Diagnosis

A pediatric psychiatrist or psychologist can conduct a thorough, in-depth examination 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 and 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 psychiatric disorders and determine if any other mental health conditions co-exist, such as:

  • Intellectual disability
  • Other adjustment disorders
  • Autism spectrum disorder
  • Depressive disorders

Diagnostic and Statistical Manual of Mental Disorders (DMS-5)

Your doctor may use the diagnostic criteria for reactive attachment disorder in the DSM-5, published by the American Psychiatric Association. Diagnosis isn't usually made before 9 months of age. Signs and symptoms appear before the age of 5 years.

Criteria include:

  • A consistent pattern of emotionally withdrawn behavior toward caregivers, shown by rarely seeking or not responding to comfort when distressed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
July 13, 2017
References
  1. Reactive attachment disorder. In: Diagnostic and Statistical Manual of Mental Disorders DSM-5. 5th ed. Arlington, Va.: American Psychiatric Association; 2013. http://dsm.psychiatryonline.org. Accessed April 4, 2017.
  2. Facts for families: Attachment disorders. American Academy of Child and Adolescent Psychiatry. http://www.aacap.org/AACAP/Families_and_Youth/Facts_for_Families/FFF-Guide/Attachment-Disorders-085.aspx. Accessed April 4, 2017.
  3. Dickerson Mayes S, et al. Reactive attachment/disinhibited social engagement disorders: Callous-unemotional traits and comorbid disorders. Research in Developmental Disabilities. 2017;63:28.
  4. Zeanah CH, et al. Practice parameter for the assessment and treatment of children and adolescents with reactive attachment disorder and disinhibited social engagement disorder. Journal of the American Academy of Child & Adolescent Psychiatry. 2016;55:990.
  5. Coercive interventions for reactive attachment disorder. American Academy of Child & Adolescent Psychiatry. http://www.aacap.org/aacap/Policy_Statements/2003/Coercive_Interventions_for_Reactive_Attachment_Disorder.aspx. Accessed April 14, 2017.
  6. Hoecker JL (expert opinion). Mayo Clinic, Rochester, Minn. May 25, 2017.
  7. Position statement on reactive attachment disorder. American Psychiatric Association. Reaffirmed, 2007.