Tests and diagnosis

By Mayo Clinic Staff

The Diagnostic and Statistical Manual of Mental Disorders (DSM-5), published by the American Psychiatric Association, includes diagnostic criteria for reactive attachment disorder, such as:

  • A consistent pattern of emotionally withdrawn behavior toward caregivers, shown by rarely seeking or not responding to comfort when distressed
  • Persistent social and emotional problems that include minimal responsiveness to others, no positive response to interactions, or unexplained irritability, sadness or fearfulness during interactions with caregivers
  • Persistent lack of having emotional needs for comfort, stimulation and affection met by caregivers, or repeated changes of primary caregivers that limit opportunities to form stable attachments, or care in a setting that severely limits opportunities to form attachments (such as an institution)
  • No diagnosis of autism spectrum disorder

However, some experts use other sources, rather than the DSM-5, as a basis for diagnosing reactive attachment disorder.

Psychiatric evaluation

A thorough, in-depth examination by a child psychiatrist is necessary to diagnose reactive attachment disorder.

Your child's evaluation may include:

  • Direct observation of interaction with parents or caregivers
  • Details about the pattern of behavior over time
  • Examples of the behavior in a variety of situations
  • Information about interactions with parents or caregivers, as well as others
  • Questions about the home and living situation since birth
  • An evaluation of parenting and caregiving styles and abilities

Your child's doctor will also want to rule out other possible causes, as signs and symptoms of reactive attachment disorder may resemble those related to other disorders, including:

  • Intellectual disability
  • Adjustment disorders
  • Autism spectrum disorder
  • Depressive disorders
Jul. 10, 2014

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