Reactive Attachment Disorder is a complex psychiatric illness that can affect young children. It is characterized by serious problems in emotional attachments to others and usually presents by age 5.  A parent, daycare provider or physician may notice that a child has problems with emotional attachment by their first birthday.  Often, a parent brings an infant or very young child to the doctor with one or more of the following concerns:

• severe colic and/or feeding difficulties
• failure to gain weight
• detached and unresponsive behavior
• difficulty being comforted
• preoccupied and/or defiant behavior
• inhibition or hesitancy in social interactions

Some children with Reactive Attachment Disorder may also be overly or inappropriately social or familiar with strangers.  The physical, emotional and social problems associated with Reactive Attachment Disorder may persist as the child grows older.

The cause of Reactive Attachment Disorder is not known. Most children with this disorder have had severe problems or disruptions in their early relationships.  Many have been physically or emotionally abused or neglected.  Some have experienced inadequate care in an institutional setting or other out-of-home placement (for example a hospital, residential program, foster care or orphanage).  Others have had multiple or traumatic losses or changes in their primary caregiver.

Children who exhibit signs of Reactive Attachment Disorder need a comprehensive psychiatric assessment and individualized treatment plan. These signs or symptoms may also be found in other psychiatric disorders. A child should never be given this label or diagnosis without a comprehensive evaluation. Treatment of this complex disorder involves both the child and the family. Without treatment, this condition can permanently effect a child's social and emotional development.
While some therapists have advocated the use of so-called "rebirthing techniques", there is no scientific evidence to support the effectiveness of such interventions.  Such unproven and unconventional therapies can also be quite dangerous.  Tragically, the use of such techniques has been associated with serious injury and even death.

Parents of a young child who shows signs or symptoms of Reactive Attachment Disorder should:

• seek a comprehensive psychiatric evaluation prior to the initiation of any treatment
• make sure they understand the risks as well as the potential benefits of any intervention
• feel free to seek a second opinion if they have questions or concerns about the diagnosis and/or treatment plan

Reactive Attachment Disorder is a serious clinical condition.  Fortunately, it is relatively rare.  Evaluating and treating children with complex child psychiatric disorders such as Reactive Attachment Disorder is challenging.  There are no simple solutions or magic answers.  However, close and ongoing collaboration between the child's family and the treatment team will increase the likelihood of a successful outcome.

For additional information see: Facts for Families:
#5 Child Abuse : The Hidden Bruises
#7 Children Who Won't Go to School
#15 The Adopted Child
#47 Anxious Child
#52 Comprehensive Psychiatric Evaluation
#64 Foster Care

See also: Your Child (1998 Harper Collins) / Your Adolescent (1999 Harper Collins)

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