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
  

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

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.