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REACTIVE ATTACHMENT DISORDER

Men's Health, Mental Health, Women's Health / By

REACTIVE ATTACHMENT DISORDER

Reactive attachment disorder is a rare but serious condition in which a child fails to form and establish normal and healthy attachments with parents or caregivers – usually their mothers before age 5.

  • Attachment develops when a child is repeatedly soothed, comforted, cared for, and when the need of the child is consistently met by the caregiver.
  • When a child forms attachment with a protective and loving caregiver, the child learns to love and trust others, to become aware of others feelings and needs, to develop healthy relationships and also a positive self-image.
  • If the child is deprived of such emotional warmth during the first few years of life, it can negatively affect the child’s entire future.
  • This can lead to difficulty connecting with their emotions, resulting in a lack of self-worth, a fear of getting close to anyone, and anger.
  • As children with reactive attachment disorder grow older, they either develop an inhibited or a disinhibited pattern.
  • In an inhibited pattern, the child is extremely emotionally detached, withdrawn, and unresponsive to comforting. The child even though aware of what is appearing around them doesn’t react or respond. They may push other away, ignore them, or get aggressive when people try to get close.
  • In a disinhibited pattern, the child doesn’t seem to prefer their parents over other people, even strangers. The child seeks attention, comfort from everyone, without any distinction. They display inappropriate childish behavior much younger than their age and may appear anxious.

CAUSES

Reactive attachment disorder is caused by a problematic history of care and social relationships usually as a result of detachment between a young child and his or her primary caregiver. This can occur for so many reasons, including:

  • Constant disregard of the child’s basic need
  • Constant disregard of the child’s emotional needs for comfort, affection, and stimulation.

The risk for a child to develop the disorder may increase if:

  • The child lives in a children’s home or other institution.
  • Frequently change foster homes or caregivers
  • Have parents who have severe mental problems, such as criminal behavior, postpartum depression, anger problems or substance abuse that impair parenting
  • Have a separation from parents or other caregivers due to long-term hospitalization.
  • The child has experienced physical, sexual and verbal abuse with caregivers in their early years

SYMPTOMS

Symptoms in infants:

  • Extreme unresponsiveness or resistance to comforting.
  • Unexplained withdrawal, fear, or sadness
  • Irritability
  • Failure to smile
  • Not engaging in social interactions
  • Lack of interest in playing interactive games or playing with toys
  • Cries inconsolably
  • Doesn’t reach out to be picked

Symptoms in young children

  • Anger problems
  • An aversion to touch and physical affection
  • Control issues
  • Difficulty showing genuine care and affection
  • Failure to show guilt, remorse after behaving badly
  • Shuns relationship from everyone

DIAGNOSIS AND TREATMENT

As with adults, mental disorders in children are diagnosed based on signs and symptoms suggestive of a particular condition.  A thorough, in-depth examination may help.

This may include:

  • Direct observation with parents or caregivers
  • Details about the pattern of behavior over time
  • Questions about the home and living situation since birth
  • Information about interactions with parents or caregivers and others

The doctor will also rule out other psychiatric disorders and determine if there are other mental health conditions that co-exist such as depressive disorders, autism spectrum disorder, and intellectual disability.

The doctor may use and follow the criteria written in the Diagnostic and Statistical Manual of Mental Disorders (DSM), published by the American Psychological Association.

TREATMENT

Treatment option has two major important goals:  to ensure that the child is in a safe environment, especially in cases where the child has been abused or neglected, and also to help the child develop a healthy relationship with an appropriate caregiver.

Treatment strategies include:

  • Psychosocial support services for the family unit including financial or domestic aid, housing, and social work support.
  • Psychotherapeutic intervention including treating parents for mental illness, family therapy.
  • Parenting skill classes
  • Encouraging the child’s development by being responsive, caring and being nurturing.
  • Educating parent and caregivers about the condition.