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Symptoms
By Mayo Clinic staffReactive attachment disorder begins before age 5. Signs and symptoms of the disorder may begin when the child is still an infant.
Signs and symptoms in babies may include:
- Withdrawn, sad and listless appearance
- Failure to smile
- Lack of the normal tendency to follow others in the room with the eyes
- Failure to reach out when picked up
- No interest in playing peekaboo or other interactive games
- No interest in playing with toys
- Engaging in self-soothing behavior, such as rocking or self-stroking
- Calm when left alone
Signs and symptoms in toddlers, older children and adolescents may include:
- Withdrawing from others
- Avoiding or dismissing comforting comments or gestures
- Acting aggressively toward peers
- Watching others closely but not engaging in social interaction
- Failing to ask for support or assistance
- Obvious and consistent awkwardness or discomfort
- Masking feelings of anger or distress
- Alcohol or drug abuse in adolescents
As children with reactive attachment disorder grow older, they may develop either inhibited or disinhibited behavior patterns. While some children have signs and symptoms of just one type of behavior, many exhibit both types.
- Inhibited behavior. Children with inhibited behavior shun relationships and attachments to virtually everyone. This may happen when a baby never has the chance to develop an attachment to any caregiver.
- Disinhibited behavior. Children with disinhibited behavior seek attention from virtually everyone, including strangers. This may happen when a baby has multiple caregivers or frequent changes in caregivers. Children with this type of reactive attachment disorder may frequently ask for help doing tasks, have inappropriately childish behavior or appear anxious.
There's little research on signs and symptoms of reactive attachment disorder beyond early childhood. It may lead to controlling, aggressive or delinquent behaviors, trouble relating to peers, and other problems. While treatment can help children and adults cope with reactive attachment disorder, the changes that occur during early childhood are permanent and the disorder is a lifelong challenge.
When to see a doctor
If you think your child may have reactive attachment disorder, see a doctor. You may start by visiting your family doctor. However, if your child likely has reactive attachment disorder or another mental health problem, you'll need to see a doctor who specializes in the diagnosis and treatment of mental illness (psychiatrist) for a complete evaluation.
Consider getting an evaluation if your baby or child:
- Prefers not to be held
- Usually likes to play alone
- Doesn't seek out physical contact
- Avoids you
- Will readily go to strangers
- Seems uninterested in you
- Reactive attachment disorder of infancy or early childhood. In: Diagnostic and Statistical Manual of Mental Disorders DSM-IV-TR. 4th ed. Arlington, Va.: American Psychiatric Association; 2000. http://www.psychiatryonline.com. Accessed June 9, 2011.
- Haugaard JJ, et al. Recognizing and treating uncommon emotional disorders in children and adolescents who have been severely maltreated: Reactive attachment disorder. Child Maltreatment. 2004;9:154.
- Horner G. Reactive attachment disorder. Journal of Pediatric Health Care. 2008;22:234.
- Reactive attachment disorder. American Academy of Child and Adolescent Psychiatry. http://www.aacap.org/cs/root/facts_for_families/reactive_attachment_disorder. Accessed June 9, 2011.
- Newman L, et al. Recent advances in the theories of and interventions with attachment disorders. Current Opinion in Psychiatry. 2007;20:343.
- Boris NW, et al. Practice parameter for the assessment and treatment of children and adolescents with reactive attachment disorder of infancy and early childhood. American Academy of Child and Adolescent Psychiatry. http://aacap.browsermedia.com/galleries/PracticeParameters/rad.pdf. Accessed June 9, 2011.
- Cornell T, et al. Clinical interventions for children with attachment problems. Journal of Child and Adolescent Psychiatric Nursing. 2008;21:35.
- Report of the APSAC task force on attachment therapy, reactive attachment disorder, and attachment problems. Association for Treatment and Training in the Attachment of Children. http://www.attach.org/apsac.htm. Accessed June 9, 2011.
- Coercive interventions for reactive attachment disorder. American Academy of Child & Adolescent Psychiatry. http://www.aacap.org/cs/root/policy_statements/coercive_interventions_for_reactive_attachment_disorder. Accessed June 9, 2011.
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