reactive attachment disorder

reactive attachment disorder, rare condition in which infants and young children fail to form emotional bonds with their parents or other caregivers. The disorder is associated with trauma or other stressors that typically result from neglect or physical or emotional abuse and that affect early development. An estimated 1 to 2 percent of children are affected by reactive attachment disorder.

Infants and young children thrive in environments in which their needs are met effectively. Such needs range from regular feedings and diaper changes to interacting with caregivers in ways that involve safe physical touch, interest, and eye contact. As an example, a parent feeding an infant may look into the infant’s eyes and smile or sing to it, meeting both physical and emotional needs. When needs are met consistently, young children feel safe and learn to trust their parents and other caregivers. If needs are not met, however, young children ultimately stop trying to attract the attention of caregivers, and they stop interacting with others, which are indications of reactive attachment disorder. Even when loving caregivers are made available, affected children experience difficulty in forming emotional bonds.

Risk factors

Risk of reactive attachment disorder is increased among children who are severely neglected or who are abused, emotionally or physically. Neglect may occur in different ways. For example, children who emotionally bond with caregivers who then leave, or who have caregivers who respond inconsistently to needs, may experience neglect. There tends to be an increased risk of abuse and neglect for children who have been placed in orphanages or other institutions or who have been placed in foster care.

Children who live with their biological parents may also develop reactive attachment disorder, particularly if parents do not effectively form an emotional bond with their children. Mental or physical illnesses or substance use disorders among parents may interfere with their ability to respond consistently to their children’s needs, potentially resulting in severe neglect or abuse. Children who have experienced long separations from a parent, such as through the hospitalization of a parent, or who have experienced traumatic losses, such as the death of a parent, are also at risk of developing reactive attachment disorder.

Symptoms and complications

Symptoms of reactive attachment disorder vary. Children who are affected typically have trouble managing their emotions and forming connections with others. They are often withdrawn, rarely seek comfort from others, and fail to respond when others comfort them. They generally do not show positive emotions, such as smiling or laughing, and they rarely show affection. In the presence of caregivers, children with reactive attachment disorder may appear noticeably fearful or anxious, even if their current caregivers are loving and kind. They often avoid eye contact and physical touch, and they avoid interactive games. They throw tantrums to express fear or anger and may have a violent reaction to being held. They crave control and want to make their own decisions.

Children with reactive attachment disorder sometimes experience complications, among them the development of other mental health conditions, such as anxiety, depression, or post-traumatic stress disorder (PTSD). Affected children may also experience delays in physical growth or intellectual development. As children with reactive attachment disorder become older, they may develop eating disorders, have problems with attention, exhibit impulsive behavior, or engage in high-risk behaviors, such as substance use, unprotected sex, or theft.

Diagnosis and treatment

Diagnosis of reactive attachment disorder is made between the ages of nine months and five years. Determining whether an individual is affected generally involves ruling out other conditions, notably autism spectrum disorder, which has certain symptoms, such as avoidance of eye contact, that overlap with reactive attachment disorder.

Treatment of reactive attachment disorder centers on helping children establish healthy emotional attachments with their caregivers. Children may benefit from individual psychotherapy as well as from child-parent psychotherapy, which facilitates the development of healthy bonds between children and parents. In addition, children may participate in social skills therapy to learn how to interact appropriately with peers, while parents and other caregivers may participate in parenting skills classes to assist in developing effective support and attachment strategies.