Clinical Manifestations of RAD

• The clinical manifestations of RAD may vary depending on the type and severity and duration and frequency of the neglect or abuse or caregiver changes; the age and developmental stage and personality and coping skills of the child; the availability of social support; the presence of comorbid conditions.

• Some of the common clinical manifestations of RAD are:

  • Physical signs: such as failure to thrive; growth retardation; developmental delay; malnutrition; dehydration; poor hygiene; chronic illness; infection; injury; pain; fatigue; substance use disorder; suicidal ideation or behavior.

  • Psychological signs: such as depression; anxiety; panic disorder; phobias; obsessive-compulsive disorder (OCD); dissociative disorders; personality disorders; eating disorders; sleep disorders.

  • Emotional signs: such as fear; anger; guilt; shame; sadness; grief; loneliness; hopelessness; helplessness; low self-esteem; low self-confidence; low self-worth; distrust; resentment; bitterness.

  • Behavioral signs: such as withdrawal or isolation or avoidance or detachment or alienation or rejection; aggression or violence or vandalism or theft or lying or cheating or truancy or running away; recklessness or impulsivity or risk-taking; poor performance or attendance or participation in school or work; poor hygiene or grooming; changes in appetite or weight; changes in sleep patterns; substance use disorder; self-harm; suicidal thoughts or behaviors.

  • Social signs: such as lack of attachment or bonding or affection or trust or empathy with adult caregivers; lack of social skills or communication skills or interpersonal skills; lack of peer relationships or friendships; lack of involvement or participation in social activities or hobbies or interests; lack of respect or dignity; lack of autonomy or choice.

  • Spiritual signs: such as loss of faith or meaning or purpose or values or morals or ethics or hope.



Nursing Assessment of RAD

• The nursing assessment of RAD involves collecting subjective and objective data from the child and the caregiver and other sources such as family members, friends, neighbors, teachers, social workers, or health care providers.

• The nursing assessment of RAD should be done in a safe, private, and comfortable environment with the child’s consent and cooperation. The nurse should use a calm, gentle, and supportive approach and avoid leading, suggestive, or judgmental questions. The nurse should also use developmentally appropriate language and tools such as dolls, drawings, or games to facilitate communication with the child.

• The nursing assessment of RAD should include the following components:

  • History: The nurse should obtain a comprehensive history of the child’s physical, mental, emotional, social, and spiritual health and well-being; exposure to neglect or abuse or caregiver changes; current situation and concerns; coping strategies and support systems; strengths and resources.

  • Physical examination: The nurse should perform a thorough physical examination of the child’s head, neck, chest, abdomen, back, extremities, genitals, anus, and skin. The nurse should document any signs of injury or trauma or infection or pain or discomfort. The nurse should also assess the child’s vital signs, growth parameters, nutritional status, developmental milestones, pain level, and substance use status.

  • Laboratory tests: The nurse should order laboratory tests as indicated by the history and physical examination. Some of the common laboratory tests for RAD are complete blood count (CBC), coagulation studies, electrolytes, liver function tests (LFTs), renal function tests (RFTs), urine analysis (UA), urine toxicology screen (UTS), blood alcohol level (BAL), blood cultures, wound cultures.

  • Diagnostic tests: The nurse should order diagnostic tests as indicated by the history and physical examination. Some of the common diagnostic tests for RAD are x-rays, computed tomography (CT) scan, magnetic resonance imaging (MRI) scan, ultrasound, electroencephalogram (EEG), electrocardiogram (EKG), echocardiogram.

  • Psychological tests: The nurse should administer psychological tests as indicated by the history and physical examination. Some of the common psychological tests for RAD are Reactive Attachment Disorder Questionnaire (RADQ), Randolph Attachment Disorder Questionnaire (RADS), Attachment Behavior Q-Set (ABQ), Attachment Q-Sort (AQS), Strange Situation Procedure (SSP), Attachment Story Completion Task (ASCT), Separation Anxiety Test (SAT), Child Behavior Checklist (CBCL), Teacher Report Form (TRF), Youth Self-Report (YSR).