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.
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:
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.
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.
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.
The Diagnostic and Statistical Manual of Mental Disorders (DSM-5), published by the American Psychiatric Association, includes diagnostic criteria for reactive attachment disorder, such as:
However, some experts use other sources, rather than the DSM-5, as a basis for diagnosing reactive attachment disorder.
A thorough, in-depth examination by a child psychiatrist is necessary to diagnose reactive attachment disorder.
Your child's evaluation may include:
Your child's doctor will also want to rule out other possible causes, as signs and symptoms of reactive attachment disorder may resemble those related to other disorders, including:
Without treatment, reactive attachment disorder can continue for several years and may have lifelong consequences. However, more research is needed to determine if problems in older children and adults are related to experiences of reactive attachment disorder in infancy and 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.
If you're a parent or caregiver whose 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:
The risk of developing reactive attachment disorder from serious social and emotional neglect or the lack of opportunity to develop stable attachments may increase in children who:
However, most children who are severely neglected don't develop reactive attachment disorder.