Parents of kids diagnosed with Reactive Attachment Disorder (RAD) are all too familiar with the symptoms. Anecdotally we often list food hoarding, violent outbursts, crazy lying, to name a few. However, there is little research on just how common each of these symptoms are.

The symptoms of RAD fall into three general categories – physical aggression, relational difficulties, and survival based behaviors. This is not surprising given the diagnostic criteria for RAD in the DSM 5. Kids with RAD have experienced chronic neglect or abuse before the age of 5 and did not form a nurturing bond with a primary caregiver.

But which symptoms are most common? To explore this further we collected data on 277 children and analyzed the results of the 236 who have been formally diagnosed with RAD.

The most common symptoms

Based on the survey results these are the most common symptoms for kids diagnosed with RAD.

• “Crazy Lying” ….89%
• Superficially charming …..89%
• Damaging property …..86%
• Poor boundaries …..85%
• Stealing ….79%
• Gorging/Grazing …..77%
• Violent Outbursts ….77%

Crazy lying is the most common symptom, as many parents of kids diagnosed with RAD might have guessed. This can be as benign – though frustrating – as a kid claiming they had pizza for dinner when they had chicken. Unfortunately, it can also be dangerous. One survey respondents says her 9-year-old son has made continuous false allegations of abuse, to the point she and her husband are now now facing criminal charges. 

Being superficially charming is also a well known hallmark of the RAD diagnosis. One mom says, “I wish our child would treat the family as well as she treats strangers. They think she’s inspirational and cannot understand why she’s currently living in a treatment center.”

While it is disheartening to see these symptoms so common – over 3/4 of kids – it can be reassuring for parents to know they aren’t alone.

Aggressive symptoms

Developmental trauma can result in impaired brain development, depending on the time the trauma occurred. Many of these children have poor impulse control and are disregulated. In addition, chronic abuse they may have heightened their fight-flight response that activates in even minimally threatening situations. This can underpin many aggressive behaviors.

Out of the children studied, 94% exhibit some form of aggression. Here are the detailed results.

Damaging property	86%
Violent outbursts	77%
Physical aggression to mother	71%
Physical aggression to siblings	66%
Physical aggression to pets	46%
Weaponizing bodily fluids	39%
Physical aggression to others	37%
Physical aggression to father	26%

Worth noting:

• The most common physical aggression is towards the child’s mother. This is expected because these children see their mother as the nurturing enemy. One mom says, “I survive by being numb to everything. I’m a shell of the person I once was, having no life or spark left in me. I honestly can’t think of one thing I enjoy doing anymore.”
• The second most common physical aggression is towards siblings. They are often the overlooked victims of the disorder.

See also the results of my survey results on I-CPV (Intentional Child on Parent Violence).

Social Relational symptoms

Children diagnosed with RAD did not form a nurturing bond with a primary caregiver – typically a mother figure. As a result they struggle to know how to form attachments with others. They are often obsessed with their need for control – to combat what feels like an unsafe and unpredictable world – and view relationships as a means to an end.

Out of the children studied, 98% exhibit some form of social relational symptoms. Here are the detailed results.

Crazy lying	89%
Superficially charming	89%
Lack of boundaries	85%
Inappropriate affection	65%

Worth noting:

• These children often have underdeveloped high-level brain functions. Their cause-and-effect thinking, for example, may be impaired or not “on-line.” This likely plays into the “crazy” lying symptomology.
• These children have an innate sense of insecurity. They are afraid of authentic relationships and don’t know how to attach. They also may view relationships as a means to an end because their basic need to survive trump all.

These types of symptoms can be extremely challenging for the whole family. One parent says, “This has almost ruined our lives.  Our whole family has to go into therapy because of our son.  If it weren’t for the grace of God, we wouldn’t have a family.”

Survival symptoms

Kids with RAD have been neglected and abused. They may have cried in their crib when their belly hurt. Sometimes they were fed, but often they were hit or cried themselves to sleep – still hungry. For a young child who cannot process this, their body absorbs the trauma. They unconsciously learn that the world is unsafe and unpredictable and often their behaviors seem survival based.

Out of the children studied, 98% exhibit some form of survival based behaviors. Here are the detailed results.

Stealing	79%
Gorging/Binging/Grazing	77%
Potty Issues	64%
Food hoarding	57%

Worth noting:

• Kids often hoard even when given free access to food. This behavior is often driven by unconscious food insecurity. Understanding this can help parents better address the behavior.
• Potty issues may be developmental delays or due to neglect and abuse. Abuse and neglect can cause brain injury that results in developmental delays, and, for example, late potty training. Kids may also choose not to use the toilet because of PTSD type symptoms from abuse.

If you’re a mental health professional reading these survey results, please know how desperately these children need affordable, accessible, effective treatments. Many therapists disregard parents reports of these symptoms because they seem too extreme. These results prove they are not.

If you are a parent, I highly recommend The A-Z of Therapeutic Parenting. It’s an excellent practical resource. Check out my review here.

Do these results jibe with your own experience? Drop a note in the comments to let me know.