Reactive attachment disorder of infancy or early childhood

Definition

Reactive attachment disorder is a problem with social interaction that occurs when a child's basic physical and emotional needs are neglected, particularly when the child is an infant.

Causes

Reactive attachment disorder is caused by abuse or neglect of an infant's needs for:

• Emotional bonds with a primary or secondary caretaker
• Food
• Physical safety
• Touching

The risk of neglect to the infant or child increases when the:

• Caregiver is mentally retarded
• Caregiver lacks parenting skills
• Parents are isolated
• Parents are teenagers

A frequent change in caregivers (for example, in orphanages or foster care) is another cause of reactive attachment disorder.
Children who are adopted from foreign orphanages are commonly affected, particularly if they were removed from their birth parents during the first weeks of life.

Symptoms

Child:

• Avoids caregiver
• Avoids physical contact
• Is difficult to comfort
• Does not make distinctions when socializing with strangers
• Resists social interaction
• Wants to be alone

Caregiver:

• Disregard for child's basic emotional needs for comfort, stimulation, and affection
• Disregard for child's basic physical needs like food, toileting, and play

Exams and Tests

This disorder is diagnosed with a:

• Complete history
• Physical examination
• Psychiatric evaluation

Treatment

Treatment has two parts. The first priority is to make sure the child is currently 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 has caused the problem. Parenting skills classes can help with this. These skills give the caregiver the ability to meet the child's needs and help them bond with the child.
The caregiver should also have counseling to work on any current 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.
Parents who adopt babies or young children from foreign orphanages should be aware that this condition may occur and be sensitive to the child's need for consistency, physical affection, and love.
These children may be frightened of people and find physical affection overwhelming at first, and parents should try not to see this as rejection. It is a normal response in someone who has been abused to avoid contact. Hugs should be offered frequently, but not forced.
A mental health evaluation should be completed. This evaluation will be helpful in developing a treatment plan.

Outlook (Prognosis)

The right intervention can improve the outcome.

Possible Complications

If not treated, this condition can permanently affect the child's social interactions. It can be connected with:

• Anxiety
• Depression
• Other psychological problems
• Post-traumatic stress disorder

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.

Prevention

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.

References

Milosavljevic N, Brendel RW. Child abuse and neglect. In: Stern TA, Rosenbaum JF, Fava M, Biederman J, Rauch SL, eds. Massachusetts General Hospital Comprehensive Clinical Psychiatry. 1st ed. Philadelphia, Pa: Mosby Elsevier; 2008:chap 8.
Schechter DS. Disturbances of attachment and parental psychopathology in early childhood. Child Adolesc Psychiatr Clin N Am - 01-JUL-2009; 18(3): 665-86.

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Review Date: 4/26/2010
Reviewed By: Neil K. Kaneshiro, MD, MHA, Clinical Assistant Professor of Pediatrics, University of Washington School of Medicine. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.

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Comments by: Thumper Pruitt

Based on the actions of our son Jesus, and in knowing his past history, this appears to be an issue that my wife is dealing with concerning our son. I will be posting additional information in this blog, so that I can share information with my wife and family. I am on the road a lot, with my new job as a truck driver, and we need to get on top of this issue with Jesus so that we can proceed with the forthcoming adoption plans that we have. We love Jesus, but when only my wife is home, without a good support system in place, makes this situation difficult and trying. I am praying that we can turn this around, as we want what is best for Jesus. Of course, doing this without loosing all of our hair in the process would be nice too. If any of you has good information to share that can be helpful to us, we would love to hear from you. This is draining for my wife, and anything that can aid us in helping our new son would be gratefully accepted.