Reactive attachment disorder is when an infant or young child doesn't establish healthy attachments with parents or caregivers due to neglect.
Reactive attachment disorder is a rare but serious condition in which an infant or young child doesn't establish healthy attachments with parents or caregivers. Reactive attachment disorder may develop if the child's basic needs for comfort, affection and nurturing aren't met and loving, caring, stable attachments with others are not established.
With appropriate treatment, children who have reactive attachment disorder may develop more stable and healthy relationships with caregivers and others. Treatments for reactive attachment disorder include learning how to create a stable, nurturing environment and providing positive child and caregiver interactions. Parent or caregiver counseling and education can help.
Reactive attachment disorder usually starts in infancy. There's little research on signs and symptoms of reactive attachment disorder beyond early childhood, and it remains uncertain whether it occurs in children older than 5 years.
Signs and symptoms may include:
Consider getting an evaluation if your child shows any concerning signs that persist across time. Some signs can occur in children who don't have reactive attachment disorder or who have another disorder, such as autism spectrum disorder. Sometimes young children may display some temporary signs and symptoms, but they tend to be brief, minor or don't cause developmental problems. It's important to have your child evaluated by a pediatric psychiatrist or psychologist who can determine whether behaviors indicate a more serious problem.
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 by caregivers. For instance, when a baby cries, the need for comfort, a meal or a diaper change must be met with a shared emotional exchange that may include eye contact, smiling and caressing.
A child whose needs are ignored or who is met with a lack of emotional response from caregivers does not come to expect care or comfort or form a stable attachment to caregivers.
It's not clear why some babies and children develop reactive attachment disorder and others don't. Various theories about reactive attachment disorder and its causes exist, and more research is needed to develop a better understanding and improve diagnosis and treatment options.
The risk of developing reactive attachment disorder from severe social and emotional neglect or the lack of opportunity to develop stable attachments may increase in children who, for example:
However, most children who are severely neglected don't develop reactive attachment disorder.
Without proper treatment, reactive attachment disorder can continue for several years and may have lifelong consequences. These can include problems with relationships, social interactions, mental and physical health, behavior, intellectual development, and substance abuse.
More research is needed to determine if problems in older children and adults are related to experiences of reactive attachment disorder in early childhood.
While it's not known with certainty if reactive attachment disorder can be prevented, there may be ways to reduce the risk of its development. Infants and young children need a stable, caring environment and their basic emotional and physical needs must be consistently met. The following parenting suggestions may help.
A pediatric psychiatrist or psychologist can conduct a thorough, in-depth examination to diagnose reactive attachment disorder.
Your child's evaluation may include:
Your child's mental health provider will also want to rule out other psychiatric disorders and determine if any other mental health conditions coexist, such as:
Your child's mental health provider may use the diagnostic criteria for reactive attachment disorder in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), published by the American Psychiatric Association. Diagnosis isn't usually made before 9 months of age. Signs and symptoms typically appear before the age of 5 years.
DSM-5 criteria for diagnosis include:
Children with reactive attachment disorder are believed to have the capacity to form attachments, but this ability has been hindered by their early developmental experiences.
Most children are naturally resilient. And even those who've been neglected, lived in a children's home or other institution, or had multiple caregivers can develop healthy relationships. Early intervention appears to improve outcomes.
There's no standard treatment for reactive attachment disorder, but it should involve both the child and parents or primary caregivers. Goals of treatment are to help ensure that the child:
A mental health professional can provide both education and coaching in skills that help improve signs and symptoms of reactive attachment disorder. Treatment strategies include:
Other services that may benefit the child and the family include:
The American Academy of Child and Adolescent Psychiatry has criticized dangerous and unproven treatment techniques for reactive attachment disorder.
These techniques include any type of physical restraint or force to break down what's believed to be the child's resistance to attachments — an unproven theory of the cause of reactive attachment disorder. There is no scientific evidence to support these controversial practices, which can be psychologically and physically damaging and have led to accidental deaths.
If you're considering any kind of unconventional treatment, talk to your child's psychiatrist or psychologist first to make sure it's evidence based and not harmful.
If you're a parent or caregiver whose child has reactive attachment disorder, it's easy to become angry, frustrated, guilty and distressed. You may feel like your child doesn't love you — or that it's hard to like your child sometimes.
These actions may help:
You may start by visiting your child's pediatrician. However, you may be referred to a child psychiatrist or psychologist who specializes in the diagnosis and treatment of reactive attachment disorder or a pediatrician specializing in child development.
Here's some information to help you get ready and know what to expect from your health care provider or mental health professional.
Before your appointment, make a list of:
Some basic questions to ask may include:
Your child's health care provider or mental health professional is likely to ask you a number of questions, such as:
Your health care provider or mental health professional will ask additional questions based on your responses, symptoms and needs. Preparing and anticipating questions will help you make the most of your appointment time.