Tests and diagnosis

By Mayo Clinic Staff

To be diagnosed with reactive attachment disorder, a baby or child must meet criteria spelled out in the Diagnostic and Statistical Manual of Mental Disorders (DSM). This manual is published by the American Psychiatric Association and is used by mental health providers to diagnose mental conditions.

The main criteria for the diagnosis of reactive attachment disorder must include:

  • Disturbed and developmentally inappropriate social relationships beginning before age 5, not due to developmental delay
  • Failure to respond to or initiate social interactions, or being inappropriately friendly and familiar with strangers
  • Failure of early caregivers to meet the baby's or child's emotional needs for comfort and affection, failure of early caregivers to attend to the child's physical needs, or repeated changes in the child's primary caregiver

Psychiatric evaluation

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

A thorough evaluation may include:

  • Direct observation of the baby's or child's interaction with his or her parents or caregivers
  • Details about the baby's or child's pattern of behavior over time
  • Examples of the baby's or child's behavior in a variety of situations
  • Information about how the baby or child interacts with parents or caregivers as well as others, including other family members, peers and teachers
  • Questions about the baby's or child's 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 of behavior problems or emotional issues. Signs and symptoms of reactive attachment disorder may resemble those related to other disorders, such as:

  • Post-traumatic stress disorder (PTSD)
  • Anxiety disorders
  • Adjustment disorder
  • Autism spectrum disorders
  • Social phobia
  • Conduct disorder
  • Attention-deficit/hyperactivity disorder (ADHD)

Disagreement over diagnosis methods

Not all experts agree on the signs and symptoms of reactive attachment disorder, or which tests should be used to diagnose the condition. Some therapists use checklists with numerous signs and symptoms that go beyond the criteria spelled out in the DSM. Be cautious when trying to interpret checklists that include such signs and symptoms as lack of eye contact, rage, aggression, lying, stealing, hoarding food, an apparent lack of a conscience, nonstop chatter and a desire to wield control. These can be signs and symptoms of a number of mental health conditions.

Jul. 06, 2011