Parenting a teen with reactive attachment disorder (RAD)

Reactive attachment disorder (RAD) is a childhood mental health condition caused by early abuse or neglect from primary caregivers. Because of these circumstances, young people with RAD are often unable to form healthy attachments. They may continue to have trouble forming loving relationships as they grow up. 

Like other attachment disorders, early intervention can help parents and children navigate these challenges. However, without support, symptoms of RAD can persist into the teenage years and beyond.

Symptoms of reactive attachment disorder in teens

If you’re a parent or caregiver and are concerned about your child’s behavior, it’s important to know that RAD can present differently in teens than in younger children. 

However, some of the most common symptoms of RAD in teens include:

• Having difficulty forming attachments or close emotional bonds with others, including caregivers
• Rarely exhibiting positive emotions, like joy, excitement, or happiness
• Not being able to seek out physical affection and reacting violently to touch
• Behaving unpredictably  
• Wanting to control their environment  
• Not responding to age-appropriate discipline
• Having extreme, outsized reactions to change, consequences, or attempts to connect and may respond with violence, rage, or self-harm
• Struggling academically   
• Having problems with the legal system and/or experiencing incarceration
• Engaging in substance abuse, risky sexual activity, or other unsafe behaviors

As you review this list of symptoms, keep in mind that RAD is typically diagnosed in early childhood. According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-V), symptoms must be present before age five and a child must reach the developmental age of at least nine months to receive a RAD diagnosis. However, if a teen didn’t receive an evaluation when they were younger, it’s possible that they could be diagnosed with RAD later in life. 

What causes reactive attachment disorder in teenagers?

What causes RAD in teens is the same that causes RAD in younger children. RAD occurs when a child can’t form secure attachments with caregivers. This is due to the caregivers’ inability to meet the child’s basic physical and emotional needs. 

While parents may not intentionally seek to harm their children, a child might be more likely to develop RAD if their parents:

• Are teenagers at the time of their birth
• Have a disability or mental health condition that impacts their parenting
• Are isolated and don’t have access to resources
• Don’t have adequate parenting skills
• Are unable to provide a safe home environment

Does reactive attachment disorder ever go away?

RAD is a lifelong condition that typically requires ongoing support. Children with RAD who receive treatment may continue to have difficulties at home, school, and in relationships. While there’s no cure for RAD, with early detection and intervention, outcomes can improve. 

In addition to seeking professional help for the teen, parents will also need support and education about RAD. This will be especially important for people who are seeking to adopt children or teens from state custody, international orphanages, or other institutional settings, as these environments may increase a child’s risk of developing RAD.

Guidance for telling your teen they have RAD

If you’re the parent of a teen recently diagnosed with RAD, you might feel unsure how to discuss it with them. This can be a delicate topic, and if your teen is prone to reactivity or violence, you’ll need to be very intentional when bringing it up. 

First, choose a quiet, private space where you both can feel safe, and pick a time when you won’t feel rushed. You also might want to do some brainstorming beforehand to consider what you want to say. Your teen may not need to know every detail about their diagnosis or trauma history at this time, and you can always ask a provider for recommendations on what to share. The goal is to be honest and transparent with your teen while providing developmentally appropriate details.

When you talk to your teen, one of the most important things to emphasize is that they’re not to blame for their diagnosis. Their condition isn’t their fault — it’s the result of their caregivers’ behavior when they were very young. It’s OK for them to feel hurt, betrayed, or angry about what happened to them. And it might not feel fair to have to seek treatment for something they didn’t cause. Let your teen know that their emotions are valid and that you’ll continue to be there to help them get the support they need to heal.

How to help a teenager with reactive attachment disorder

One of the most important steps you can take to help a teen with RAD is to seek professional help both for them and yourself. Working with a therapist who specializes in treating trauma and attachment disorders can help you both deepen your understanding of RAD and learn coping skills to manage the condition. 

Working with a trauma-informed therapist can help you:

• Create a safe, secure, predictable home environment where a teen can build trust gradually
• Better understand your teen’s reactions and cues (even if they don’t seem to make sense at first)
• Pay attention to your teen’s needs and emotions while upholding healthy boundaries
• Know when it might be OK (or not OK) to use nurturing physical touch 
• Create opportunities for your teen to have positive social interactions and explore new behaviors
• Nurture your teen’s strengths so that they can increase their self-esteem and build resilience

Parents of teens with RAD may also benefit from the occasional respite from caregiving. RAD can cause challenging behaviors that can affect the whole family, and it’s often best for everyone to take a break. You’ll need to ensure that whoever is supervising your teen is well-versed in RAD, understands the boundaries your child needs to be successful, and is able to provide a safe, secure environment. 

Find care with Rula

RAD is a childhood mental health condition that results from an inability to form a healthy attachment with caregivers. Signs of RAD are typically evident before a child turns five, but if a child isn’t evaluated until they’re older, they could be diagnosed in their teen years. While RAD can present differently in teenagers than young children, its main symptoms are difficulty forming close relationships, demonstrating positive emotions, and regulating behavior. So if a teen in your life is exhibiting signs of RAD, don’t hesitate to seek help. 

With Rula, you and your family can access therapy from the comfort of home as soon as tomorrow. No matter the mental health concern you’re facing, you can use our therapist-matching program to find a teletherapy provider who works with teens and offers the specialized care you and your child deserve. 

Start therapy with Rula