Infants innately need for love, care, and attention. The love an infant will receive may affect his or her view of the world emotionally and psychologically. If a baby does not receive the love, care and attention he deserves, he might develop a condition called reactive attachment disorder (RAD).
Reactive attachment disorder is a rare but severe condition wherein a baby or child fails to receive adequate support, care and nurturing from caregivers. As a result, the child does not establish healthy attachments with the caregivers, particularly the parents.
The attachment between the infant and the caregiver develops when a child is comforted, soothed and cared for. Moreover, it’s met when the caregiver persistently meets the needs of the child, physically, emotionally and psychologically.
Through the love, affection, and attachment of an infant to the caregiver that he or she learns to trust and love others. The infant or child also learns to regulate his or her emotions, develop a positive self-image and develop a healthy relationship with others.
In the Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5), RAD is grouped under trauma and stressor-related disorders. However, RAD is very rare, which is seen in less than 10 percent of the cases.
With proper diagnosis and treatment, the infants and children with reactive attachment disorder may develop healthier and more stable relationship with others, especially the parents and family members.
Inhibited reactive attachment disorder – The child is withdrawn, resistant to comforting and emotionally detached. Though he or she is aware of the surroundings, he or she does not react. As a result, the child may push others away or reject being comforted.
Disinhibited reactive attachment disorder – The child does not seem to prefer the parents over other people. He or she gets attention from anyone without distinction.
Reactive attachment disorder (RAD) usually starts during infancy. This condition occurs in children who are under the age of five years old. The signs and symptoms of RAD include:
- Doesn’t smile
- Avoids eye contact
- Doesn’t reach out to be picked or hugged
- Cries inconsolably
- Doesn’t make coo sounds
- Unexplained fear, sadness, withdrawal, and irritability
- Sad and listless appearance
- Not seeking comfort or shows no responses when comforted
- Rejects efforts to soothe, connect or calm
- Doesn’t follow another person with his or her eyes
- Is not interested in playing interactive games
- Spends a lot of time comforting them like rocking
- Does not notice when left alone
- Unresponsive to comfort
- Holds back emotions
- Avoiding socialization
Infants and children need basic physical and emotional needs. However, in some cases, these needs are not met by the caregivers. Though many children may still develop healthy relationships and attachments as a result of neglect, some can’t.
Reactive attachment disorder happens when the attachment between a child and his or her primary caregiver is interrupted or does not exist because of gross negligent care. Infants need constant assurance of care, comfort, and safety. RAD occurs because of many reasons such as being ignored and neglected. The other reasons include:
- Persistent disregard of the infant or child’s emotional needs like affection and comfort
- Changes in primary caregivers preventing the formation of attachments (orphanage and foster care)
- Persistent disregard of the infant’s physical needs
The other possible causes include attachment problems that happen when the infant was unable to connect to a primary caregiver, like the parents because of some reasons, including:
- The baby is left crying and no one responds or comforts him or her
- The baby is left hungry or wet, left unattended for hours
- The infant or child is abused or mistreated
- The child gets attention by showing extreme behaviors and acting out
- No one smiles or looks at the baby and he or she feels alone
- The infant has been separated from the parents
- The baby has been passed from one caregiver to another (adoption, loss of a parent or foster care)
- The parent cannot take care of the infant or become emotionally available due to an illness, substance abuse problem or depression.
- Unwanted pregnancy
- Abuse (physical, emotional and sexual)
- Pre-birth exposure to drugs, alcohol, and trauma
- Ongoing acute pain such as a hernia, ear infections or colic
Some babies and children are at a higher risk of developing reactive detachment disorder (RAD) like those who:
- Live in an orphanage, foster care or children’s home
- Always change caregivers or foster homes
- Have separation from parents or other caregivers as a result of hospitalization.
- Are severely neglected
- Have parents who have other mental health issues that hinder them from providing the proper care to their children.
If the condition is left untreated, it may continue or persist for several years and may have lifelong complications.
Children who have experienced neglect and developed RAD may also experience developmental delays and even delays in physical growth. Older kids may be at risk of other conditions such as anger management problems, depression, anxiety, eating disorders, difficulties in school, drug abuse and alcohol abuse.
Other complications include:
- Extreme anger problems
- Irritable when touched physically by others
- Can’t relate to other people interpersonally
- Control issues
- Do not develop or maintain lasting interpersonal relationships
To be diagnosed with reactive attachment disorder, a child should have a pattern of withdrawn or inhibited attitude toward caregivers or parents. The doctor will assess the baby or infant depending on the symptoms the parents observed.
The child must have experienced neglect or abuse. During his infancy, the caregivers failed to meet the emotional and physical needs of the baby. Usually, a pediatric psychiatrist can perform a comprehensive examination to ensure that the baby has reactive attachment disorder. The child must not meet the criteria for autism and should be less than five years old.
The pediatrician may assess through direct observation of the baby’s interaction with parents and caregivers. The doctor should also ask about the details of the pattern of behavior, interactions with caregivers and home and living situation.
The child will also undergo diagnostic tests for other mental health diseases such as intellectual disability, adjustment disorders, depressive disorders and autism spectrum disorder.
The doctor will also diagnose the condition through the Diagnostic and Statistical Manual of Mental Disorders (DMS-5). Diagnosis is not made before nine months old and the signs and symptoms of the condition appear before the child turns five years old.
The pediatrician can refer the child to another doctor who specializes in treating reactive attachment disorder. The symptoms of RAD may lessen or disappear completely when the child will live in a more supportive and caring environment. The primary caregivers should be available emotionally and physically, to provide the basic needs of the baby.
There is no standard treatment for RAD, but it should involve the parents as well as the child. The goals of treatment include making the child feel safe and secure, letting the child live in a stable living condition, develop positive interactions, strengthen the attachment and relationship of the child to his or her parents or caregivers, and provide a positive environment for the child.
The other goals include giving consistent caregiver to promote a stable attachment for the infant, making sure the child has a good medical, housing and safety condition, and to promote education among the parents.
Psychological and Behavioral Interventions
Psychological and behavioral interventions involve playing therapy with a psychotherapist, the child, and the parents or primary caregivers. This method will help the child express his emotions, anxieties, and fears. Moreover, children will express their dependency needs through play.
The success of RAD therapy is to give the child a sense of security, stability, and sensitivity.
There is no specific medicine to treat RAD. However, some psychopharmacologic agents can be used to address related problems such as hyperactivity, explosive anger, problems with sleeping and difficulty in focusing or concentrating.
Preventive measures for reactive attachment disorder are essential. The first thing a baby needs is the care of his or her primary caregivers. Providing support and a safe environment may help children have a good and positive early experience. These may also help a child form appropriate bonds to the people surrounding him or her.
Here are ways to prevent reactive attachment disorder or reduce its risk:
- When you’re expecting a baby, take classes or volunteer with children. These will help you gain the experience and skills to deal with kids or babies. Moreover, these will help you interact in a nurturing and caring manner.
- Learn to interpret the cues of your baby, when he’s hungry, in pain or sleepy. This way, you can meet his or her needs faster and more effectively.
- Provide a warm, caring and nurturing interaction with your baby. This can be done during feeding or bathing.
- Provide time for your baby to play, talk or spend time with him or her.
- Offer both nonverbal and verbal responses such as touch, the tone of voice or expressions.
- If you are working, make sure you get someone to take care of your child. Ensure that the caregiver is skilled enough to provide adequate care to your child.
Infants and children with reactive attachment disorder may have the ability to form attachments and positive relationships. However, these abilities may have been altered or hindered by their negative experiences.
Most infants are resilient. However, even those who live in children’s homes or orphanages can form good relationships with others. The keys to preventing the occurrence of RAD are through early intervention and prevention.