Reactive attachment disorder is a serious condition in which an infant or young child fails to establish healthy attachments with parents or caregivers. This disorder may develop if the child’s basic needs for comfort, affection, and nurturing are not met, and loving, stable attachments with others are not established.
With appropriate treatment, children with reactive attachment disorder may develop more stable and healthy relationships with caregivers and others. Treatments include creating a stable, nurturing environment and providing positive interactions between the child and caregiver. Parent or caregiver counseling and education can also be helpful.
Reactive attachment disorder usually starts in infancy, and symptoms may include unexplained withdrawal, fear, sadness, irritability, and a lack of interest in seeking comfort or responding to comfort given. Children with reactive attachment disorder may also display behavior problems and fail to seek support or assistance.
If your child shows concerning signs that persist over time, consider getting an evaluation by a pediatric psychiatrist or psychologist. It’s essential to determine whether the behaviors indicate reactive attachment disorder or another disorder, such as autism spectrum disorder.
The development of reactive attachment disorder is linked to a lack of a stable, caring environment and inconsistent meeting of the child’s emotional and physical needs by caregivers. Infants and young children need to feel safe and develop trust through shared emotional exchanges with caregivers. The reasons why some children develop reactive attachment disorder are not entirely clear, and further research is needed to understand the causes better and improve diagnosis and treatment options.
The risk of developing reactive attachment disorder may increase in children who experience severe social and emotional neglect, frequent changes in foster homes or caregivers, or have parents with severe mental health problems, criminal behavior, or substance abuse that impairs their parenting. However, most severely neglected children do not develop reactive attachment disorder.
Without proper treatment, reactive attachment disorder can have lifelong consequences, affecting relationships, social interactions, mental and physical health, behavior, intellectual development, and potentially leading to substance abuse. More research is needed to understand how experiences of reactive attachment disorder in early childhood may affect older children and adults.
While it’s uncertain if reactive attachment disorder can be entirely prevented, there are ways to reduce its risk. Infants and young children need a stable, caring environment, and their emotional and physical needs must be consistently met. Parenting suggestions to help reduce the risk of reactive attachment disorder include being actively engaged with your child, learning to interpret their cues, providing warm and nurturing interaction, offering both verbal and nonverbal responses to their feelings, and seeking experience or training if needed.
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A pediatric psychiatrist or psychologist can conduct a thorough examination to diagnose reactive attachment disorder. The evaluation may include direct observation of interactions, details about behavior patterns over time, information about interactions with parents or caregivers, questions about the home and living situation since birth, and an evaluation of parenting and caregiving styles.
The diagnostic criteria for reactive attachment disorder in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) are used for diagnosis. Signs and symptoms typically appear before the age of 5 years, and diagnosis is usually not made before 9 months of age.
Treatment for reactive attachment disorder involves both the child and parents or primary caregivers. Goals include providing a safe and stable living situation and developing positive interactions and strong attachment between the child and caregivers. A mental health professional can provide education and coaching in skills that help improve symptoms. Treatment strategies may include being nurturing, responsive, and consistent caregivers, providing a positive and interactive environment, and addressing the child’s medical and safety needs.
Other services that may benefit the child and family include individual and family psychological counseling, education for parents and caregivers about the condition, and parenting skills classes.
The American Academy of Child and Adolescent Psychiatry warns against dangerous and unproven treatment techniques for reactive attachment disorder. These techniques, involving physical restraint or force, are not supported by scientific evidence and can be psychologically and physically damaging.
If considering unconventional treatment, consult your child’s psychiatrist or psychologist first to ensure it is evidence-based and safe.
If you are a parent or caregiver of a child with reactive attachment disorder, it’s important to educate yourself about the condition and find support. Taking breaks when needed, practicing stress management, making time for yourself, and seeking professional help are essential coping strategies.
If you suspect your child has reactive attachment disorder, start by visiting their pediatrician. You may be referred to a child psychiatrist or psychologist who specializes in the diagnosis and treatment of the condition.
Before the appointment, make a list of behavior problems, emotional issues, and any other relevant information. Be prepared to ask questions about the likely causes, best treatments, alternatives, and any other concerns you may have.
Your child’s health care provider or mental health professional will likely ask questions about when the issues were first noticed, the frequency of the problems, their impact on your child’s functioning, the home and living situation, and previous approaches that have been tried.