Reactive attachment disorder can develop when a child fails to receive adequate comfort and nurturing from caregivers. It is grouped under “Trauma-and-Stressor-Related Disorders” in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. However, even in populations of severely neglected children, the disorder is uncommon, occurring in less than 10 percent of such cases.
An essential feature is that the child exhibits an absent or grossly underdeveloped level of attachment towards caregiving adults compared to what is normal or expected. For example, an infant or very young child would be observed as rarely or minimally turning to their adult caregivers for comfort, support, protection, or nurturance.
Children with reactive attachment disorder are believed to have the capacity to form selective attachments; that is, there is nothing neurobiologically or medically wrong that can explain a child’s failure to form a secure relationship with parents or other caregivers. However, because of limited healthy physical contact and nurturance during early development (e.g, neglect), they fail to show the behavioral manifestations of selective attachments.
- They handle their emotions independently.
- Do not look for or reach for caregivers for support, nurturance, or protection.
- Lack a preferred attachment figure.
- Lack an interest in playing interactive games.
- Will not ask questions.
- When caregivers do sporadically make the effort to comfort the child, the child with this disorder will not respond reciprocally. For example, if a parent were to go to comfort their child when he/she is distressed, the child may appear confused, aloof, or fail to hug the adult back. The child may fail to reach out when picked up.
Essentially, the child has not learned to accept or expect a comforting response. As such, children with reactive attachment disorder may show diminished or absent expression of positive emotions during routine interactions with caregivers (e.g., they fail to smile). They may have difficulty regulating distressing emotions, resulting in their displaying pervasive patterns of negative emotions, such as fear, sadness, or irritability in instances in which it is uncalled for.
A diagnosis of reactive attachment disorder should not be made in children who are developmentally unable to form selective attachments. For this reason, the child must have a developmental age of at least 9 months.
There are two specifiers of reactive attachment disorder:
- Used when the disorder has been present for more than 12 months.
- Used when the child meets all of the diagnostic criteria of the disorder, with each symptom manifesting at relatively high levels.
DSM-5 Diagnostic code 313.89