Reactive Attachment Disorder – Description Based on the DSM

A number of posts on my blog will be about Reactive Attachment Disorder (RAD). I don’t want to rule out other children, though. Much of what I write may be applicable for parents whose children are not labeled but who present behaviors difficult to handle. Take what fits and apply it.

For those unfamiliar with RAD, here is a brief explanation:

RAD is a psychological label for a constellation of behaviors observed in some children, most often in adopted children. In order to diagnose “disorders,” psychologists and psychiatrists use the Diagnostic and Statistical Manual of Mental Disorders (DSM). My studies for the writing of my book were based on the DSM-IV. A revision, the DSM-V is due to be released in May 2013.

According to the DSM-IV, a child fitting the label “RAD” practices social behaviors in most contexts that are noticeably inappropriate and abnormal for his age beginning prior to age five and that behavior is presumed to originate in the context of severe maltreatment, what the DSM calls “grossly pathological care.”

For example, the child persistently fails to respond or initiate normally, resists being comforted by others, may be hypervigilant (intensely watchful) toward others, or fluctuates between avoidance and overdone approach. He shows excessive familiarity and charm with relative strangers but offers highly ambivalent responses to family. Because the DSM description is vague, psychologists often include other aberrant behaviors in the list of symptoms.

How is RAD distinguished from common childhood defiance and teen-aged rebellion? The DSM-IV provides three distinguishing criteria.

  • Attachment – There is a lack of attachment, exhibited by disturbed social relatedness.
  • Timing – Onset of symptoms of abnormal behavior begins prior to age five.
  • Cause – It forms in the environment of pathological, not supportive, care.

The “grossly pathological care” can include abuse, repeated change of primary caregivers such as happens in foster care, or persistent neglect, even the unintended neglect that occurs during an extended hospital stay.

The label “RAD” not describe the abused child who still forms attachments and is not markedly maladjusted. It is unlike disorders such as autism, which develop within a relatively supportive setting. Although it can present like Attention-Deficit/Hyperactivity Disorder (ADHD), it is different in that children with ADHD will form attachments. The label is not applied to children with mental retardation or brain damage. Neither does it describe rebellion which develops in the teen years in children who have had strong attachments with caregivers until then.

Psychologists use a variety of terms for the child: unattached, character disordered, dissociated, antisocial, or a “RAD.” He is commonly known as a child without a conscience.

Psychologists have arrived at various categories of attachment. The DSM-IV lists two sub-types, a socially inhibited, emotionally withdrawn type and a disinhibited, indiscriminately socially aberrant type. A major change proposed for the DSM-V, due to be released in May 2013, is a split into two disorders–Reactive Attachment Disorder and Disinhibited Social Engagement Disorder.

I have not distinguished between types but have taken the main category as a whole. I am not opposed to the categories. They may help parents and counselors to differentiate the differences in heart desires of the child. Meanwhile, the Bible would have us understand each individual uniquely and apply its principles to that individual regardless of a man-made category.

Also, especially as I read reviews of the coming DSM-V, I observe that the psychologies are creating more categories of all kinds of behaviors. I think that this is evidence that people are individuals and not so easily categorized. Just because we see a set of behaviors does not mean that those behaviors are being generated by the same motives in every person who practices the behavior set.

This is a simple snapshot of the label RAD as defined by a psychiatric standard, the DSM-IV. As a Christian, I take a different viewpoint which affects how I perceive and speak about RAD. For that viewpoint, read the post “Guidelines – My Approach.”


About Linda

Wifing, Singing, Studying, Counseling. I counsel at Gateway Biblical Counseling and Training Center. M.A. in Biblical Counseling. Certified by Association of Certified Biblical Counselors
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