Common Symptoms of Reactive Attachment Disorder in Children, Adolescents, and Adults

Reactive attachment disorder, also known as RAD, is a condition that affects a child’s ability to bond with significant people in his or her life due to his or her emotional needs going unmet during infancy or serious abuse or neglect.

It is most likely to occur in children who live in orphanages or other institutional settings, have been in multiple foster care homes, or whose mother or primary caregiver has been physically or emotionally absent for extended periods.

As children with reactive attachment disorder get older, their symptoms fall into one of two subtypes – inhibited reactive attachment disorder or disinhibited reactive attachment disorder.

Children with inhibited reactive attachment disorder are often withdrawn, emotionally unresponsive, show no interest in what is going on around them, do not seek comfort from their caregivers, and prefer to keep to themselves.

On the other hand, children with disinhibited reactive attachment disorder may be overly friendly with strangers, lack the desire or need to stay close to their primary caregiver for safety, violate social boundaries, and seek affection from others in a potentially unsafe way.

Without treatment, the symptoms of children with reactive attachment disorder are likely to persist into adulthood and affect the way they function in society.

Common symptoms of reactive attachment disorder in children

  • Avoiding eye contact.
  • Failure to smile.
  • Failure to coo or babble.
  • Crying inconsolably.
  • Not reaching arms out to be picked up.
  • Not seeming to notice when you walk into the room.
  • Not seeming to care when you leave him or her alone.
  • Not seeking comfort or responding when comfort is given.
  • Pushing away or leaning away from a person trying to be affectionate or offer comfort.
  • Angry outbursts or tantrums.
  • Reacting violently when held or cuddled.
  • Withdrawing from social situations.
  • Lack of interest in people around them.
  • Lack of conscience.
  • Inability to feel guilt, remorse, or regret.
  • Uninterested in playing interactive games such as peek-a-boo.
  • Failure to seek support or help when needed.
  • Lack of interaction with peers.
  • Engaging in self-soothing behaviors such as rocking back and forth.

Common symptoms of reactive attachment disorder in adolescents

  • Appearing withdrawn and emotionally detached.
  • Looking sad and lethargic.
  • Lack of eye contact.
  • Dislike being touched.
  • Inability to form meaningful relationships.
  • Lacking basic social skills.
  • Defiant and argumentative.
  • Anger issues.
  • Difficult to discipline.
  • Lack of self-control.
  • Problems at school.
  • Low self-esteem.
  • Unpredictability.
  • Lack of empathy.
  • Irritability.
  • Destructive behavior.
  • Cruelty to animals.
  • Engaging in risky behaviors.
  • Failure to seek or respond to comfort when upset.
  • Avoid interacting with peers.
  • Manipulative behavior.
  • Lying.
  • Stealing.
  • Lack of conscience, and an inability to feel guilt or remorse.
  • Substance abuse.
  • Preoccupation with blood, fire, and gore.

Common symptoms of reactive attachment disorder in adults

  • Fear of being alone.
  • Minimizing feelings of hurt or pain.
  • Physically or emotionally distancing themselves from others.
  • Feel as though they don’t fit in.
  • Inability to show genuine care or affection.
  • Reject love.
  • Failure to seek support when they need it.
  • Avoid making eye contact.
  • Pushing people away.
  • Absence of joy.
  • Addictive and/or risky behaviors.
  • Lack of conscience, and an inability to feel emotions such as regret, guilt, or remorse.
  • Tendency to avoid serious relationships.
  • Communication difficulties.
  • Anger issues.

Treatment options

The focus of treatment is on strengthening the child emotionally, helping him or her create healthy bonds and relationships, and/or repairing existing negative relationships between him or her and caregivers. For adolescents and adults, there is an added focus on improving social and communication skills.

Common interventions include:

Psychotherapy

In psychotherapy, the counselor works with both the child and his or her parents to teach them how to build healthy emotional skills and reduce the problematic behaviors that prevent bonding from taking place.

Family therapy

In family therapy, the counselor works with the child and his or her family members to help them learn how to interact healthily.

Social skills intervention

Social skills intervention is focused on teaching the child how to interact appropriately with his or her peers.

Parenting skills classes

Parenting skills classes are geared toward teaching parents how to increase their responsiveness and sensitivity toward their child, meet his or her needs, and bond with him or her, as well as how to manage their child’s challenging behaviors and help him or her use the skills learned during therapy in the outside world more effectively.

If you have questions or would like to set up an appointment to meet with a counselor in Newport Beach, California, please give us a call at Newport Beach Christian Counseling. We can help you or your child address and overcome reactive attachment disorder.

References:

Aaron Kandola. “What is reactive attachment disorder?” Medical News Today. November 2, 2020. medicalnewstoday.com/articles/reactive-attachment-disorder.

Elizabeth E. Ellis and Musa Yilanli. “Reactive Attachment Disorder.” StatPearls. Updated May 1, 2023. statpearls.com/ArticleLibrary/viewarticle/19406.

Photos:
“Pink Flowers”, Courtesy of Annie Spratt, Unsplash.com, CC0 License

Effects of Childhood Trauma

We know childhood affects us as adults, but we may be unaware of the extent to which this is true. Childhood trauma, whether you know about it or not, may be impacting you or someone you love in ways you don’t realize. Identifying trauma symptoms and finding healing can make an immense difference in your life today.

Trauma isn’t something we want to spend a lot of time thinking about, but it’s a vital topic to consider, not just for the adults who are affected with post-traumatic stress, but for children who’ve experienced it.

Let’s start by defining what we mean by childhood trauma. The National Child Trauma Stress Network defines it this way: “When a child feels intensely threatened by an event he or she is involved in or witnesses, we call that event a trauma.”

Risk Factors for Childhood Trauma

The Trauma Services Network lists a number of factors that increase the risk for childhood trauma, although they are not established as definitive causes. They are:

  • Disabilities
  • Social isolation (family)
  • Lack of parental understanding of child development or children’s needs
  • Domestic abuse (parents’ history)
  • Poverty
  • Family disorganization/violence
  • Lack of cohesion
  • Substance abuse
  • Young, single non-biological parents
  • Poor parent-child relationships and negative interactions
  • Parental thoughts and emotions supporting maltreatment behaviors
  • Parental stress and distress, including depression or other mental health conditions
  • Community violence

While some of these factors may constitute traumatic experiences, some are not directly traumatic but contribute to an unsafe environment that increases the risk that the child will experience trauma. If, for example, you are a parent of a child with disabilities and you are socially isolated and/or a single parent, you may not be able to change all of those factors, but you can be aware of the risks for trauma and take action to make your child’s environment as safe as possible.

Types of Childhood Trauma

The NCTSN lists several types of trauma that are commonly experienced in childhood:

  • Physical abuse
  • Sexual abuse
  • Early childhood trauma (ages 0-6)
  • Traumatic grief
  • Medical trauma
  • Complex trauma
  • Domestic violence
  • Bullying
  • Community violence
  • Refugee trauma
  • Disasters
  • Terrorism and violence

Look Through Their Eyes is another organization that works to identify, prevent, and heal childhood trauma. Their list of most common childhood trauma includes most of those listed above, as well as:

  • Accidents
  • Chaos or dysfunction in the house (such as domestic violence, parent with a mental illness, substance abuse or incarcerated)
  • Emotional abuse or neglect
  • Separation from a parent or caregiver
  • Stress caused by poverty

From both of these lists, we can see that abuse, neglect, and violence within the family cause traumatic stress for children, and so do wider-scale disasters, war, and terrorism.

So, if a child experiences any of these things, how does it affect them? How do they respond?

The difference between a child’s stress response and an adult’s stress response is that children are still developing. They don’t have the understanding that adults do, and their brain hasn’t finished growing.

This reality means that trauma can have a different impact as the child grows older than it would on an adult who has already reached full cognitive development.

Physical Responses to Trauma

While most people are aware of the “fight or flight” response to frightening events, the “freeze” response is not as well known. “Freeze” is a type of dissociation that means the person perceives the threat to be so severe that neither running nor fighting back is a possibility.

Freezing is the body’s reaction to being flooded with stress. A child, who is smaller and more vulnerable in every way than an adult, may experience the freeze response in a variety of different traumatic situations.

What happens if a child is exposed to trauma over a long period of time? Their trauma response continues, and this unhealthy state of physical stress, with hormones such as adrenaline and cortisol coursing through the body, can lead to PTSD (post-traumatic stress disorder) or C-PTSD (complex PTSD). The American Psychological Association notes that, “Children exposed to chronic and pervasive trauma are especially vulnerable to the impact of subsequent trauma.” (APA)

Regardless of whether the trauma response turns into a full-fledged disorder or not, the stress it causes can make a lasting impact on a child’s development.

How Trauma Affects Development

Researchers have noted that trauma in childhood can actually reduce the size of the brain cortex, which is a significant effect on a child’s physical and mental health and development.

Besser van der Kolk, who wrote the book The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma, explains that, “Children’s brains are literally shaped by traumatic experiences, which can lead to problems with anger, addiction, and even criminal activity in adulthood.” In an interview with Side Effects Public Media, he explained:

“The human brain is a social organ that is shaped by experience, and that is shaped in order to respond to the experience that you’re having. So particularly earlier in life, if you’re in a constant state of terror; your brain is shaped to be on alert for danger, and to try to make those terrible feelings go away.

The brain gets very confused. And that leads to problems with excessive anger, excessive shutting down, and doing things like taking drugs to make yourself feel better. These things are almost always the result of having a brain that is set to feel in danger and fear.

As you grow up and get a more stable brain, these early traumatic events can still cause changes that make you hyper-alert to danger, and hypo-alert to the pleasures of everyday life…

If you’re an adult and life’s been good to you, and then something bad happens, that sort of injures a little piece of the whole structure. But toxic stress in childhood from abandonment or chronic violence has pervasive effects on the capacity to pay attention, to learn, to see where other people are coming from, and it really creates havoc with the whole social environment.”

As an adult who experienced childhood trauma, you may have mental health effects, including anxiety or expression, continued PTSD, substance use disorders, problems with relationships, or struggles with self-harm and suicidal ideation. Even if you do not have serious mental health problems, you may struggle with psychological issues. Psychology Today discusses four subtle but real effects of childhood trauma in adulthood:

Creating a false self that we think will be accepted (burying feelings, wearing a mask)

  1. Victimhood thinking (negative self-talk)
  2. Passive-aggressiveness (suppressed anger)
  3. Passivity (buried feelings = buried personhood)

Of course, these things can lead to problems with relationships and difficulty at work and in other areas of your adult life.

Harvard Health has reported on research conducted on adverse childhood experiences, shortened to ACEs, many of which include traumatic experiences, and these experiences have drastic effects on health, and are linked to negative outcomes in adulthood.

The bottom line is, if you have experienced childhood trauma—even if you are unaware of it—you may still be suffering from post-traumatic stress as an adult. And this stress can manifest in a number of ways: physically, mentally, and psychologically.

Child Trauma Symptoms

How can parents, caregivers, or teachers know when a child is exhibiting trauma symptoms, even if they are unaware of the trauma itself?

A child who is experiencing trauma, or has post-traumatic stress, may exhibit signs of clinginess, fear, aggression, and impulsivity, and have difficulty regulating their behavior and emotions. They may become fixated on death and/or safety. They might have trouble eating or sleeping. Other common symptoms are irritability, difficulty focusing, or separation anxiety.

While just one or two of these symptoms may be part of a normal developmental stage for a child, if you know a child who is exhibiting several of these symptoms, it may be time to find out if there is a more serious explanation.

Preventing and Responding to Childhood Trauma

Although it’s not possible to remove all risk factors for childhood trauma, we can work to create safe environments for children, and then educate responsible adults in how to respond in the best way to alleviate the aftereffects of trauma.

The National Child Traumatic Stress Network says that resilience is the biggest factor in a positive outcome for childhood trauma, and the biggest factor in resilience is the presence of one consistent caregiver in the child’s life:

“Research on resilience in children demonstrates that an essential protective factor is the reliable presence of a positive, caring, and protective parent or caregiver, who can help shield children against adverse experiences. They can be a consistent resource for their children, encouraging them to talk about their experiences, and they can provide reassurance to their children that the adults in their lives are working to keep them safe.”

The American Psychological Association adds that “The majority of children and adolescents manifest resilience in the aftermath of traumatic experiences. This is especially true of single-incident exposure.”

So, in a way, it’s possible to set children up for success both before and after any traumatic events have occurred. According to the Trauma Survivors Network, the following are protective factors in a child’s life that can help them with trauma and recovery:

  • Supportive family environment
  • Nurturing parenting skills
  • Stable family relationships
  • Household rules and monitoring of the child
  • Parental employment
  • Adequate housing
  • Access to health care and social services
  • Caring adults outside family who can serve as role models or mentors
  • Communities that support parents and take responsibility for preventing abuse

In other words, a child needs a safe environment with adult support. The good news is that if you are a parent or caregiver of a child, you can be that safe person for them, a consistent presence, and you can make a big difference for that child.

What about a child who has already undergone one, or multiple traumatic experiences? There are evidence-based treatment options, including Cognitive-Behavioral Therapy (CBT) with a trauma focus. There is even inpatient treatment if necessary. The Gil Institute recommends trauma-focused integrated play therapy, and there is some evidence that neurofeedback can successfully treat trauma, even in children.

The bottom line is not to hesitate to get a child evaluated for professional treatment. It can make a big difference in the possibility of a positive outcome and trauma healing.

If you are an adult and you think or know that you were traumatized as a child, it’s not too late to get help. You can explore childhood trauma with a licensed counselor or therapist, and work through treatment for those issues.

Revisiting the past can be very painful, and a licensed counselor can help you walk through the process safely and compassionately. Contact our office today to take the first steps towards trauma healing for you or your child.

Resources:

  • https://www.nctsn.org/what-is-child-trauma/trauma-types
  • https://www.ecmhc.org/tutorials/trauma/mod2_3.html
  • http://lookthroughtheireyes.org/
  • https://www.psychologytoday.com/us/blog/evolution-the-self/201507/trauma-and-the-freeze-response-good-bad-or-both
  • https://www.nctsn.org/what-is-child-trauma/trauma-types/complex-trauma/effects
  • https://www.traumasurvivorsnetwork.org/traumapedias/777
  • https://www.samhsa.gov/child-trauma/recognizing-and-treating-child-traumatic-stress#types
  • https://www.kidsmentalhealthinfo.com/topics/child-trauma/effective-treatments-child-traumatic-stress/
  • http://www.gilinstitute.com/services/treatment/tfipt.php
  • http://www.istss.org/public-resources/what-is-childhood-trauma/effects-of-childhood-trauma.aspx
  • https://www.health.harvard.edu/diseases-and-conditions/past-trauma-may-haunt-your-future-health
  • https://www.addictionpolicy.org/blog/adverse-childhood-experiences-and-trauma
  • https://www.psychologytoday.com/us/blog/mindful-anger/201706/4-ways-childhood-trauma-impacts-adults
  • https://www.psychologytoday.com/us/blog/mindful-anger/201804/9-steps-healing-childhood-trauma-adult
  • https://www.apa.org/pi/families/resources/childrenz-trauma-update
  • https://www.sideeffectspublicmedia.org/post/childhood-trauma-leads-brains-wired-fear
  • https://childmind.org/article/signs-trauma-children/

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“Tidal Pool”, Courtesy of Micaela Parente, Unsplash.com, CC0 License; “Rocky Shore”, Courtesy of Zachary Staines, Unsplash.com, CC0 License; “Waves”, Courtesy of Michael Baldovinos, Unsplash.com, CC0 License; “Rocks in the Water”, Courtesy of Joshua Humpfer, Unsplash.com, CC0 License