reactive attachment disorder

What Causes Reactive Attachment Disorder in Teens?

October 15, 2021

When a child or teen struggles with reactive attachment disorder or RAD, they cannot form healthy, secure, loving bonds with primary caregivers. It doesn’t matter if the caregivers are their biological parents or another form of caregiver. A child struggling with reactive attachment disorder experiences challenges adequately managing emotions and forming healthy or meaningful connections with others, including friends, family, and parents. Where most children their age find security and safety in the presence of family or loved ones, a child or teen with reactive attachment disorder may appear fearful, disconnected, or even traumatized in the presence of these individuals.


There are limited statistics surrounding reactive attachment disorder in children and teens. Unfortunately, data regarding the prevalence of mental illness is often based on surveys or research. In the case of reactive attachment disorder, there are few widespread surveys, and those that are published often contain older data that is nearly a decade old. However, the most recent data suggest that reactive attachment disorder affects approximately 1 to 2% of children. The prevalence rate among children who have been removed from their homes and placed in alternate housings such as foster care is over 40%. This is because children and teens who experience trauma or abuse in their home environment are at a greater risk for developing reactive attachment disorder as they grow.


Explaining Reactive Attachment Disorder (RAD)

In the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5), reactive attachment disorder is classified as a trauma and stressor-related condition. Reactive attachment disorder most commonly presents in children during infancy or early childhood. It is widely found in incidences where children experience maltreatment or social neglect during developmental years. While reactive to attachment disorder is rooted in infant or childhood experiences, without treatment at Hillcrest, the struggles and symptoms related to reactive attachment disorder can extend through the teen years and well into adulthood.


Adolescents or teens who struggle with reactive attachment disorder experience significant difficulty forming and maintaining relationships with anyone. This includes not only biological parents but emotional and healthy attachments to family, significant others, caregivers, and anyone else who may provide care and compassion. Positive emotions are also difficult for teens with reactive attachment disorder. It is not uncommon for them to experience significant challenges experiencing healthy or positive emotions. Additionally, they cannot accept and will not seek out emotional or physical closeness with others. In severe cases, an adolescent or teen with reactive attachment disorder may react violently or aggressively when cuddled, held, or comforted by a parent or caregiver.


Reactive Attachment Disorder Risk Factors and Causes

Reactive attachment disorder is most common in children between nine months and five years of age who have experienced physical abuse, emotional abuse, or neglect in their home environments have a higher chance of reactive attachment disorder.  However, it can be diagnosed in older adolescents and teens. This often occurs because reactive attachment disorder is sometimes misdiagnosed as another mental health condition. The exact causes of reactive attachment disorder remain unknown. However, many in the mental health profession and scientific researchers believe that a lack of consistent caretaking and age-appropriate love and care are significant contributors to its development. When children experience improper caretaking, it can lead them to believe that they are abandoned, alone, or unloved. Any of these emotions can prevent a child from developing secure and healthy bonds with those they believe left them (or will abandon them).


Additionally, children who were taken away from their biological parents or primary caretakers before forming strong emotional bonds are at an increased risk for developing reactive attachment disorder. Similarly, children who had many different foster care providers during infancy and childhood or who were the victims of multiple traumatic events or losses during early childhood are also at an elevated risk. This could occur in children who experience a home environment where violence or domestic abuse is common or children who are part of the foster care system beginning in infancy or at an early age.


Unfortunately, maltreatment in trauma alone does not explain all the causes of reactive attachment disorder. Sadly, reactive attachment disorder is considered one of the least researched and most poorly understood mental health disorders. Although there is a better understanding of how the illness presents in children under the age of five, there is an overwhelming lack of clarity in how the disorder presents in children over the age of five. Consequently, it can be challenging to distinguish between reactive attachment disorder and other teen and childhood mental health conditions. According to members of the American Academy of Child and Adolescent Psychiatry, a child (regardless of age) who exhibits symptoms of reactive attachment disorder could benefit from a comprehensive assessment and a uniquely designed treatment plan designed by treatment providers at Hillcrest. They understand the unique nature of teen-focused mental health treatment. 


It is also essential for mental health providers to rule out other mental health conditions with similar symptoms or characteristics. Common examples include post-traumatic stress disorder, oppositional defiant disorder (ODD), various anxiety disorders, social phobias, and conduct disorders. It is also essential to rule out other medical or mental health causes. One of them is an autism spectrum disorder, a developmental disorder that affects behavior and communication and can present with similar characteristics to reactive attachment disorder.


Understanding the Symptoms of Reactive Attachment Disorder

Symptoms of reactive attachment disorder will appear different depending on your child’s age and developmental progress. However, the most common concern in all cases is difficulties with age-appropriate social interaction. The Diagnostic and Statistical Manual of Mental Disorders states the primary symptom of reactive attachment disorder is “severely inappropriate social relating.” Depending on the child’s age and other factors unique to the child, this can present in a range of different ways. Another symptom noted in the Diagnostic and Statistical Manual of Mental Disorders is a notable failure to show a “typical” range of age-appropriate emotions when interacting with others. This can consist of feelings of comfort, remorse, guilt, or regret. Children and teens with RAD are often incapable of showing emotions of consciousness.


A child with reactive attachment disorder may be incapable of forming relationships with caregivers. However, they may display inappropriate levels of affection towards those who are not caregivers or members of their families. They may actively seek affection and love from strangers while avoiding the same emotions from caregivers or family. Other signs of reactive attachment disorder include avoiding eye contact and physical touch and unpredictable negative emotions such as anger, tantrums, sadness, irritability, and disobedience (beyond what would be expected based on the child’s age and environment).


As children who are diagnosed with or have symptoms of reactive attachment disorder develop into teens, their symptoms often fall into two distinct patterns. 


Inhibited Reactive Attachment Disorder Symptoms

In this category, teens are aware of what happens around them and of their surroundings, but they do not respond as expected to outside stimuli. They are often withdrawn and emotionally unresponsive. They may not show or seek affection from caregivers or loved ones, preferring to keep to themselves. 


Disinhibited Reactive Attachment Disorder Symptoms

Opposite of the above, teens with this pattern of symptoms may be overly, abnormally, or dangerously friendly with strangers. They prefer the presence and comfort of others over their primary caretakers. In many instances, teens with disinhibited reactive attachment disorder act younger than their biological age and intentionally seek out affection and attention from others, often strangers, in unsafe and unhealthy ways. 


Treating Reactive Attachment Disorder

Treatment for reactive attachment disorder at a teen-focused treatment center like Hillcrest centers on creating new and healthy family bonds while working to heal broken ones. During therapy, your teen will focus on improving emotional relationships with family and caretakers. This can also help to repair and improve relationships outside of the family unit. Your teen’s treatment plan will consist of a uniquely designed therapy program including therapy, social skills intervention, and support for family and caretakers. 


As part of counseling sessions, your teen will work with their therapist in individual, group, and family sessions. Using a range of evidence-based therapy models, your teen’s treatment team at Hillcrest will guide your teen as they learn healthy ways to build relationships skills and reduce harmful and disruptive behaviors that suppress social and emotional skills. In addition to therapy, your teen will practice social skills techniques designed to help them manage triggers that cause emotional and behavioral challenges. Social skills interventions aim to provide your teen with the skills they need to interact appropriately with other teens their age. 


Many teens with reactive attachment disorder who seek treatment at a facility like Hillcrest complete treatment can form healthy, stable bonds. Teens who do not receive treatment often continue to struggle with chronic emotional challenges related to the symptoms of reactive attachment disorder. It is vital to remember that it is never “too late” to address the obstacles reactive attachment disorder causes for your teen and your family. The symptoms of reactive attachment disorder often closely resemble other childhood mental health disorders. Unfortunately, this can sometimes lead to misdiagnosis and delayed treatment. If you are concerned about your teen’s symptoms, it is essential to reach out to our caring and compassionate admissions team at Hillcrest today. We will work with your teen and family to create a uniquely designed treatment plan that addresses your teen’s unique needs and goals. Contact us today to learn more about how treatment here at Hillcrest can help your child learn healthy, safer ways to manage reactive attachment disorder.