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- A consistent pattern of emotionally withdrawn behavior toward caregivers, shown by rarely seeking or not responding to comfort when distressed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.
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:
July 10, 2014
- Intellectual disability
- Adjustment disorders
- Autism spectrum disorder
- Depressive disorders
- 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.