Reactive Attachment

Reactive attachment disorder is a psychological disorder in which the child fails to form normal, loving relationships with the primary caregivers, including mother, before the age of 5.

It is usually seen in children who did not receive adequate love, caring, affection, which are the basic needs of comfort for the child.

These children fail to establish a stable attachment with any of the caregivers at this time.

A child with reactive attachment disorder is often unable to control his/her emotions, or be aware of other’s feelings and needs.

Lack of emotional attachment in the early years of life may affect the entire life.

Psychological counseling, and parent and caregiver education help to control the symptoms. 

Symptoms of reactive attachment disorder starts early in the infancy and include:

• Unresponsive to comfort or not seeking comfort,
• Detached and not engaging in social interactions,
• Withdrawal or avoidance to comfort,
• Fear or sadness,
• Irritability,
• Avoiding support or assistance when needed,
• Lack of smile.

It is not known whether this disorder is seen in children above 5 years.

The symptoms may be seen in children with other disorders like autism spectrum disorder.

Reactive attachment disorder is caused by gross negligence care or disregard for comfort, stimulation, and affection to a child in the early formative years.

The child fails to form an emotional attachment to any of the primary caregivers, including mother, before the age of 5.

Children needs a stable, loving, and caring environment, while growing, to develop love and trust towards others.

In the absence of loving care, the child fails to understand other’s needs and feelings, and is unable to control his/her emotions. They often do not have a positive self-image and do not develop a healthy interaction or relationship with others.

The negativity and lack of emotional attachment may affect the future of the child. Frequent changes in the caregivers or foster care may also affect the formation of attachments in the child.

Common risk factors for reactive attachment disorder are:

• Living in children’s home or other institution,
• Frequent changes in foster homes or caregivers,
• Separation from parents or caregivers for a long duration,
• Mother with postpartum depression,
• No or reduced quality time with parents or caregivers.

Diagnosis of reactive attachment disorder is based on the The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) criteria given by American Psychiatric Association.

The diagnostic criteria include:

• Consistently showing withdrawn behavior or not responding to comfort,
• Reduced response to others or no positive interactions. They are mostly irritable, sad, or scared during any of the interactions,
• Lack of stable attachment or needs for comfort, stimulation, or affection,
• No diagnosis of autism spectrum disorder.

Psychiatric evaluation of the child help in diagnosing the disorder. This includes an observation of the child’s interaction with parents and caregivers over a period of time.

Behavior of the child to different situations is also assessed. The psychiatrist evaluates the information given by caregivers and parents to understand the situation better.

Review of the situation at home or a foster home after birth of the child, and assessing the parenting styles also enable to diagnose the condition.

Other possible conditions or disorders that may cause similar symptoms are also ruled out.

Treatment for reactive attachment disorder focuses on enabling the child to form stable attachments with the caregivers and parents.

The best method to reinforce this is to provide loving, stable, caring environment.

The treatment strategy involves counseling for both child and parents/caregivers. This enables the child to develop a stable emotional attachment with the people around.

The treatment encourages the parents to provide a more responsive and nurturing environment. Having consistent caregivers also help the child to have a stable environment.

The positive, interactive environment enables the child to develop a trust and emotional attachment. Individual or family psychological counseling, parent education, and parenting skills also help in controlling the situation.

Reactive attachment disorder can be prevented by:

• being actively engaged with the children,
• understanding and responding to the child’s needs,
• providing a nurturing environment,
• offering warm, loving responses through expressions. 

Animal therapy, wilderness therapy, and music therapy are used as alternative remedies for reactive attachment disorder.

Pets like

• dogs,
• horses,
• cats,
• birds,
• goats

help to reduce feelings of loneliness in the children.

It helps the child to learn about the steps to care for animals and to reduce stress.

Relationship with the animals help to improve:

• self-confidence,
• patience,
• emotional attachment.

Wilderness programs are ideal to promote emotional growth through adventure trips.

It teaches life skills like:

• decision-making,
• communication,
• character building.

Music therapy is considered to have therapeutic abilities, particularly to improve awareness of internal states. It develops attention, interpersonal relationships and build strengths of the individual. 

Reactive attachment disorder is a condition which is difficult to cope with, especially when the child is not responding to your warmth.

Taking help from the community and doctors may make it easier.

Stress management is very important to avoid feeling exhausted after taking care of the child with the disorder.

Having a good support system at home helps to take care of things. 

Reactive attachment disorder may have lifelong complications that will affect the future of the child.