Reactive Attachment Disorder

Child abuse and neglect affects the lives of many American children and can result in physical injury and disability as well as psychological trauma. Reactive attachment disorder (RAD) is one possible psychological consequence of child abuse and neglect for very young children, younger than 5 years of age. RAD is described as markedly disturbed and developmentally inappropriate social relatedness usually beginning before age 5 years. These behavioral manifestations are the direct result of and come after pathogenic care. To better understand RAD, it is first necessary to understand attachment; therefore, attachment theory is examined. Risk factors for the development of RAD are presented. Implications for pediatric nurse practitioner practice are explored. The pediatric nurse practitioner can play a vital role in recognizing RAD and ensuring that children with this disorder receive prompt mental health assessment and therapy.