When a baby is born, he or she has physical and safety needs that must be met quickly and consistently. But infants and young children also have emotional needs as well—they need to be nurtured and comforted by a stable and responsive caregiver who can provide a secure base for them to develop and explore the world. When caregivers are unstable or unresponsive during the first few years of a child’s life, the child is at risk for developing an attachment disorder.

Reactive attachment disorder is a type of disorder where a child does not develop healthy, stable attachments to a caregiver due to physical and emotional neglect. It is rarely given as a diagnosis, primarily affecting infants and young children who have spent their first few years without the lack of a stable or nurturing caregiver. Due to parents recently being separated from their children at the US immigration border, there’s been renewed concern among experts.

Causes

A stable and nurturing environment is essential for the development of an infant or young child. In addition to having basic physical and safety needs met, such as feeding, diaper changing, and being in a safe environment, children also need consistent emotional contact to help them regulate their own emotions. Emotional contact consists of human touch and interaction such as making eye contact, reflecting a baby’s emotions in your own facial expressions, and holding/soothing the baby.

A young child may be at risk for developing reactive attachment disorder when they have received insufficient care and little to no emotional response from their caregivers. This might include:

  • Not receiving comfort, affection, and appropriate stimulation from caregivers
  • Lack of stable attachments due to repeated changing of primary caregiver
  • Receiving care in settings that offer limited possibility for attachment

Examples of these environments might include:

  • Living in an institution
  • Changing foster homes often
  • Having parents with mental health or substances abuse problems
  • Being separated from caregivers due to illness or other reasons
  • Having teenage parents
  • Having an intellectually disabled caregiver

Researchers have a lot to learn about why some neglected children develop an attachment disorder and others do not, as the majority of neglected children will not exhibit signs of reactive attachment disorder. Researchers have found that there is a link between the duration of deprivation and the severity of symptoms. Boys are more likely than girls to receive a diagnosis, but due to a lack of research and the rarity of the condition, researchers struggle to estimate the prevalence of reactive attachment disorder among young children.

If you think a child is being neglected or abused, you can report the abuse to the National Child Abuse Hotline at 1-800-4-A-CHILD (800-422-4453).

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Symptoms

Evidence of reactive attachment disorder falls into two categories: behavioral patterns and social and emotional disturbances.

Behavioral Patterns

Children with reactive attachment disorder will appear withdrawn in their behavior, especially towards caregivers. They might:

  • Not seek comfort when upset
  • Not respond to comfort when upset

Emotional and Social Disturbances

If a child has reactive attachment disorder, caregivers will also notice disturbances in their emotions and how they interact with others. This can look like:

  • Acting fearful, sad, or irritable for no reason
  • Not showing emotion in their facial expressions (otherwise known as having a flat affect)
  • Not engaging socially with others
  • Lack of interest in playing

Diagnosis 

According to the American Academy of Child and Adolescent Psychiatry, parents or caregivers often first bring their concerns to their child’s pediatrician once they notice the child is not developing properly. Children may fail to gain the proper amount of weight or may develop severe colic. They are not as responsive as their peers, are very hesitant in social situations, and they do not respond when caregivers attempt to comfort them.

For a child to be diagnosed with reactive attachment disorder, they must meet several criteria in addition to the symptoms listed above. They cannot have a diagnosis of autism spectrum disorder. Symptoms must also appear after the developmental age of 9 months and before the child turns 5 years old. Symptoms must also have been present for at least one year.

If you think a child may meet some of the criteria for reactive attachment disorder, express your concerns to their pediatrician. They can conduct a physical examination to determine whether there has been physical neglect. They will likely refer you to a mental health professional who can evaluate them, rule out other possible causes, and recommend treatment options.

Children with reactive attachment disorder or with signs of the disorder may also be diagnosed with attention deficit hyperactivity disorder (ADHD), posttraumatic stress disorder (PTSD), oppositional defiant disorder (ODD), a specific phobia, or other psychiatric diagnoses.

If you are a foster parent or adoptive parent, getting more information about the child’s history can also help a professional give them a proper diagnosis and also help you understand how the child was neglected and how you can best serve their needs. It can be frustrating to have an unresponsive infant or child, but with time, support, and patience, your relationship with them can grow.

Treatment

Treatment for reactive attachment disorder will not be successful unless a child is first put in a safe environment where his or her physical and safety needs are met. Once the child is in a safe and secure environment, treatment will focus on psychoeducation for caregivers. This typically involves helping a caregiver develop an emotional relationship with the child as well as addressing whatever additional challenges, such as substance abuse, domestic violence, etc. are preventing the caregiver from being able to connect with the child and meet their needs.

Children with reactive attachment disorder who do not receive treatment are at risk for developing psychological problems later in life.

Prevention

Caregivers who emotionally engage with their infants can prevent the development of reactive attachment disorder. Emotional engagement can look like:

  • Making eye contact
  • Reflecting the baby’s emotions in facial expressions and words
  • Limiting distractions such as technology
  • Interacting with the child when changing a diaper or bathing him

There are lots of ways that you can educate yourself about how to meet the emotional needs of a developing infant. Don’t hesitate to reach out to your child’s pediatrician if you have questions or concerns. Social workers and other professionals can help you make sure that you meet your baby’s physical and emotional needs. Parenting classes can also provide you with examples and practice for engaging emotionally with your baby and meeting their physical needs as well.

Early and comprehensive treatment is key because children with reactive attachment disorder who do not receive treatment are at risk for developing psychological issues and other problems later in life. This can include developing a personality disorder or struggling with a lifetime of criminal behavior and/or substance abuse.

If you think your child has reactive attachment disorder, don’t hesitate to reach out to their doctor or a mental health professional today.

Last Updated: Nov 18, 2018