Reactive Attachment Disorder

Prevalence

• Prevalence unknown, but the disorder is seen relatively rarely in clinical settings (young children exposed to severe neglect before being placed in foster care or raised in institutions).

• Even in populations of severely neglected children, the disorder is uncommon, occurring in less than 10% of such children.

Symptoms

• A consistent pattern of inhibited, emotionally withdrawn behavior toward adult caregivers, manifested by both of the following:

  1. The child rarely or minimally seeks comfort when distressed.

  2. The child rarely or minimally responds to comfort when distressed.

• A persistent social and emotional disturbance characterized by at least two of the following:

  1. Minimal social and emotional responsiveness to others.

  2. Limited positive affect.

  3. Episodes of unexplained irritability, sadness, or fearfulness that are evident even during nonthreatening interactions with adult caregivers.

• The child has experienced a pattern of extremes of insufficient care as evidenced by at least one of the following:

  1. Social neglect or deprivation (lack of having basic emotional needs for comfort, stimulation, and affection).

  2. Repeated changes of primary caregivers.

  3. Rearing in unusual settings that severely limit opportunities to form selective attachments (e.g., institutions with high child-to-caregiver ratios).

• Conditions associated with neglect, including cognitive delays, language delays, and stereotypes, often co-occur with reactive attachment disorder.