Reactive Attachment Disorder

Reactive Attachment Disorder is a type of trauma- and stress-related disorder. After all, the term reactive attachment disorder includes the meaning of a disorder that is formed due to a response to the negative attachment as stress that is continuously formed.

Reactive Attachment Disorder is a serious psychological condition that occurs when children or infants under the age of 5 do not form healthy attachments with caregivers or parents. In other words, it is found most often when children are neglected or abused by their primary caregivers or are adopted during this period when emotional bonds are formed between children and their guardians.

As children with Reactive Attachment Disorder as a severe impairment in social functioning grow older, they develop patterns in one of two subtypes: Inhibited type, in which children are excessively wary of people, and disinhibited type, in which children show indiscriminately kind behavior to people and open social relationships with strangers.

In clinical settings, it is often indistinguishable between reactive attachment disorder and autism. This is because children with Reactive Attachment Disorder do not make eye contact with people, do not respond to stimuli, and appear to live in their own world, similar to the symptoms of autism. And in Korea, there is a tendency to be reluctant to make a diagnosis of autism. Therefore, it is speculated that reactive attachment disorder is often used as a substitute for the term autism in Korean society. To briefly summarize the relationship between the two, autism is not caused by incorrect parenting attitudes or personality reasons. Conversely, the parenting attitude and attachment relationship of the primary caregiver have a profound effect on the occurrence of reactive attachment disorder.

 

Cause:

This disorder occurs when a child's basic needs related to nurture, affection, and comfort for infants and children are not met. If their physical and emotional needs are not met, they may feel anxious, abandoned, and lonely. Infants who are ignored or not cared for in love may not be able to build the trust necessary for healthy relationships. Ultimately, the trauma and stress of abuse and neglect can make infants wither, fear their caregivers, and do not expect affection or care. This can cause long-term behavioral and emotional problems for them. However, not all children in abused or neglected situations develop reactive attachment disorder, and in some cases, it can be found in some children who are now in overtly loving environments.

 

Risk factors:

Reactive attachment disorder usually occurs in children between the ages of 9 months and 5 years. Children who have experienced severe emotional or physical abuse or neglect are at increased risk of reactive attachment disorder. Children of parents with drug addictions, serious mental health problems, or criminal records that interfere with proper parenting are more likely to develop a reactive attachment disorder.

This disorder is often found in children who were raised without warm parenting at home during childhood, that is, children whose emotional needs for comfort, stimulation, and affection are consistently ignored, children who grew up in foster homes, or experience frequent changes in primary caregivers. It often occurs in children who have been orphans, children raised in orphanages, daycare centers, or other facilities that lack the care for children, and children who have been hospitalized for a long period of time apart from their primary caregivers during childhood.

 

Diagnostic Criteria: DSM-5

A. A consistent pattern of inhibited, emotionally withdrawn behavior toward adult caregivers,

manifested by both of the following:

1. The child rarely or minimally seeks comfort when distressed.

2. The child rarely or minimally responds to comfort when distressed.

B. A persistent social and emotional disturbance characterized by at least two of the following:

1. Minimal social and emotional responsiveness to others.

2. Limited positive affect.

3. Episodes of unexplained irritability, sadness, or fearfulness that are evident even

during nonthreatening interactions with adult caregivers.

C. The child has experienced a pattern of extremes of insufficient care as evidenced by

at least one of the following:

1. Social neglect or deprivation in the form of persistent lack of having basic emotional

needs for comfort, stimulation, and affection met by caregiving adults.

2. Repeated changes of primary caregivers that limit opportunities to form stable attachments

(e.g., frequent changes in foster care).

3. Rearing in unusual settings that severely limit opportunities to form selective attachments

(e.g., institutions with high child-to-caregiver ratios).

D. The care in Criterion C is presumed to be responsible for the disturbed behavior in Criterion

A (e.g., the disturbances in Criterion A began following the lack of adequate care

in Criterion C).

E. The criteria are not met for autism spectrum disorder.

F. The disturbance is evident before age 5 years.

G. The child has a developmental age of at least 9 months.

Specify if:

Persistent: The disorder has been present for more than 12 months.

Specify current severity:

Reactive attachment disorder is specified as severe when a child exhibits all symptoms

of the disorder, with each symptom manifesting at relatively high levels.

 

Symptoms:

Signs of reactive attachment disorder may begin in early infancy and may vary from child to child, but several general behaviors are observed. Children with this disorder show a lack of response to external stimuli, a lack of interest in the world around them, and a general lack of attachment, thus appearing withdrawn, sad, and not smiling in expected situations. They are also prone to negative emotional outbursts that are not common in their age group. They also tend to sit apart and observe other people without interacting with them. Children with Reactive Attachment Disorder do not respond to or seek solace when others offer help or comfort when they are experiencing apparent distress. This shows that the brains of children with this disorder have adapted to environments that do not provide the comfort they need. In particular, they avoid physical contact and eye contact with caregivers, are not interested in playing peek-a-boo with caregivers or people and tend not to ask for their help. After all, they do not express emotions such as remorse, guilt, or regret, and they do not interact with the world in a healthy way.

 

Treatments:

Children who do not receive appropriate treatment are more likely to experience problems associated with reactive attachment disorder throughout their lives. Children can struggle at school because of cognitive and behavioral problems and are more likely to have mental health disorders such as depression, anxiety or anger control, eating disorders, and substance abuse problems. Naturally, there are big problems with interpersonal and social skills.

There is no standardized treatment for reactive attachment disorder. However, the goals of all treatments, including art therapy, speech therapy, play therapy, sand therapy, and EEG training, are focused on solving children's behavioral and emotional problems and improving mutual bonds with caregivers. Individual psychological counseling and family counseling are necessary, and training to create a safe environment for children and to acquire social skills is necessary. In addition, it is important to provide parents with parenting education opportunities to learn appropriate parenting skills.

The risk of reactive attachment disorder can be reduced by ensuring a nurturing and loving environment in which healthy bonds are formed between the child and caregiver. Physical care should be accompanied by emotional support and loving interactions. Talking to children with love, making eye contact, playing with them, and smiling are all behaviors that help build trust with them. In particular, these behaviors give them emotional stability along with the feeling of being loved, and this relationship lays the foundation for social development. After all, the greatest treatment for reactive attachment disorder lies in the formation of a healthy bond between the primary caregiver and the child, and when this is recovered, there is a high probability that the person will be able to escape from the disorder.