Reactive attachment disorder occurs in children who may have had abusive or negligent care. They do not form a healthy emotional bond with their primary caregivers – usually their mothers – resulting in a lack of trust and self-worth, a fear of getting close to anyone, irritability, sadness and difficulty interacting with adults or peers. A child with an attachment disorder feels unsafe and/or alone.
The prevalence of reactive attachment disorder is unknown. It is seen relatively rarely in clinical settings. It is usually found in young children exposed to severe neglect before being placed in foster care or raised in institutions. However, even in such populations, the disorder occurs in less than 10% of such children.
Symptoms of Reactive Attachment Disorder
The symptoms of reactive attachment disorder appear between the ages of 9 months and 5 years. They include:
- Display of inhibited, emotionally withdrawn behavior during routine interactions with caregivers, manifesting as:
- Does not seek comfort when distressed: Avoids eye contact and physical touch, especially with caregivers
- Does not respond when comfort is given during distress.
- Minimal social and emotional responsiveness to others:
- Failure to show an expected range of emotions when interacting with others
- Failure to show “emotions of conscience” such as remorse, guilt, or regret
- No interest in playing with toys or other interactive games
- Limited positive emotions: failure to smile.
- Episodes of unexplained irritability, sadness, or fearfulness even during normal interactions with caregivers.
- Developmental delays, especially delays in cognition and language
- Other signs of severe neglect (e.g., malnutrition or signs of poor care)
- Spends a lot of time rocking or comforting themselves
- Doesn’t reach out to be picked up
- Doesn’t seem to notice or care when you leave them alone
Causes of Reactive Disorder
History reveals that the child has experienced a pattern of extremes of insufficient care as evidenced by at least one of the following:
- Social neglect or deprivation with emotional needs for comfort, stimulation, and affection not met
- Repeated changes of primary caregivers that limit opportunities to form stable attachments
- Growing up in settings that severely limit opportunities to form selective attachments (e.g., institutions with high child-to-caregiver ratios).
Examples of inappropriate caregiving that place a child at greater risk of developing reactive attachment disorder include:
- A baby cries and no one responds or offers comfort.
- Soiled diaper is not changed for many hours.
- Not fed for many hours despite hunger.
- No one looks at, talks to, or smiles at the baby, so the baby feels alone.
- Not held, touched, talked to, or interacted with for many hours at a time.
- Sometimes the child’s needs are met and sometimes they aren’t. The child never knows what to expect.
- Caregivers attend only when the baby acts up or is disruptive.
- Multiple primary caregivers, with inconsistent care from unfamiliar people.
- Physical or emotional neglect or abuse.
Treatment of Reactive Attachment Disorder
If there is any associated condition like depression, anxiety, or hyperactivity, it will need to be treated with medication. Otherwise, treatment for reactive attachment disorder usually involves a combination of therapy, counseling, and parenting education.
Family therapy: This involves working together with the parents or primary caregivers and child to develop ways to interact in healthy ways. Therapy enhances the attachment bond as well as helps understand the symptoms of the disorder and effective interventions.
Individual psychological counseling: Child may be counseled individually or with the parents observing. This aims to help the child deal with monitoring emotions and behavior.
Play therapy: This therapy teaches the child how to interact more appropriately with peers in typical social settings. Parents also get involved and help the child to use the skills they learn.
Special education services: These are school-based programs that help the child learn skills for academic and social success. This also addresses behavioral and emotional problems.
Parenting skills classes: Parents are taught more effective ways of managing their child’s disorder and the challenges and problems that come with it.