About reactive attachment disorder

What is reactive attachment disorder?

Reactive attachment disorder is a rare but serious condition in which an infant or young child doesn't establish healthy attachments with parents or caregivers. Reactive attachment disorder may develop if the child's basic needs for comfort, affection and nurturing aren't met and loving, caring, stable attachments with others are not established.

With treatment, children with reactive attachment disorder may develop more stable and healthy relationships with caregivers and others. Treatments for reactive attachment disorder include psychological counseling, parent or caregiver counseling and education, learning positive child and caregiver interactions, and creating a stable, nurturing environment.

What are the symptoms for reactive attachment disorder?

Reactive attachment disorder can start in infancy. There's little research on signs and symptoms of reactive attachment disorder beyond early childhood, and it remains uncertain whether it occurs in children older than 5 years.

Signs and symptoms may include:

  • Unexplained withdrawal, fear, Sadness or irritability
  • Sad and listless appearance
  • Not seeking comfort or showing no response when comfort is given
  • Failure to smile
  • Watching others closely but not engaging in social interaction
  • Failing to ask for support or assistance
  • Failure to reach out when picked up
  • No interest in playing peekaboo or other interactive games

When to see a doctor

Consider getting an evaluation if your child shows any of the signs above. Signs can occur in children who don't have reactive attachment disorder or who have another disorder, such as autism spectrum disorder. It's important to have your child evaluated by a pediatric psychiatrist or psychologist who can determine whether such behaviors indicate a more serious problem.

What are the causes for reactive attachment disorder?

To feel safe and develop trust, infants and young children need a stable, caring environment. Their basic emotional and physical needs must be consistently met. For instance, when a baby cries, the need for a meal or a diaper change must be met with a shared emotional exchange that may include eye contact, smiling and caressing.

A child whose needs are ignored or met with a lack of emotional response from caregivers does not come to expect care or comfort or form a stable attachment to caregivers.

It's not clear why some babies and children develop reactive attachment disorder and others don't. Various theories about reactive attachment disorder and its causes exist, and more research is needed to develop a better understanding and improve diagnosis and treatment options.

What are the treatments for reactive attachment disorder?

Children with reactive attachment disorder are believed to have the capacity to form attachments, but this ability has been hindered by their experiences.

Most children are naturally resilient. And even those who've been neglected, lived in a children's home or other institution, or had multiple caregivers can develop healthy relationships. Early intervention appears to improve outcomes.

There's no standard treatment for reactive attachment disorder, but it should involve both the child and parents or primary caregivers. Goals of treatment are to help ensure that the child:

  • Has a safe and stable living situation
  • Develops positive interactions and strengthens the attachment with parents and caregivers

Treatment strategies include:

  • Encouraging the child's development by being nurturing, responsive and caring
  • Providing consistent caregivers to encourage a stable attachment for the child
  • Providing a positive, stimulating and interactive environment for the child
  • Addressing the child's medical, safety and housing needs, as appropriate

Other services that may benefit the child and the family include:

  • Individual and family psychological counseling
  • Education of parents and caregivers about the condition
  • Parenting skills classes

Controversial and coercive techniques

The American Academy of Child and Adolescent Psychiatry and the American Psychiatric Association have criticized dangerous and unproven treatment techniques for reactive attachment disorder.

These techniques include any type of physical restraint or force to break down what's believed to be the child's resistance to attachments — an unproven theory of the cause of reactive attachment disorder. There is no scientific evidence to support these controversial practices, which can be psychologically and physically damaging and have led to accidental deaths.

If you're considering any kind of unconventional treatment, talk to your child's psychiatrist or psychologist first to make sure it's evidence based and not harmful.

What are the risk factors for reactive attachment disorder?

The risk of developing reactive attachment disorder from serious social and emotional neglect or the lack of opportunity to develop stable attachments may increase in children who, for example:

  • Live in a children's home or other institution
  • Frequently change foster homes or caregivers
  • Have parents who have severe mental health problems, criminal behavior or substance abuse that impairs their parenting
  • Have prolonged separation from parents or other caregivers due to hospitalization

However, most children who are severely neglected don't develop reactive attachment disorder.

Is there a cure/medications for reactive attachment disorder?

Reactive Attachment Disorder arises when a child is not subjected to healthy emotional bonds at an early age. Experiencing emotional neglect and any kind of abuse inflicted by parental figures or caretakers result in avoidance of touch and any form of physical affection.

Because the child has been through abuse or ignorance, even positive touch registers as a threat in their mind. You can notice them flinching, laughing or verbally expressing resistance to affectionate gestures.

Ignored and left untreated, these negative feelings toward a source of comfort lead to trust issues and may propel the child toward a downward spiral of addiction.

Cure/medications for Reactive Attachment Disorder
1. RAD is a psychological disorder; it will be attended to by certified child psychotherapists or psychologists. It is very much curable, or in other words, managed in a healthier way. While medication is available, it is crucial to comprehend a few things beforehand.
2. Don’t expect it to be an instant solution; it won’t be
3. Ensure that it is correctly prescribed by a licensed psychiatrist
4. There is always a chance the drugs won’t work; your child is not at fault
5. May take trial and error before you find what works

Medications for RAD are given below:
1. Antidepressants (includes SSRI’s, SNRI’s, Atypical antidepressants, tricycling)
2. Serotonin Reuptake Inhibitors (include Zoloft, Celexa, Lexapro and Cipralex, Prozac and Sarafem,
3. Luvax, Brisdelle, Paxil, Paxil CR and Pexava)
4. Serotonin-norepinephrine Reuptake Inhibitors (Trintellix, Cymbalta and Irenka, Khedezla and Pristiq)
5. All of the above have side effects along with benefits.

Unexplained withdrawal, fear, sadness or irritability,Sad and listless appearance,Not seeking comfort or showing no response when comfort is given,Failure to smile,Watching others closely but not engaging in social interaction,Failure to reach out when picked up,No interest in playing peekaboo or other interactive games,Behavior problems,Failing to seek support or assistance
A child doesn't form healthy emotional bonds with their caretakers often because of emotional neglect or abuse at an early age,Trouble managing their emotions

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