Nicholas Rogu M.D. 
Article Title
Reactive Attachment Disorder in the Internationally adopted child 
Posted Date

Reactive Attachment Disorder (RAD) is a condition in which individuals exhibit markedly disturbed and developmentally inappropriate social relatedness. Children with RAD have considerable difficulty forming meaningful, affectionate relationships. Since prenatal experience (e.g., exposure to substances), birth trauma, inconsistent or inadequate day care, separation issues, abuse and neglect are precipitating factors that may lead to RAD, internationally adopted children evidence this disorder at a significantly higher rate than the general population. Since healthy attachment to a caregiver is necessary for cognitive, emotional, social and behavioral development, individuals with RAD often experience difficulties in these areas.

The bottom line is that problems with attachment during the early years of life may compromise the quality of an individual’s life—particularly when it comes to relating with others. What are some of the signs that parents should look for? In infants, we see a general lack of connectedness. There is an indifference to others, including the parents, a resistance to physical contact, a lack of cuddling (e.g., the infant may appear stiff), poor eye contact, a lack of reciprocal smiles and, oftentimes, a delay in reaching developmental milestones. With children, we see a continuation of these behaviors, as well as a host of other problematic behaviors including poor peer relationships, poor impulse control, depression, aggression, a lack of conscience, abnormal speech patterns, and what seems like a preoccupation with control issues.

What can parents do? Structure and consistency are critical for healthy development in all children. Additionally, modeling and reinforcement for successive approximations of appropriate social relatedness are critical. However, these variables are even more important for the child with attachment problems. Children with RAD will often require professional intervention in order to work through traumatic experiences that compromised early developmental bonding. However, it is important to recognize that not all mental health practitioners are trained or willing to address the challenge of a child with RAD. Speak with your pediatrician and find a child psychiatrist, psychologist or social worker with experience in working with attachment problems and childhood trauma. With early intervention, children with RAD can become respectful, resourceful, responsible members of society.

The information and advice provided is intended to be general information, NOT as advice on how to deal with a particular child's situation and or problem. If your child has a specific problem you need to ask your pediatrician about it - only after a careful history and physical exam can a medical diagnosis and/or treatment plan be made. This Web site does not constitute a physician-patient relationship.

Dr. Mark Lerner is a Clinical Psychologist and Traumatic Stress Consultant who focuses on helping people during and in the aftermath of traumatic events. He is the President of the American Academy of Experts in Traumatic Stress ( and the originator of the Acute Traumatic Stress Management intervention model ( Dr. Lerner wrote and produced the newly released audio book, Surviving and Thriving: Living Through a Traumatic Experience ( 
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