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, incidence, and risk factors
Reactive attachment disorder is caused by abuse or neglect of an infant's needs for:
The risk of neglect to the infant or child increases when the:
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.
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.
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.
The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed physician should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. Copyright 2004 A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.
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
Signs and tests
This disorder is diagnosed with a:
Complete history
Physical examination
Psychiatric evaluation
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.
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.
The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed physician should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. Copyright 2004 A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.
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.
Expectations (prognosis)
The right intervention can improve the outcome.
Complications
If not treated, this condition can permanently affect the child's social interactions. It can be connected with:
Anxiety
Depression
Other psychological problems
Calling your health care provider
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.
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.
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.
The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed physician should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. Copyright 2004 A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.
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.
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.
The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed physician should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. Copyright 2004 A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.
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.
The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed physician should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. Copyright 2004 A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.