Reactive Attachment Disorder is a complex psychiatric illness that affects young children before five years of age. It is characterized by serious problems in emotional attachments to others. It is also known as Attachment Disorder. Reactive Attachment Disorder is often misunderstood and relatively unknown. Attachment refers to the bond between a child and the primary caregiver. A secure attachment is vital for a child’s emotional development and for them to be able to obtain healthy social relationships. Children with Reactive Attachment Disorder do not initiate or respond to most social interactions.

There are two major subtypes of Reactive Attachment Disorder. The inhibited type is characterized by a persistent failure to initiate or respond to social interactions in an appropriate way. The disinhibited type is characterized by an indiscriminate sociability or lack of selectivity in the choice of attachment figures.

Causes and risk factors of Reactive Attachment Disorder are physical, emotional and sexual abuse, frequent moves because of foster care or failed adoptions, neglect of infant’s personal needs for physical safety, food, touching and emotional bond with primary and/or secondary caretaker, traumatic experiences, lack of attunement between mother and child, maternal depression and an undiagnosed, painful illness such as colic or an ear infection. There are also psychosocial factors such as parents who abuse drugs, have multiple unmanageable stressors or have been abused or experienced multiple attachment disorders themselves. Children who are adopted from foreign orphanages are commonly affected, especially if they are removed from their birth parents during their first weeks of life.

The symptoms in infants include weak crying response, rage, constant whining, sensitivity to touch, poor sucking response, no reciprocal smile response and indifference to others. The symptoms in children are lack of conscience development, superficially charming, lack of eye contact, inability to give and receive affection, extreme control issues, destructive to self, others, animals and property, no impulse control, unusual eating patterns, unsuccessful peer relationships, incessant chatter in order to control, very demanding and an unusual speech pattern such as mumbling, robotic speech and talking very softly except when raging. Some children may also be overly or inappropriately social or familiar with strangers. The physical, emotional and social problems may persist as the child grows older.

There are many disorders that share similar symptoms with Reactive Attachment Disorder. The disorders are Attention Deficit Disorder, Anti-social Personality Disorder, Conduct Disorder, Oppositional Defiant Disorder, Fetal Alcohol Syndrome, Mental Retardation, Schizophrenia, Rett’s Syndrome, Developmental Disorder of Receptive Language and Socio-Emotional Problems.

Diagnosis of Reactive Attachment Disorder is made by the signs and symptoms present and by a complete medical history and physical exam. There are no lab tests that can specifically diagnose the disorder, but x-rays and blood tests may be used to rule out physical illnesses or side effects from medications as the cause. If no physical cause can be established the child is referred to a psychiatrist or psychologist who uses specifically designed tools and interviews to evaluate the child for mental illness. The diagnosis is then based on the child’s symptoms and by the observation of the child’s attitude and behavior made by the psychiatrist or psychologist. Reactive Attachment Disorder has been misdiagnosed as Bipolar Disorder or Attention Deficit Disorder in an estimated forty to seventy percent of the cases.

Treatment of Reactive Attachment Disorder requires the participation of several specialists. Most treatment, however, is given by the primary caregiver during everyday interaction with the child. Many individuals go untreated and become sociopaths. Not treating this disorder can also be connected with post-traumatic stress syndrome, depression, anxiety and other psychological problems.

Reactive Attachment Disorder was made popular by the award-winning movie “Good Will Hunting”.