Reactive attachment disorder of infancy or early childhood

Definition

Reactive attachment disorder is a disturbance of social interaction caused by neglect of a child’s basic physical and emotional needs, particularly during infancy.

Babies placed in orphanages at birth and raised by multiple caretakers without primary parent-figures can also develop this disorder, even if physical care was adequate.

Causes, incidence, and risk factors

Reactive attachment disorder is caused by neglect of an infant’s needs for physical safety, food, touching, and emotional bonds with a primary and/or secondary caretaker.

The risk of neglect to the infant or child is increased with parental isolation, lack of parenting skills, teen parents, or a caregiver who is mentally retarded. A frequent change in caregivers (e.g., occuring in orphanages or foster care) is another cause of reactive attachment disorder.
Children adopted from foreign orphanages are commonly affected, particularly if they were removed from their birth parents during the first weeks of life.

Symptoms
Child:

• resistant to social interaction
  
• seeks isolation
  
• difficult to comfort
  
• avoids physical contact
  
• avoids caregiver
  
• indiscriminate sociability with strangers

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

A complete history and physical examination, and psychiatric evaluation can help diagnose this disorder.

Treatment

Treatment is twofold. 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 alter 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 an ability to meet the child’s needs and help them bond with their child.

The caregiver should also undergo 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 needs of the child 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 maltreated to avoid contact. Hugs should be offered frequently, but not forced.

Expectations (prognosis)
With appropriate intervention, the outcome can be improved.

Complications
If not treated, this condition can permanently affect the child’s social interactions. It can be connected with Post-traumatic Stress Disorder, Depression, anxiety, and other psychological problems.

Calling your health care provider

This disorder is usually identified when a parent (or prospective parent) is identified as being 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 exhibits these symptoms, see your health care provider.

Prevention

Early recognition is very important for the child. Once a parent is identified as being at high risk for neglect, parenting skills should be taught. The patient should be followed by either a social worker or doctor to make sure the child’s needs are being met.

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