Children need sensitive and responsive caregivers to develop secure attachments. RAD arises from a failure to form normal attachments to primary caregivers in early childhood. Such a failure could result from severe early experiences of neglect, abuse, abrupt separation from caregivers between the ages of six months and three years, frequent change of caregivers, or a lack of caregiver responsiveness to a child’s communicative efforts. Children with RAD are presumed to have grossly disturbed internal working models of relationships that may lead to interpersonal the presentation of the sensory development of children of early age behavioral difficulties in later life.
There are few studies of long-term effects, and there is a lack of clarity about the presentation of the disorder beyond the age of five years. Mainstream treatment and prevention programs that target RAD and other problematic early attachment behaviors are based on attachment theory and concentrate on increasing the responsiveness and sensitivity of the caregiver, or if that is not possible, placing the child with a different caregiver. Most such strategies are in the process of being evaluated. Pediatricians are often the first health professionals to assess and raise suspicions of RAD in children with the disorder.