How to Diagnose Reactive Attachment Disorder

Reactive attachment disorder (RAD) is diagnosed in children who show a lack of attachment to their caregivers, and who display difficulty in forming normal relationships with others. [1] They also may have some social and emotional impairments. There is some confusion about RAD, because with the DSM-5 it was changed from one disorder with two subtypes into two distinctive disorders: RAD and Disinhibited Social Engagement Disorder (DSED). [2] You can assess reactive attachment disorder in a child by assessing their age and environment, evaluating their emotions, and seeking a professional diagnosis.

Part 1
Part 1 of 3:

Evaluating the Child’s Age and Environment

  1. Before making a diagnosis of RAD, assess the child’s history of neglect. Most children with RAD have an extensive history of neglect, with parents or caregivers who abandoned them, did not care for them, or left them to fend for themselves at an impossibly young age. Find out if this child has faced these circumstances. [3]
  2. Reflect on your child’s background and home history. Many children with RAD are in the foster care system and/or had a parent who did not connect with them. These children find it near impossible to connect if a caregiver continually changes or is absent. [4]
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  3. In order for a child to be diagnosed with RAD, the disorder had to have developed before age 5. The first five years of life are by far the most formative and most of your personality attributes are shaped during that time. If the symptoms of RAD were not present before the child was age five, then a diagnosis cannot be made. [5]
  4. In addition, any behavior indicative of RAD has to have persisted for at least 12 months in order for a diagnosis to be made. This is to prevent children who are going through a stubborn or difficult phase from being misdiagnosed. [6]
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Part 2
Part 2 of 3:

Assessing the Child’s Emotions

  1. A child with RAD will rarely, if ever, seek comfort when under stress. They are also unlikely to respond when comforted. Since they did not form a normal attachment to a caregiver when they were younger, they will not seek comfort or affection in the way that most children would. [7]
    • For instance, if they fall off of their bicycle, they might show emotion, but they are unlikely to run to a caregiver to soothe them. They have a tendency to deal with their pain on their own.
    • In some cases, they may show emotional responses that are inappropriate or excessive for a situation. For example, a child that stubs his toe may cry hysterically for longer than would be usual.
  2. Children with RAD will often respond with very little emotion or affect to others. Though most children are socialized to laugh and smile based on the people and circumstances around them, children with RAD will typically display a very flat or neutral disposition. [8]
    • For instance, a child with RAD might receive a gift at a birthday party and not crack a smile. But a child without RAD might smile or yell with excitement.
  3. RAD diagnosis is not related to self-harm, impulsive or aggressive behavior or other harmful behaviors. Likewise, lying, stealing, destruction of property, gorging of food or inappropriate sexual behavior are also not considered symptoms of this disorder. There is a lot of misinformation about RAD online, but none of the aforementioned behaviors are considered relevant to the diagnosis. [9]
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Part 3
Part 3 of 3:

Seeking a Professional Diagnosis

  1. Perhaps you are a parent recently reconnected with your child or you are foster parent concerned about the child’s actions. Though you cannot make a diagnosis of RAD yourself, you can take the child to a therapist trained to do so. They will also be able to provide counseling for the child to help them work through their issues.
  2. Before your visit to the therapist, be ready to discuss the child’s troubling actions. Do not only discuss their actions as it relates to RAD, but discuss their other good or bad qualities as well. Give the therapist a full picture of your child and don’t attempt to sugarcoat anything. [10]
  3. In addition to telling the truth about your child, do not refrain from being honest about yourself. Talk to the therapist about what your home is like, both the good and the bad. Honesty is the only way that a true diagnosis can be made. [11]
    • For instance, if there are issues of drug abuse in your home, you should disclose this. Know that many therapists have a duty to report, however, if any abuse is occurring.
  4. The therapist may also ask you to evaluate how you are as a parent. You may be displaying some negative behaviors that you have not considered that only exacerbate your child’s RAD. Be honest in completing this evaluation so that you can improve how you parent. [12]
  5. Though there is no standard treatment for RAD, you can implement changes in your home that will improve your child’s behavior. You can take classes to become a more nurturing parent and work to create a more stable environment for your child. You can also ensure that they receive therapy regularly. [13]
    • Since there are many treatment options, such as various kinds of family therapy and specific programs designed for attachment problems, you should consult with your therapist or health care professional to determine the best options.
  6. Sometimes, a misdiagnosis of RAD is given to children who are actually on the autism spectrum. Many of the same behaviors of RAD, like unusual emotional responses, are also seen in autism. [14] Additionally, there are other attachment-related disorders associated with a history of trauma such as DSES (Disinhibited Social Engagement Disorder). Explore these possibilities before you accept a diagnosis.
    • Learn about the differences between RAD and autism.
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      References

      1. ↑ http://www.personalityresearch.org/papers/wood.html
      2. ↑ American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders: DSM-5 (pp.265-270). Washington, D.C: American Psychiatric Association.
      3. ↑ http://www.cebc4cw.org/search/topic-areas/dsm-5-criteria-for-reactive-attachment-disorder-rad/
      4. ↑ http://www.mayoclinic.org/diseases-conditions/reactive-attachment-disorder/basics/tests-diagnosis/con-20032126
      5. ↑ http://www.cebc4cw.org/search/topic-areas/dsm-5-criteria-for-reactive-attachment-disorder-rad/
      6. ↑ http://www.cebc4cw.org/search/topic-areas/dsm-5-criteria-for-reactive-attachment-disorder-rad/
      7. ↑ http://www.mayoclinic.org/diseases-conditions/reactive-attachment-disorder/basics/tests-diagnosis/con-20032126
      8. ↑ http://www.cebc4cw.org/search/topic-areas/dsm-5-criteria-for-reactive-attachment-disorder-rad/
      9. ↑ American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders: DSM-5 (pp.265-270). Washington, D.C: American Psychiatric Association.
      1. ↑ http://www.mayoclinic.org/diseases-conditions/reactive-attachment-disorder/basics/tests-diagnosis/con-20032126
      2. ↑ http://www.mayoclinic.org/diseases-conditions/reactive-attachment-disorder/basics/tests-diagnosis/con-20032126
      3. ↑ http://www.mayoclinic.org/diseases-conditions/reactive-attachment-disorder/basics/tests-diagnosis/con-20032126
      4. ↑ http://www.mayoclinic.org/diseases-conditions/reactive-attachment-disorder/basics/treatment/con-20032126
      5. ↑ https://www.cdc.gov/ncbddd/autism/screening.html

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