Reactive attachment disorder is an unusual personality disorder in a number of ways. First, it is one of the few personality disorders, which is only diagnosed in children. Most personality disorders affect only adults or, in rare cases, affect both adults and children. Second, in comparison to other personality disorders, it is quite uncommon. Even among severely neglected children, it is only found about 10% of the time and much less frequently in children who are not neglected or only mildly neglected.
The primary symptom of reactive attachment disorder is an extreme lack of attachment towards caregiving adults by a child. This lack of attachment shows itself in a variety of ways:
- Not seeking comfort from caregivers when in distress
- Minimal interest in socializing or playing games with others, especially caregivers
- Rarely showing emotions to adults
- Asks significantly fewer questions than other kids their age
- Confused or alarmed responses when subject to comforting or support from a caregiver
In most cases, children develop this disorder in response to serious neglect. These symptoms usually represent a coping response that the child has developed to deal with such neglect.
According to the DSM-5, reactive attachment disorder can only be diagnosed in a child that has a developmental age of at least 9 months old and is not older than 5 years old. Furthermore, the child in question must not be on the autism spectrum. If these pre-requisites are true, mental health professionals look for the following three traits:
- A consistent pattern of emotional withdrawal from caregivers, represented by both a lack of need for comfort and lack of interest in any offered comforting
- Regular social disturbances, usually appearing as out-of-place fearfulness, emotionally limited responses, or muted positive emotions
- A pattern of neglect, often in the form of minimal opportunities for the child to build normal social interactions with caregivers
A trained professional can identify these traits in a controlled investigative therapy session. If these traits have all been consistently present for a year or more, reactive attachment disorder is a proper diagnosis.
Psychological counseling is considered, by far, the most effective treatment for reactive attachment disorder. Evidence shows that this treatment is most effective when it is started as early as possible. Young children are significantly more likely to recover from this disorder and develop healthy, positive relationships with caregivers if they start receiving treatment at an earlier age.
Unlike most treatments for personality disorders, treatment for reactive attachment disorder is best performed both with the child suffering from the disorder and with the primary caregivers in the child’s life. Not only does the child need to learn how to develop healthy, traditional attachments, the caregivers need to learn how to provide for the child’s needs in a healthy and comforting manner. Without such training, the child is likely to regress.
Finally, because almost all cases of this disorder involve some level of neglect bordering on abuse, there is almost always a non-psychological component to treatment. Mental health professionals will usually work with local authorities to ensure that the child receives a full medical inspection and that the home of the child is inspected for safety. Regular follow-up visits at the home are usually made to ensure that the child lives in an environment that is conducive to both good mental and physical health.