Reactive attachment disorder
Reactive attachment disorder
Reactive attachment disorder is a rare but serious condition in which infants and young children don't establish healthy bonds with parents or caregivers.
A child with reactive attachment disorder is typically neglected, abused or orphaned. Reactive attachment disorder develops because the child's basic needs for comfort, affection and nurturing aren't met and loving, caring attachments with others are never established. This may permanently change the child's growing brain, hurting the ability to establish future relationships.
Reactive attachment disorder is a lifelong condition, but with treatment children can develop more stable and healthy relationships with caregivers and others. Safe and proven treatments for reactive attachment disorder include psychological counseling and parent or caregiver education.
Reactive attachment disorder begins before age 5. Signs and symptoms of the disorder may begin when the child is still an infant.
Signs and symptoms in babies may include:
Signs and symptoms in toddlers, older children and adolescents may include:
As children with reactive attachment disorder grow older, they may develop either inhibited or disinhibited behavior patterns. While some children have signs and symptoms of just one type of behavior, many exhibit both types.
There's little research on signs and symptoms of reactive attachment disorder beyond early childhood. It may lead to controlling, aggressive or delinquent behaviors, trouble relating to peers, and other problems. While treatment can help children and adults cope with reactive attachment disorder, the changes that occur during early childhood are permanent and the disorder is a lifelong challenge.
When to see a doctor
Consider getting an evaluation if your baby or child:
To feel safe and develop trust, infants and young children need a stable, caring environment. Their basic emotional and physical needs must be consistently met. For instance, when a baby cries, his or her need for a meal or a diaper must be met with a shared emotional exchange that may include eye contact, smiling and caressing.
A child whose needs are ignored or met with emotionally or physically abusive responses from caregivers comes to expect rejection or hostility. The child then becomes distrustful and learns to avoid social contact. Emotional interactions between babies and caregivers may affect development in the brain, leading to attachment problems and affecting personality and relationships throughout life.
Most children are naturally resilient, and even those who've been neglected, lived in orphanages or had multiple caregivers can develop healthy relationships and strong bonds. It's not clear why some babies and children develop reactive attachment disorder and others don't.
Reactive attachment disorder is rare. However, there are no accurate statistics on how many babies and children have the condition. Reactive attachment disorder begins before age 5, usually starting in infancy.
Factors that may increase the chance of developing reactive attachment disorder include:
Complications of reactive attachment disorder can continue into adulthood and can include:
Preparing for your appointment
If you suspect your child may have reactive attachment disorder, you may start by taking your child to see your family doctor or a general practitioner. However, in some cases when you call to set up an appointment, your child may be referred to a child and adolescent psychiatrist for a complete evaluation.
Because there's often a lot of ground to cover, it's a good idea to be well prepared for your appointment. Here's some information to help you get ready, and what to expect from your doctor.
What you can do
Your time with your doctor may be limited, so preparing a list of questions ahead of time will help you make the most of your time together. List your questions from most important to least important in case time runs out. For signs and symptoms that could be caused by attachment problems, some basic questions to ask your doctor include:
What to expect from your doctor
Tests and diagnosis
To be diagnosed with reactive attachment disorder, a baby or child must meet criteria spelled out in the Diagnostic and Statistical Manual of Mental Disorders (DSM). This manual is published by the American Psychiatric Association and is used by mental health providers to diagnose mental conditions.
The main criteria for the diagnosis of reactive attachment disorder must include:
A thorough evaluation may include:
Your child's doctor will also want to rule out other possible causes of behavior problems or emotional issues. Signs and symptoms of reactive attachment disorder may resemble those related to other disorders, such as:
Disagreement over diagnosis methods
Treatments and drugs
Treatment of reactive attachment disorder often involves a mix of psychological counseling, medications and education about the disorder. It may involve a team of medical and mental health providers with expertise in attachment disorders. Treatment usually includes both the baby or child and the parents or caregivers.
Goals of treatment are to help ensure that the baby or child has a safe and stable living situation and that he or she develops positive interactions with parents and caregivers. Treatment can also boost self-esteem and improve peer relationships.
There's no standard treatment for reactive attachment disorder. However, it often includes:
Other treatments for reactive attachment disorder that may be helpful include:
Managing reactive attachment disorder is a long-term challenge and can be quite demanding for parents and caregivers. You may want to consider seeking psychological counseling yourself or taking other steps to learn how to cope with the stress of having a child with reactive attachment disorder.
Controversial and coercive techniques
Some unproven treatments for reactive attachment disorder include:
Beware of mental health providers who promote these methods. Some offer research as evidence to support their techniques, but none has been published in reputable medical or mental health journals.
If you're considering any kind of unconventional treatment, talk to your child's psychiatrist first to make sure it's legitimate and not harmful.
Coping and support
If you're a parent or caregiver whose baby or child has reactive attachment disorder, it's easy to become angry, frustrated and distressed. You may feel like your child doesn't love you — or that it's hard to like your child sometimes.
You may find it helpful to:
While it's not known if reactive attachment disorder can be prevented with certainty, there may be ways to reduce the risk of its development.
Last Updated: 2011-07-06
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