Best Medication for Reactive Attachment Disorder in Kids

Are you at your wits end and looking for medication for RAD for your child? If you are wondering how medicine can be used in the treatment for attachment disorders, keep reading for helpful information.

As you consider medication for treating a child with attachment disorder, you may be uncertain if you are making the right choice. We know it isn’t an easy decision for any parent to make. You may not even believe your child can overcome RAD. We have been there and we want you to have the information you need to make the best decision for your child.

While there is no one specific medication to treat attachment disorder, there are a number of medication options that can help with the difficult behaviors that are part of the life of a child with attachment issues, RAD, or Developmental Trauma Disorder (DTD).

This article is for information purposes only and not intended as medical advice. Consult a medical professional to determine the best treatment for your child.

Medication is a Tool Not a Cure

The use of medication can be an effective tool when treating a child with RAD. Children with attachment disorders display a number of intense behaviors that are driven by anxiety, depression, mood instability and their trauma response.

In the instances where a professional can evaluate and identify these symptoms, mental health medications can be a helpful addition to other strategies already in place such as structure, therapeutic parenting, and attachment therapy.

Children with attachment disorders often have little tolerance to everyday stimuli and even small irritations can result in major meltdowns. Medication can be the tool you need to increase the window of tolerance for your child. In other words, if your child takes medication that reduces their anxiety, they may be able to begin to learn how to tolerate everyday upsets.

As their window of tolerance increases, you may be able to teach self-soothing techniques. We all have a minimum and maximum level of tolerance when problem solving. When a child with RAD is being treated for anxiety, medication can help increase their tolerance to treatment.

Common Diagnosis Together with RAD

Children with attachment disorders often have additional diagnoses.

These diagnoses can include:

• Attention Deficit Disorder (ADD)
• Attention Deficit Hyperactivity Disorder (ADHD)
• Conduct Disorder (CD)
• Generalized Anxiety Disorder (GAD)
• Intermittent Explosive Disorder (IED)
• Major Depressive Disorder (MDD)
• Obsessive Compulsive Disorder (OCD)
• Oppositional Defiant Disorder (ODD)
• Post Traumatic Stress Disorder (PTSD)

When considering medication for a child with attachment issues, it’s important to consider the whole picture and choose a medication that will help the child with other concurrent diagnoses.

What is the Best Medication for Kids with Reactive Attachment Disorder?

As much as we all wish there was one best medication to treat RAD, the truth is that there is no best med or simple solution. A prescription that helps one child may not help another.

Each child has a unique combination of symptoms. Two siblings with the same diagnosis may not exhibit symptoms in the same way. Meaning, the same combinations of medication may not be used with children who hold the same clinical diagnosis.

This is where it’s important to work as a team with the doctors who are treating your child. Consider which behaviors your child exhibits that are most difficult and how you hope medication will improve the situation. We know the behaviors are overwhelming, but the more you can explain specifics to your doctor, the better you’ll be able to find medications that can help your child regulate.

One disadvantage to medication is that every drug carries the risk of side effects. Many side effects are mild and go away after a couple weeks, but it’s important to monitor your child carefully when starting a new medication.

Drugs Most Commonly Used with RAD

The most common types of medication used include anti-depressants, stimulants, mood stabilizers and antipsychotics.

Anti-Depressants

Anti-depressants are used to reduce depression, lift anxiety, stabilize ups and downs, and improve mood.

Categories of Anti-Depressants

There are multiple categories of antidepressants including SSRI’s, SNRI’s, Atypical antidepressants and Tricycling. We have put together a list of the most common medications prescribed to children.

Review of Serotonin Reuptake Inhibitors (SSRIs)

SSRI’s or serotonin reuptake inhibitors are the most common category of antidepressants used with children and adults. Medical professionals may prescribe an SSRI to treat patients with PTSD, GAD, OCD and MDD.

SSRI’s includes: Citalopram (Celexa), Escitalopram (Lexapro and Cipralex) , Fluoxetine (Prozac and Sarafem), Fluvoxamine (Luvox), Paroxetine (Brisdelle, Paxil, Paxil CR and Pexava) and Sertraline (Zoloft)

Most Commonly Used SSRI’s and Side Effects

• Zoloft: side effects can include sour stomach and drowsiness
• Celexa: side effects can include change in sex drive and mood
• Lexapro and Cipralex: side effects can include nausea, upset stomach and drowsiness
• Prozac and Sarafem: side effects can include nervousness and change in sleep patterns
• Luvax: side effects can include constipation and change in sleep patterns
• Brisdelle, Paxil, Paxil CR and Pexava: side effects can include acid reflux and upset stomach

Review of Serotonin-norepinephrine Reuptake Inhibitors (SNRIs)

SNRI’s such as Venlafaxine (Trintellix), Duloxetine (Cymbalta and Irenka ), and Desvenlafaxine (Khedezla and Pristiq ) are used with children and adults. Medical professionals may prescribe a SNRI in the treatment of MDD and GAD.

Most Commonly Used SNRI’s and Side Effects

• Trintellix: side effects can include headaches and sweating
• Cymbalta and Irenka: side effects can include dry mouth and body aches
• Khedezla and Pristiq: side effects can include decrease in appetite and sensitivity to light

Review of Atypical Antidepressants

Atypical Antidepressants are frequently used in patients with major depression who have inadequate responses or intolerable side effects during first-line treatment with SSRIs.

Atypical Antidepressants commonly prescribed include Bupropion (Aplenzin, Budeprion SR/XL, Buproban, ForfivoXL, WellbutrinSR/XL, and Zyban), Mirtazapine (Remeron), Vilazodone (Viibryd), and Vortioxetine.

Most Commonly Used Atypical Antidepressants and Side Effects

• Aplenzin, Budeprion SR, Budeprion XL, Buproban, Fofivo XL, Wellbutrin, Wellbutrin SR, Wellbutrin XL and Zyban: side effects can include anxiety and irritability
• Remeron: side effects can include constipation and dizziness
• Viibryd: side effects can include trouble sleeping and upsets stomach
• Vortioxetine: side effects can include constipation and dry mouth

Review of Tricyclic Antidepressants

Tricyclic and tetracyclic antidepressants are effective but have been replaced by antidepressants with fewer side effects. However, cyclic antidepressants may be a good option when other treatments have failed.

Tricyclic antidepressants commonly prescribed include Clomipramine (Anafranil), Desipramine (Norpramin), Nortriptyline (Aventyl and Pamelor), and Imipramine (Tofranil).

Most Commonly Used Tricyclic Antidepressants and Side Effects

• Anafranil: side effects can include bladder pain
• Norpramin: side effects can include swelling of mouth, change in stool
• Aventyl and Pamelor: side effects can include blurred vision
• Tofranil: side effects can include agitation and cold sweats

Stimulant Medications

Stimulants are used to reduce hyperactivity and improve concentration. Stimulant and similar medications are used with children to treat ADHD, narcolepsy and exogenous obesity.

Stimulant medications have been used in the treatment of ADHD since the 1930’s. Why stimulants work is mostly unknown. Stimulant medications increase the neurotransmission of dopamine and norepinephrine.

Review of Stimulants

Commonly prescribed stimulant medication includes amphetamine (Dyanavel XR and Evekeo), dextroamphetamine (Dexedrine, Dexedrine Spansules, Dextrostat, Liquadd, ProCentra and Zenzedi ), atomoxetine (Strattera), benzphetamine (Didrex), clonidine ER (Duraclon), guanfacine (Intuniv and Tenez), lisdexamfetamine (Vyvanse), methamphetamine (Desoxyn), methylphenidate (Daytrana), methylphenidate (Ritalin), and amphetamine-dextroamphetamine (Adderall).

Most Commonly used Stimulants and Side effects

• Dyanavel XR and Evekeo: side effects include agitation and anxiety
• Dexedrine, Dexedrine Spansules, Dextrostat, Liquadd, ProCentra and Zenzedi: side effects can include dizziness and decreased alertness
• Strattera: side effects can include drowsiness, dizziness and lightheaded
• Didrex: side effects can include dizziness, drowsiness and hypertension
• Duraclon: side effects can include dizziness, fainting and slower heartbeat
• Intuniv and Tenez: side effects can include blurred vision, sweating and confusion
• Vyvanse: side effects can include decreased appetite, headache and nausea
• Desoxyn: side effects can include habit formation
• Daytrana: side effects can include increased aggression and agitation

Mood Stabilizers

Mood stabilizers may be used with children to treat mood swings, hyperactivity, manic-like symptoms, depression and other bipolar-type symptoms.

Review of Mood Stabilizers

The most commonly used mood stabilizers among adolescent include lithobid (Lithium), carbamazepine (Carbatrol and Equetro) and sodium valproate (Depakote).

Most Commonly Used Mood Stabilizers and Side Effects

• Lithium: side effects can include anxiety, restlessness and muscle spasms
• Carbatrol and Equetro: side effects can include double vision and back-and-forth eye movements
• Depakote: side effects can include blood in urine or stool, chills, confusion or cough

Antipsychotics

Antipsychotic medications are traditionally used to reduce or relieve symptoms of psychosis, such as delusions and hallucinations. However, they have also been found to be effective for the management of behavior in children, including reducing aggression.

Review of Antipsychotics

Medications available in this class include risperidone (Risperdal), quetiapine (Seroquel), olanzapine (Zyprexa), ziprasidone (Zeldox), paliperidone (Invega), aripiprazole (Abilify) and clozapine (Clozaril).

Most Commonly Used Antipsychotics and Side Effects

• Risperdal: side effects can include weight gain, dizziness, tics, and swollen breasts (including in males)
• Seroquel: side effects can include weight gain, dry mouth, and upset stomach
• Abilify: side effects can include weight gain, nausea, and insomnia

Tips for Parents

Here are helpful guidelines for parents who are considering the use of prescription meds for a child with RAD.

1. You are the Expert for Your Child

The best advice we can give is trust what you know about your child. No expert can tell you more about your child than you can. If you believe medication will be helpful, then you need to say so. Don’t wait for the doctor to recommend medication as an option. Ask for what you think your child needs.

Try to ensure you are providing medication consistently and document changes in behavior. Don’t make big changes or take a child off and on medication without doctor approval.

Try making small adjustments like time of day, taking medication with food, tracking medication compliance and documenting side effects. All of this information will help your provider be better able to determine how the medication is working and if adjustments need to be made.

2. Let Go of Parent Guilt

We know people hold strong opinions on providing psychiatric medication to children. The criticism of using medication is typically the unknown impacts on a developing brain. In reality parents have a million reasons to feel guilty about what choices they make when caring for their children.

Deciding to use medications to treat attachment disorder is a deeply personal decision that each caregiver must make. Parents often face criticism, and we want to provide you with the information you need to make the best choice for your situation.

Keep in mind that medication use is protected by HIPPA laws and is a private decision. You are not obligated to share this information with anyone besides your child’s doctor. While we recommend informing your child’s teacher, therapist, and treatment team, telling family members or friends is not necessary and may add to your burden.

Because you are researching what options are available for you and your child, that means you are taking this decision seriously. Consider looking into 5 Ways to Discipline a Child with RAD as an additional resource. The good news is you don’t have to try just one approach. A plan to combines a number of strategies will be most effective in treating RAD since it’s such a complex and difficult diagnosis.

3. Medication Takes Time to Work

Medication is most effective when used in addition to other treatments. Some medications such as an SSRI inhibitors can take weeks to build up in the body, meaning that it may be nearly a month before you notice a change in behaviors.

Medication often needs to be started at the lowest dose and gradually adjusted in order to monitor behavior and side effects. If a medication isn’t a good fit for your child, another will need to be started and the process starts over.

For this reason, plan for the whole process to take months rather than weeks, and remember that as your child grows, continual adjustments will be necessary. Growth spurts, puberty, and the body adapting over time are all reasons that psych meds for children will need to be adjusted.

You will also get more out of using medication along with a treatment commonly used with RAD.

We don’t recommend taking your child off or putting your child on any medication without consulting your healthcare professional first. In the event that your child has a negative reaction to the medication, contact your healthcare professional immediately.

4. Document Behavior Changes

Medication can impact behavior in both a positive or negative way. Pay close attention to changes in your child’s behavior and document.

Some parents report medications can make RAD behaviors worse. This can be due to several reasons including an overdose, chemical incompatibility or other unknown, undiagnosed conditions.

Most importantly, be patient with yourself and consider finding the right medication a process. It can take several tries before you get the right medication combination and can take time for the medication to build up to a therapeutic level.

As we outlined above, there are many medications that can be part of the treatment option for your child. If one is not working, document the concerns, and call your medical professional.

Some parents find medicating their children with RAD as an invaluable tool to support positive change. There are options and you can see behavior improvement. You can do this! While the process of finding the right medication won’t be an easy road, it’s worth it.

Have you used medication to treat a child with RAD? Share your experiences in the comments below.

Click here for a free PDF printable checklist of the 7 steps to take when your child needs residential treatment.