What is Reactive Attachment Disorder

Reactive attachment disorder is a condition in which a child has problems developing relationships or responding correctly to social situations. This disorder usually affects children who are younger than 5 years old.

There are two types of reactive attachment disorder:

• Inhibited. Children with this type may resist relationships or social interactions.
• Disinhibited. Children with this type may be too friendly with strangers.

What are the causes?

The exact cause of this condition is not known.

What increases the risk?

This condition is more likely to develop in children:

• Who were mistreated, abused, or neglected in early childhood.
• Who have a parent with a drug or alcohol addiction.
• Who have a parent with a mental illness.
• Who were adopted or are living in foster care.

What are the signs or symptoms?

A child with reactive attachment disorder may:

• Have trouble eating, feeding, or gaining weight.
• Lack empathy.
• Act hesitant in social situations.
• Appear detached or not responsive.
• Struggle with controlling impulses.
• Not be easily comforted.
• Become too friendly with strangers.
• Seem distant or show defiant behavior.

How is this diagnosed?

This condition is diagnosed based on:

• A history of your child’s behavior around family members, caregivers, friends, peers, and strangers.
• An assessment of your child’s mental health. This includes learning about:
  • Your child’s living arrangements.
  • Any history of:
    • Child abuse.
    • Foster care.
    • Parental mental illness.
    • Separation from a parent.
    • Parental drug or alcohol abuse.

Your child’s health care provider may also refer your child to a children’s mental health specialist, such as a psychologist, psychiatrist, or clinical social worker.

How is this treated?

Treatment for reactive attachment disorder focuses first on making sure the child is safe. Then, it aims to strengthen the child’s bond with caregivers by helping him or her understand these relationships. Treatment will be specific to your child and may include:

• Support for a caregiving environment. A relationship with a safe and loving caregiver is the most important intervention. This may include:
  • Education about the caregiver–child relationship.
  • Other resources to decrease caregiver stress, such as housing or financial support.
• Psychotherapy. This is also called talk therapy or counseling. This may be prescribed for your child and for any caregivers and family members who are feeling frustrated or anxious.
• Positive parenting training. The therapist may recommend resources, such as online or video series, to educate caregivers.

Follow these instructions at home:

• Provide a safe, stable, consistent setting for your child at home and with his or her caregivers.
• Be patient and sensitive when interacting with your child.
• Keep track of your child’s behavior and interactions with family members, caregivers, friends, peers, and strangers. This will help your child’s health care provider to make the best treatment plan for your child.
• Keep all follow-up visits as told by your child’s health care providers. This is important.

Contact a health care provider if:

• Your child’s symptoms get worse.
• Your child develops new symptoms.
• You need more support.

Summary

• Reactive attachment disorder is a behavioral condition in which a child has problems developing relationships or responding correctly to social situations.
• There are two types of reactive attachment disorder, including inhibited and disinhibited.
• Children who have been mistreated, abused, or neglected early in their childhood are more likely to develop reactive attachment disorder.