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Reactive attachment disorder of infancy or early childhood

  • Definition
    • Reactive attachment disorder is a problem in which a child is not able to easily form a normal or loving relationship with others. It is considered to be a result of not forming an attachment to any specific caregiver when very young.

  • Causes
    • Reactive attachment disorder is caused by abuse or neglect of an infant's needs for:

      • Emotional bonds with a primary or secondary caretaker
      • Food
      • Physical safety
      • Touching

      An infant or child may be neglected when the:

      • Caregiver is intellectually disabled
      • Caregiver lacks parenting skills
      • Parents are isolated
      • Parents are teenagers

      A frequent change in caregivers (for example, in orphanages or foster care) is another cause of reactive attachment disorder.

  • Symptoms
    • In a child, symptoms may include:

      • Avoiding caregiver
      • Avoiding physical contact
      • Difficulty being comforted
      • Not making distinctions when socializing with strangers
      • Wanting to be alone rather than interacting with others

      The caregiver will often neglect the child's:

      • Needs for comfort, stimulation, and affection
      • Needs like food, toileting, and play
  • Exams and Tests
    • This disorder is diagnosed with a:

      • Complete history
      • Physical examination
      • Psychiatric evaluation
  • Treatment
    • Treatment has two parts. The first goal is to make sure the child is in a safe environment where emotional and physical needs are met.

      Once that has been established, the next step is to change the relationship between the caregiver and the child, if the caregiver is the problem. Parenting classes can help the caregiver meet the child's needs and bond with the child.

      Counseling may help the caregiver work on problems, such as drug abuse or family violence. Social Services should follow the family to make sure the child remains in a safe, stable environment.

  • Outlook (Prognosis)
    • The right intervention can improve the outcome.

  • Possible Complications
    • If not treated, this condition can permanently affect the child's ability to interact with others. It can be connected with:

  • When to Contact a Medical Professional
    • This disorder is usually identified when a parent (or prospective parent) is at high risk for neglect or when an adoptive parent has difficulty coping with a newly adopted child.

      If you have recently adopted a child from a foreign orphanage or another situation where neglect may have occurred and your child shows these symptoms, see your health care provider.

  • Prevention
    • Early recognition is very important for the child. Parents who are at high risk for neglect should be taught parenting skills. The family should be followed by either a social worker or doctor to make sure the child's needs are being met.

  • References
    • American Academy of Adolescent and Child Psychiatry. Facts for families, No. 85: reactive attachment disorder. 2011. www.aacap.org/App_Themes/AACAP/docs/facts_for_families/85_reactive_attachment_disorder.pdf. Accessed July 8, 2016.

      American Psychiatric Association. Reactive attachment disorder. In: American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 5th ed. Arlington, VA: American Psychiatric Publishing; 2013:265-268.

      McDermott B. Major psychiatric disorders. In: South M, Isaacs D, eds. Practical Paediatrics. 7th ed. Philadelphia, PA: Elsevier; 2012:chap 4.4.