Reactive attachment disorder can start in infancy. There's little research on signs and symptoms of reactive attachment disorder beyond early childhood, and it remains uncertain whether it occurs in children older than 5 years.
Signs and symptoms may include:
- Withdrawal, fear, sadness or irritability that is not readily explained
- Sad and listless appearance
- Not seeking comfort or showing no response when comfort is given
- Failure to smile
- Watching others closely but not engaging in social interaction
- Failing to ask for support or assistance
- Failure to reach out when picked up
- No interest in playing peekaboo or other interactive games
Reactive attachment disorder is rare. Signs and symptoms can occur in children who don't have reactive attachment disorder or who have another disorder such as autism spectrum disorder. It's important to have your child evaluated by a psychiatrist who can tell whether such behaviors indicate a more serious problem.
When to see a doctor
If you think your child may have reactive attachment disorder, you may start by visiting your primary care provider or pediatrician. However, you may be referred to a doctor who specializes in the diagnosis and treatment of reactive attachment disorder or a pediatrician specializing in behavior and development for a complete evaluation.
Consider getting an evaluation if your baby or child shows any of the signs and symptoms above.
July 10, 2014
- Reactive attachment disorder of infancy or early childhood. In: Diagnostic and Statistical Manual of Mental Disorders DSM-5. 5th ed. Arlington, Va.: American Psychiatric Association; 2013. http://www.psychiatryonline.org. Accessed April 9, 2014.
- Highlights of changes from DSM-IV-TR to DSM-5. American Psychiatric Association. http://www.dsm5.org/Pages/Default.aspx. Accessed April 9, 2014.
- Reactive attachment disorder. American Academy of Child and Adolescent Psychiatry. http://www.aacap.org/aacap/Families_and_Youth/Facts_for_Families/Facts_for_Families_Pages/Reactive_Attachment_Disorder_85.aspx. Accessed April 9, 2014.
- 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 April 9, 2014.
- Boris NW, et al. Practice parameter for the assessment and treatment of children and adolescents with reactive attachment disorder of infancy and early childhood. Journal of the American Academy of Child and Adolescent Psychiatry. 2005;44:1206.
- Hales RE, et al. The American Psychiatric Publishing Textbook of Psychiatry. 5th ed. Washington, D.C.: American Psychiatric Publishing; 2008. http://www.psychiatryonline.org/resourceToc.aspx?resourceID=5. Accessed April 9, 2014.
- Chaffin M, et al. Report of the APSAC task force on attachment therapy, reactive attachment disorder, and attachment problems. Child Maltreatment. 2006;11:76.
- Position statement on reactive attachment disorder. American Psychiatric Association. http://www.psych.org/advocacy--newsroom/position-statements. Accessed April 9, 2014.
- Hoecker JL (expert opinion). Mayo Clinic, Rochester, Minn. April 22, 2014.
- Tervo RC (expert opinion). Mayo Clinic, Rochester, Minn. May 20, 2014.
- Mikic N, et al. Mentalization and attachment representations: A theoretical contribution to the understanding of reactive attachment disorder. Bulletin of the Menninger Clinic. 2014;78:34.