personality in children from child guidance centers, child psychiatry units, and control families]. Prax Kinderpsychol Kinderpsychiatr. 2013;62:5-29 pubmed
    ..The results suggest that personality differences may be a risk factor for behaviour problems, however problem severity and the choice of the treatment institution seem to be influenced by attachment security. ..
  17. Newman L, Mares S. Recent advances in the theories of and interventions with attachment disorders. Curr Opin Psychiatry. 2007;20:343-8 pubmed
    ..The lack of agreed definition and conceptualization of these conditions is reflected in disparate approaches to intervention and limited empirical data. Interventions have little demonstrated benefit and some potential risk. ..
  18. Dülks R. [Remedial pedagogic developmental intervention with children displaying psychosocial disorders]. Prax Kinderpsychol Kinderpsychiatr. 2003;52:182-93 pubmed
    ..Thus, the author tries to show a highly promising way from theory of attachment to attachment therapy. ..
  19. McNally A, Palfai T, Levine R, Moore B. Attachment dimensions and drinking-related problems among young adults: the mediational role of coping motives. Addict Behav. 2003;28:1115-27 pubmed
    ..The findings support the basic theoretical supposition that one primary function of interpersonal attachment is the regulation of emotions. ..
  20. Vyssoki D, Schürmann Emanuely A. [Psychosocial consequences of sexual abuse]. Psychiatr Danub. 2008;20:546-50 pubmed
    ..Victims of all fields of violence can be found in Western Europe, the last mentioned form of violence predominant among refugees, but also among survivors of the last world war. ..
  21. Farnfield S, Hautamäki A, Nørbech P, Sahhar N. DMM assessments of attachment and adaptation: Procedures, validity and utility. Clin Child Psychol Psychiatry. 2010;15:313-28 pubmed publisher
    ..The aims are twofold: to provide an introduction to DMM theory and its application that underlie the articles in this issue of CCPP; and to provide researchers and clinicians with a guide to DMM assessments. ..
  22. Follan M, Minnis H. Forty-four juvenile thieves revisited: from Bowlby to reactive attachment disorder. Child Care Health Dev. 2010;36:639-45 pubmed publisher
    ..described in a subgroup of these offenders, the 'affectionless psychopaths', might be recognized now as reactive attachment disorder (RAD)...
  23. Edel M, Juckel G, Brune M. Interaction of recalled parental ADHD symptoms and rearing behavior with current attachment and emotional dysfunction in adult offspring with ADHD. Psychiatry Res. 2010;178:137-41 pubmed publisher
    ..ADHD symptoms in parents of children with ADHD may present a risk factor for attachment problems and poor emotion regulation when ADHD children are grown. ..
  24. Miller L, Miller H, Bjorklund D. Helping military children cope with parental deployment: role of attachment theory and recommendations for mental health clinicians and counselors. Int J Emerg Ment Health. 2010;12:231-5 pubmed
  25. Toth S, Rogosch F, Manly J, Cicchetti D. The efficacy of toddler-parent psychotherapy to reorganize attachment in the young offspring of mothers with major depressive disorder: a randomized preventive trial. J Consult Clin Psychol. 2006;74:1006-16 pubmed
    ..These results demonstrate the efficacy of toddler-parent psychotherapy in fostering secure attachment relationships in young children of depressed mothers. ..
  26. Dahmen B, Pütz V, Herpertz Dahlmann B, Konrad K. Early pathogenic care and the development of ADHD-like symptoms. J Neural Transm (Vienna). 2012;119:1023-36 pubmed publisher
    ..b>Reactive attachment disorder (RAD) is a developmental disorder associated with early pathogenic care that is characterised by ..
  27. Crawford T, Shaver P, Cohen P, Pilkonis P, Gillath O, Kasen S. Self-reported attachment, interpersonal aggression, and personality disorder in a prospective community sample of adolescents and adults. J Pers Disord. 2006;20:331-51 pubmed
    ..Interpersonal aggression was higher in Cluster B symptoms and lower in Cluster C symptoms, thus differentiating between these symptom clusters. ..
  28. Marchand W, Wirth L, Simon C. Adverse life events and pediatric bipolar disorder in a community mental health setting. Community Ment Health J. 2005;41:67-75 pubmed
    ..035), residential treatment (p = .003) and a decreased response to treatment (p = .006). Exposure to adverse events may be common among pediatric bipolar patients and have a negative impact on prognosis. ..
  29. Wearden A, Lamberton N, Crook N, Walsh V. Adult attachment, alexithymia, and symptom reporting: an extension to the four category model of attachment. J Psychosom Res. 2005;58:279-88 pubmed
    ..This difference is thought to be linked to the model of others developed in early interactions with caregivers. ..
  30. Hughes D. An attachment-based treatment of maltreated children and young people. Attach Hum Dev. 2004;6:263-78 pubmed
    ..The co-regulation of affect and the co-construction of meaning are central to the treatment process, just as they are central features in attachment security. ..
  31. Berant E, Mikulincer M, Shaver P, Segal Y. Rorschach correlates of self-reported attachment dimensions: dynamic manifestations of hyperactivating and deactivating strategies. J Pers Assess. 2005;84:70-81 pubmed
    ..We discuss the findings in terms of implicit psychodynamic processes inherent in attachment-system functioning. ..
  32. Goldwyn R, Hugh Jones S. Using the adult attachment interview to understand reactive attachment disorder: findings from a 10-case adolescent sample. Attach Hum Dev. 2011;13:169-91 pubmed publisher
    ..of the Adult Attachment Interview (AAI) and its coding system with 10 adolescents presenting with Reactive Attachment Disorder (RAD)...
  33. Schuengel C, Bakermans Kranenburg M, Van Ijzendoorn M. Frightening maternal behavior linking unresolved loss and disorganized infant attachment. J Consult Clin Psychol. 1999;67:54-63 pubmed
    ..Frightening behavior predicted infant disorganized attachment irrespective of maternal security. ..
  34. Krieg A, Dickie J. Attachment and hikikomori: a psychosocial developmental model. Int J Soc Psychiatry. 2013;59:61-72 pubmed publisher
    ..Finally, we examine implications of the model for intervention, treatment and future research. ..
  35. Puckering C, Connolly B, Werner C, Toms Whittle L, Thompson L, Lennox J, et al. Rebuilding relationships: a pilot study of the effectiveness of the Mellow Parenting Programme for children with Reactive Attachment Disorder. Clin Child Psychol Psychiatry. 2011;16:73-87 pubmed publisher
    ..We used a complex interventions model to evaluate its use with school-age children with Reactive Attachment Disorder (RAD), a serious disorder of social functioning associated with maltreatment...
  36. Claussen A, Mundy P, Mallik S, Willoughby J. Joint attention and disorganized attachment status in infants at risk. Dev Psychopathol. 2002;14:279-91 pubmed
    ..Theory and research is reviewed to suggest that an early impairment in joint attention facility may make a significant contribution to risk for negative cognitive and emotional outcomes among these infants. ..
  37. Bakermans Kranenburg M, Van Ijzendoorn M. No association of the dopamine D4 receptor (DRD4) and -521 C/T promoter polymorphisms with infant attachment disorganization. Attach Hum Dev. 2004;6:211-8; discussion 219-22 pubmed
    ..Even when we combined our sample with the Lakatos sample, the interaction effect of the DRD4 and -521 C/T polymorphisms on disorganized attachment was absent. ..
  38. Seidel R. Anna, leaving home--an adolescent girl's journey. Psychoanal Study Child. 2006;61:101-20; discussion 123-51 pubmed
    ..Psychoanalysis helps to put developmental processes back on track and results in significant intrapsychic and interpersonal change, allowing Anna to separate and to leave home. ..
  39. Madigan S, Moran G, Schuengel C, Pederson D, Otten R. Unresolved maternal attachment representations, disrupted maternal behavior and disorganized attachment in infancy: links to toddler behavior problems. J Child Psychol Psychiatry. 2007;48:1042-50 pubmed
    ..Effects of unresolved attachment on externalizing problems await further explanation. ..
  40. Klütsch V, Reich G. [Intergenerational transmission of trauma--empirical research and family dynamics approach]. Prax Kinderpsychol Kinderpsychiatr. 2012;61:564-83 pubmed
    ..A case example and considerations of resilience processes are given as well. ..
  41. Delhaye M, Kempenaers C, Burton J, Linkowski P, Stroobants R, Goossens L. Attachment, parenting, and separation--individuation in adolescence: a comparison of hospitalized adolescents, institutionalized delinquents, and controls. J Genet Psychol. 2012;173:119-41 pubmed
    ..These findings add to the growing consensus in the literature that associations between adolescent psychopathology and parent-related perceptions are typically complex and somewhat counterintuitive. ..
  42. Tetzlaff A, Hilbert A. [The role of the family in childhood and adolescent binge eating - a systematic review]. Z Kinder Jugendpsychiatr Psychother. 2014;42:61-70 pubmed publisher
    ..Mithilfe von prospektiven Studiendesigns könnten die divergierenden Ergebnisse aufgeklärt werden. ..
  43. Tharner A, Herba C, Luijk M, van IJzendoorn M, Bakermans Kranenburg M, Govaert P, et al. Subcortical structures and the neurobiology of infant attachment disorganization: a longitudinal ultrasound imaging study. Soc Neurosci. 2011;6:336-47 pubmed publisher
    ..These findings provide new insight into the etiology of infant attachment disorganization that may in part be neurodevelopmentally determined. ..
  44. Chaffin M. Commentary on Buckner and implications for treatment selection among foster children with RAD. Child Maltreat. 2008;13:313-4 pubmed publisher
    ..successfully applied behavioral parent training for a child in out-of-home care who was diagnosed with reactive attachment disorder (RAD)...
  45. Guedeney A, Foucault C, Bougen E, Larroque B, Mentre F. Screening for risk factors of relational withdrawal behaviour in infants aged 14-18 months. Eur Psychiatry. 2008;23:150-5 pubmed
    ..The scale could be used in screening early psychopathology in infants aged 2-24 months of age. ..
  46. Mercer J, Misbach A, Pennington R, Rosa L. The report of the APSAC Task Force on Attachment Therapy, Reactive Attachment Disorder, and Attachment Problems. Child Maltreat. 2006;11:378; author reply 381-6 pubmed
  47. Curtner Smith M, Middlemiss W, Green K, Murray A, Barone M, Stolzer J, et al. An elaboration on the distinction between controversial parenting and therapeutic practices versus developmentally appropriate attachment parenting: a comment on the APSAC Task Force report. Child Maltreat. 2006;11:373-4; author reply 381-6 pubmed
  48. Abrams K, Rifkin A, Hesse E. Examining the role of parental frightened/frightening subtypes in predicting disorganized attachment within a brief observational procedure. Dev Psychopathol. 2006;18:345-61 pubmed
    ..The possible role of dissociative processes in unresolved adult attachment, disorganized attachment, and FR parental behavior is discussed. ..
  49. Poehlmann J. Representations of attachment relationships in children of incarcerated mothers. Child Dev. 2005;76:679-96 pubmed
  50. Campbell S, Brownell C, Hungerford A, Spieker S, Mohan R, Blessing J. The course of maternal depressive symptoms and maternal sensitivity as predictors of attachment security at 36 months. Dev Psychopathol. 2004;16:231-52 pubmed
    ..These data have implications for understanding the combined impact of maternal depressive symptoms and maternal sensitivity on children's socioemotional development. ..
  51. Zeanah C, Keyes A, Settles L. Attachment relationship experiences and childhood psychopathology. Ann N Y Acad Sci. 2003;1008:22-30 pubmed
    ..We describe recent findings and highlight areas of emerging consensus and areas of continuing controversy regarding both disorganized patterns of attachment and clinical disorders of attachment in young children. ..
  52. Dozier M, Stovall K, Albus K, Bates B. Attachment for infants in foster care: the role of caregiver state of mind. Child Dev. 2001;72:1467-77 pubmed
    ..Second, these data argue for a nongenetic mechanism for the intergenerational transmission of attachment. ..
  53. Becker Weidman A. The report of the APSAC Task Force on Attachment Therapy, Reactive Attachment Disorder, and Attachment Problems. Child Maltreat. 2006;11:379-80; author reply 381-6 pubmed