Reactive Attachment Disorder of Infancy or Early Childhood
Andrea Barkoukis, M.A., Natalie Staats Reiss, Ph.D., and Mark Dombeck, Ph.D.At a certain point in the normal course of interpersonal development, most children form strong attachments to specific caregivers who take care of them. They develop a clear preference for being with and interacting with those specific caregivers over lesser-known individuals. In cases of Reactive Attachment Disorder of Infancy or Early Childhood (hereafter called Reactive Attachment Disorder), however, the normal attachment process does not occur. Instead, such children develop abnormal relationships with caregivers that are described, in the language of the DSM criteria for the disorder as either Inhibited or Disinhibited.
Children with Reactive Attachment Disorder of the Inhibited type remain unresponsive and ambivalent towards their caregivers. In contrast, children with Reactive Attachment Disorder of the Disinhibited type respond to caregivers, but fail to discriminate them as special people and show a similar level of responsiveness to strangers.
Inhibited type children don't seek out contact with their caregivers, and generally won't respond to caregivers' attempts at making contact either. Such children may come across as apathetic on occasion, but more frequently they appear to simultaneously want and reject the possibility of social comfort. Such children may be guarded, distant, and withdrawn when around caregivers. They may ignore a caregiver's attempts to engage them in conversation, regarding the situation as a threat to be warded off rather than as something safe to engage in. Inhibited type children may actively push away caregivers' attempts to give them hugs or even act aggressively. Instead of seeking comfort from caregivers (which is typical), such children may instead engage in self-soothing behaviors (rocking back and forth or engaging in other forms of self-stimulation)
Disinhibited type children seek out and accept are indiscriminant and may not show a preference for social contact with caregivers vs. relative strangers. These children may act as though they are familiar with strangers, seeking to hug, touch, or otherwise obtain comfort or assistance from them. The interpersonal behavior of Disinhibited type children may remain excessively childish and dependent (younger than appropriate to their years). They may also appear chronically anxious.
Both Inhibited and Disinhibited type children's lack of normal attachment to caregivers is very different than the interpersonal attachment behavior characteristic of Separation Anxiety Disorder where children form an exaggeratedly intense but otherwise normal preferential attachment to particular caregivers.
Disturbances in normal attachment do not happen without reason. The disturbed attachments characteristic of Reactive Attachment Disorder occur as a consequence of what the DSM terms "grossly pathological care" which ultimately fails to meet children's early emotional and physical needs. In other words, Reactive Attachment Disorder is a consequence of neglectful or abusive early parenting which may happen for a variety of reasons, including incapacitated (e.g., drug addicted) or clueless parents; early institutionalization; or serial foster care environments, to name but a few. Not all children who were neglected develop Reactive Attachment disorder. Instead, some children appear to be more vulnerable to the effects of neglect than others who are more resilient. In other words, abusive caregiving is a necessary precursor of Reactive Attachment Disorder, but it is not sufficient in of itself to create the disorder.
Reactive Attachment Disorder is uncommon; however, information on prevalence rates is limited. Because the diagnostic criteria are somewhat nonspecific, the diagnosis for Reactive Attachment Disorder may be given to children who come from a wide range of backgrounds (e.g., children who are institutionalized, children who were maltreated as toddlers and then placed in a series of foster care placements, or children who were once maltreated and now live in stable, loving homes). As a group, children who have been adopted are at elevated risk for the condition because of the increased possibility that they suffered early neglect or abuse, and the variable quality of institutional child care they may have experienced prior to adoption.
DSM criteria require that Reactive Attachment Disorder be first diagnosed prior to a child's 5th birthday. Once established, however, the disorder can persist for years in the absence of appropriate intervention. The early timing and pervasive effect of the disorder means that it can influence and interfere with subsequent interpersonal relationships, such as the development of normal peer and ultimately romantic relationships in later childhood.
Separation Anxiety Disorder Assessment and Treatment
Reactive Attachment Disorder Assessment and Treatment
Resources
-
Articles
-
Introduction to Disorders of Childhood
- Introduction to Disorders of Childhood
- Forms and Causes of Childhood Disorders
- Diagnostic Criteria for Childhood Disorders
-
Intellectual Disabilities
- Intellectual Disabilities
- The Causes and Prevention of Intellectual Disability
- Signs and Symptoms of Intellectual Disability
- Support & Help for Children with Intellectual Disabilities
- Support & Help for Families with Intellectually Disabled Children
-
Motor Skills Disorders
- Disorders of Childhood: Motor Skills Disorders
- Motor Skills Disorder Treatment and Recommended Reading
-
Learning Disorders
- Disorders of Childhood: Learning Disorders
- Learning Disorders Diagnosis
- Learning Disorders Treatment and Recommended Reading
-
Communication Disorders
- Disorders of Childhood: Communication Disorders
- Communication Disorders: Stuttering and Prevalence / Diagnosis of Communication Disorders
- Treatment of Communication Disorders and Recommended Reading
- Autism and Pervasive Developmental Disorders
-
ADHD and Disruptive Behavior Disorders
- Disorders of Childhood: Attention-Deficit and Disruptive Behavior Disorders
- Diagnosis of Conduct Disorder
- Treatment of Conduct Disorder
- Treatment of Conduct Disorder Continued
- Introduction to Oppositional Defiant Disorder
- Treatment of Oppositional Defiant Disorder
- Disruptive Behavior Disorder NOS and Recommended Reading for Conduct Disorder / ODD
-
Feeding and Elimination Disorders
- Feeding and Eating Disorders of Infancy or Early Childhood: Pica
- Rumination Disorder
- Feeding Disorder of Early Childhood
- Elimination Disorders: Enuresis
- Enuresis Assessment and Treatment
- Elimination Disorders: Encopresis
-
Anxiety Disorders
- Selective Mutism
- Treatment of Selective Mutism
- Disorders of Childhood: Separation Anxiety Disorder
- Separation Anxiety Disorder Assessment and Treatment
-
Reactive Attachment Disorder
- Reactive Attachment Disorder of Infancy or Early Childhood
- Reactive Attachment Disorder Assessment and Treatment
-
Stereotypic Movement Disorder
- Disorders of Childhood: Stereotypic Movement Disorder
- Treatment of Stereotyped Movement Disorders
-
Tic Disorders
- Disorders of Childhood: Tic Disorders
- Treatment of Tic Disorders and Recommended Reading
-
Infancy, Childhood or Adolescence, Not Otherwise Specified
- Disorder of Infancy, Childhood, or Adolescence Not Otherwise Specified
-
Introduction to Disorders of Childhood
-
News
- Guideline Changes Have Asperger's Community on Edge
-
Questions and Answers
- Should My 9 Year Old Daughter Be Evaluated?
- What's Going On?
- My 10 Year Old
- Is This Normal?
- My 9 Year Old Wants To Be An Only Child
- Ten Year Old's Severe Emotional and Behavioral Problems
- Chronically Ill Non-Compliant 19 Year Old
- ODD and Risperdal
- Voices
- Fear of death and dying
-
6 more
- ADHD in Twins
- Spitting Behavior
- Granddaughter needs help before I send her home
- HELP ME!!!
- MY son said he hears voices and whispers
- How do I keep my conduct disordered step-son from molesting my children?
-
Book & Media Reviews
- Assessment of Childhood Disorders
- Bipolar Kids
- Black-eyed Suzie
- Bleeding to Ease the Pain
- Brain-Based Therapy with Children and Adolescents
- Child and Adolescent Psychiatry
- Child and Adolescent Psychopathology
- Emotional and Behavioral Problems of Young Children
- Girlhood
- Handbook of Evidence-Based Therapies for Children and Adolescents
-
23 more
- Helping Teens Who Cut
- In the Company of Crazies
- Life As We Know It
- Medicating Children
- Mommy I'm Still in Here
- Parenting a Child Who Has Intense Emotions
- Please Don't Label My Child
- Psychotherapy with Adolescent Girls and Young Women
- Raising a Moody Child
- Raising Blaze
- Raising Generation Rx
- Sex, Therapy, and Kids
- Straight Talk about Psychiatric Medications for Kids
- Suicidal Behavior in Children and Adolescents
- The Anti-Romantic Child
- The Boy Who Loved Too Much
- The Boy Who Was Raised as a Dog
- The Eyes of van Gogh
- The Medicated Child
- The Thing About Jellyfish
- Totally Wired
- What Works for Bipolar Kids
- Your Child in the Balance
-
Links
- [15] Articles
- [18] Associations
- [6] Government
- [28] Information
- [2] Journals
- [1] Training
- [1] Research
- [2] Self-Help
- [100] Videos
- [1] Personal-Experiences
- [2] Blogs
- [1] Apps
-
Videos
- Disruptive Behaviors in Children with Oppositional Defiant Disorder
- New Genetic Tools to Treat Autism and Pediatric Neurological Disorders
- What Is Asperger's?
- Conditions May Mimic ADHD
- Autism Early Intervention
- Minority Children May Miss Autism Diagnosis
- Anxiety and Teen Girls with Lisa Damour, PhD
- Autism and Minorities
- FYI on ADHD Evaluations
- Teaching Grit, Perseverance and Frustration Tolerance to Students with ADHD
-
90 more
- Does my Child Have ADHD?
- The Role of Psychotropic Medication in Children’s Mental Health
- Catching Autism Early
- 5 Signs Your Teenager is Battling Depression
- Identifying and Treating Anxiety in Kids and Teens
- Child Anxiety, It’s Real
- The World of Autism PSA
- Helping Children Cope with Anxiety
- Screening for Depression in Kids
- Learning the Signs of Autism
- What is Autism?
- Understanding Autism
- Recognizing OCD
- Addressing Childhood Anxiety
- Creating the Best Learning Environment for Students with ADHD
- Department of Education Guidance Broadens Understanding of 504 Rights for Kids with ADHD Part II
- Ask The Expert: Neurofeedback Treatment for ADHD
- Talking About Child Mental Health: A Strategic Approach to Communications
- Kids and Depression
- Childhood Bipolar Disorder
- Understanding Bipolar Disorder in Children
- Understanding and Supporting Young Adults with ADHD
- Helping Your Young Adult Become Independent
- Self-Advocacy Tips For Teens With ADHD
- Know the Differences Between Adult and Teen Depression
- The Perils of Adolescence
- Autism: The Whys of Increased Prevalence
- ADHD: Signs, Symptoms, Research
- Children and Parents in the Age of Medication
- Focus on ADHD
- Autism & Asperger's: What's The Difference?
- Screening for Signs of Autism
- My Child Won't Eat: Diagnosing Pediatric Feeding Disorders
- Pediatrics: Child Eating Disorders - Part 2
- Pediatrics: Child Eating Disorders - Part 1
- Pediatrics: ADHD and Food Allergies
- ADHD Treatment
- ADHD: It's a Family Affair
- Does Your Child Have ADHD?
- ADHD in Children
- Too Scared: Social Anxiety Disorder
- Anorexia Nervosa Video
- Beyond the Data -- Autism Spectrum Disorder
- 10 Common Warning Signs of a Mental Health Condition in Teens and Young Adults
- Attention Deficit Hyperactivity Disorder
- Adolescent Depression
- Behavioral Activation: Treatment of Adolescent Depression
- NAMI's Ask the Doctor Calls--Dialectical Behavior Therapy
- NAMI Ending the Silence - A mental health awareness program for teens
- Finding Effective Mental Health Treatment for Children
- Treating Childhood OCD
- Treating Youth with Bipolar Disorder
- Treating Tourette Syndrome
- Treating Autism
- Treating Depression in Youth
- Medication Treatment for ADHD
- Using Time Out
- Treating Childhood ADHD
- Treating Youth Anxiety and Social Phobia
- 5 Ways Technology Can Complement Mental Health Services
- What it’s like to have a brother on the autism spectrum
- ADHD-friendly Summer Family FUNdamentals
- Autism Jargon: Pica
- Is Asperger’s Included in the DSM5?
- Overcoming Anxiety in Children and Teens
- How childhood trauma affects health across a lifetime
- Back-to-School Anxiety
- How the Diagnosis of Autism Helps Us Learn More About Autism
- Breaking the Silence, Breaking the Cycle Honoring Youth Voices
- A Frontline to ADHD
- Interview: Sleep Disorders: Caryn, Mom of Riley
- Sleep Problems in Kids
- Advice on Telling Your Teen they have ASD
- Understanding Girls with ADHD
- What is ADHD?
- School Anxiety! Activities To Help Kids and Teens Manage It
- Social Intervention Helps Adults With Autism
- Childhood Apraxia of Speech: Information for Parents
- Recognizing and Treating Problematic Fear and Anxiety in Children
- "Crazy" Girl– On Surviving and Thriving with Mental Illness
- Speech and Language Disorders
- Overview of possible causes and types of problems in speech development
- Is It ADHD?
- Autism Signs
- Common Childhood Illnesses & Immunizations
- Managing Anxiety in Youth: More Action Than Talk
- Irritability in Children - How Parents Can Help
- Altering the Course: First Episode Psychosis Intervention
- Psychosis in Youth: Risk Factors and Treatments
- Recent Advances in Anxiety - Children/Adolescents
Topics
-
Related Topic Centers
-
Addictions
-
Aging & Elder Care
-
Assessments & Interventions
-
Career & Workplace
-
Emotional Well-Being
-
Life Issues
-
Parenting & Child Care
-
Abuse
-
ADHD: Attention Deficit Hyperactivity Disorder
-
Adoption
-
Autism
-
Child & Adolescent Development: Overview
-
Child & Adolescent Development: Puberty
-
Child Development & Parenting: Early (3-7)
-
Child Development & Parenting: Infants (0-2)
-
Child Development & Parenting: Middle (8-11)
-
Child Development & Parenting:Adolescence (12-24)
-
Child Development Theory: Adolescence (12-24)
-
Child Development Theory: Middle Childhood (8-11)
-
Childhood Mental Disorders and Illnesses
-
Childhood Special Education
-
Divorce
-
Family & Relationship Issues
-
Intellectual Disabilities
-
Learning Disorders
-
Oppositional Defiant Disorder
-
Parenting
-
Self Esteem
-
-
Psychological Disorders
-
Anxiety Disorders
-
Bipolar Disorder
-
Conversion Disorders
-
Depression: Depression & Related Conditions
-
Dissociative Disorders
-
Domestic Violence and Rape
-
Eating Disorders
-
Impulse Control Disorders
-
Intellectual Disabilities
-
Mental Disorders
-
Obsessive-Compulsive Spectrum Disorders
-
Personality Disorders
-
Post-Traumatic Stress Disorder
-
Schizophrenia
-
Sexual Disorders
-
Somatic Symptom and Related Disorders
-
Suicide
-
Tourettes and other Tic Disorders
-