- Emotional bonds with a primary or secondary caretaker
- Physical safety
- Caregiver is intellectually disabled
- Caregiver lacks parenting skills
- Parents are isolated
- Parents are teenagers
- Avoiding caregiver
- Avoiding physical contact
- Difficulty being comforted
- Not making distinctions when socializing with strangers
- Wanting to be alone rather than interacting with others
- Needs for comfort, stimulation, and affection
- Needs like food, toileting, and play
- Complete history
- Physical examination
- Psychiatric evaluation
- Other psychological problems
- Post-traumatic stress disorder
Reactive attachment disorder is a problem in which a child is not able to easily form a normal or loving relationship with others. It is considered to be a result of not forming an attachment to any specific caregiver when very young.
Reactive attachment disorder is caused by abuse or neglect of an infant's needs for:
An infant or child may be neglected when the:
A frequent change in caregivers (for example, in orphanages or foster care) is another cause of reactive attachment disorder.
In a child, symptoms may include:
The caregiver will often neglect the child's:
Exams and Tests
This disorder is diagnosed with a:
Treatment has two parts. The first goal is to make sure the child is in a safe environment where emotional and physical needs are met.
Once that has been established, the next step is to change the relationship between the caregiver and the child, if the caregiver is the problem. Parenting classes can help the caregiver meet the child's needs and bond with the child.
Counseling may help the caregiver work on problems, such as drug abuse or family violence. Social Services should follow the family to make sure the child remains in a safe, stable environment.
The right intervention can improve the outcome.
If not treated, this condition can permanently affect the child's ability to interact with others. It can be connected with:
When to Contact a Medical Professional
This disorder is usually identified when a parent (or prospective parent) is at high risk for neglect or when an adoptive parent has difficulty coping with a newly adopted child.
If you have recently adopted a child from a foreign orphanage or another situation where neglect may have occurred and your child shows these symptoms, see your health care provider.
Early recognition is very important for the child. Parents who are at high risk for neglect should be taught parenting skills. The family should be followed by either a social worker or doctor to make sure the child's needs are being met.
American Academy of Adolescent and Child Psychiatry. Facts for families, No. 85: reactive attachment disorder. 2011. www.aacap.org/App_Themes/AACAP/docs/facts_for_families/85_reactive_attachment_disorder.pdf. Accessed July 8, 2016.
American Psychiatric Association. Reactive attachment disorder. In: American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 5th ed. Arlington, VA: American Psychiatric Publishing; 2013:265-268.
McDermott B. Major psychiatric disorders. In: South M, Isaacs D, eds. Practical Paediatrics. 7th ed. Philadelphia, PA: Elsevier; 2012:chap 4.4.
- Review date:
- December 07, 2016
- Reviewed by:
- Neil K. Kaneshiro, MD, MHA, Clinical Assistant Professor of Pediatrics, University of Washington School of Medicine, Seattle, WA. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.
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