Reactive attachment disorder
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 treatment, children with reactive attachment disorder may develop more stable and healthy relationships with caregivers and others. Treatments for reactive attachment disorder include positive child and caregiver interactions, a stable, nurturing environment, psychological counseling, and parent or caregiver education.
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 change 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 a lack of emotional response from caregivers does not come to expect care or comfort or form a stable attachment to caregivers.
Most children are naturally resilient, and even those who’ve been neglected, lived in orphanages or had multiple caregivers can develop healthy relationships. 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.
Reactive attachment disorder can start 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:
- Withdrawal, fear, sadness or irritability that is not readily explained
- Sad and listless appearance
- Not seeking comfort or showing no response when comfort is given
- Failure to smile
- Watching others closely but not engaging in social interaction
- Failing to ask for support or assistance
- Failure to reach out when picked up
- No interest in playing peekaboo or other interactive games
Reactive attachment disorder is rare. Signs and symptoms can occur in children who don’t have reactive attachment disorder or who have another disorder such as autism spectrum disorder. It’s important to have your child evaluated by a psychiatrist who can tell whether such behaviors indicate a more serious problem.
When to see a doctor
If you think your child may have reactive attachment disorder, you may start by visiting your primary care provider or pediatrician. However, you may be referred to a doctor who specializes in the diagnosis and treatment of reactive attachment disorder or a pediatrician specializing in behavior and development for a complete evaluation.
Consider getting an evaluation if your baby or child shows any of the signs and symptoms above.