REACTIVE ATTACHMENT DISORDER :
REACTIVE ATTACHMENT DISORDER may occur when a child is severely neglected where the neglect involves being deprived of close, consistent, stable care and nurturing from those who would normally provide it (i.e. a parent or primary caregiver). For example, a child who is raised in an orphanage in which the child has no sole, main carer, but, instead, a variety of overworked carers who work in shifts would be at increased risk of developing the disorder.
There are two types of REACTIVE ATTACHMENT DISORDER ; these are :
- INHIBITED REACTIVE ATTACHMENT DISORDER
- DISINHIBITED REACTIVE ATTACHMENT DISORDER
Let’s look at each of these in turn :
THE TWO TYPES OF REACTIVE ATTACHMENT DISORDER : INHIBITED AND DISINHIBITED :
INHIBITED REACTIVE ATTACHMENT DISORDER :
A child suffering from inhibited reactive attachment disorder may commonly suffer a range of symptoms which include :
- a preference for solitary play / no interest in games that involve interaction with others
- avoidance of / detachment from others (including an avoidance of any physical contact with others)
- avoidance of eye contact
- appears sad and lethargic
- lack of any positive response to attempts by others to give comfort / does not seek comfort from others
- does not smile
- failure to reach out when picked up
DISINHIBITED REACTIVE ATTACHMENT DISORDER :
A child suffering from disinhibited reactive attachment disorder may commonly suffer a range of symptoms which include
- high anxiety level
- unusually eager to interact with strangers /rarely socially distinguishes between caregiver and unfamiliar adults
- exaggerating a need for help with basic daily tasks
- behaving much younger than chronological age / taking part in activities appropriate to much younger children
MORE ABOUT THE CAUSES OF REACTIVE ATTACHMENT DISORDER :
I have already touched on the causes of reactive attachment disorder in the opening paragraph of this article. However, to elaborate further, a baby / young child does not only require his/her physical needs to be met (such as being fed or having his/her nappy changed) but also requires SIMULTANEOUS WARM EMOTIONAL INTERACTION WITH THE CAREGIVER WHO IS PERFORMING THESE PHYSICAL TASKS.
Such warm, emotional interaction is less likely to occur in underfunded and under-resourced orphanages (as already mentioned above). Also, however, young children who are forced to undergo frequent changes in foster homes, or who live with severely mentally ill parents, or with parents with serious substance misuse problems, are also at higher risk of extreme emotional neglect and, consequently, at increased risk of developing reactive attachment disorder.
WHO SUFFERS FROM REACTIVE ATTACHMENT DISORDER ?
Research into reactive attachment disorder has focused on babies / young children between the ages of 0 and 5 years of age. It is not certain if the disorder exists in children over the age of 5 years ; more research needs to be conducted in order to establish whether or not it does.
However, some preliminary research suggests that older children and adolescents may express symptoms of reactive attachment disorder through :
- lack of emotional responsiveness
- cruelty towards animals
- cruelty towards people
- general problems relating to their behavior
CAN REACTIVE ATTACHMENT DISORDER BE SUCCESSFULLY TREATED?
Although there is currently no one, specific, specialized treatment or therapy for reactive attachment disorder, the evidence is that, with the right kind of intervention, children suffering from the disorder can learn to form healthy relationships with others.
As with all psychological problems, the earlier the therapeutic intervention is made, the higher its probability of success.
Therapies likely to be helpful include :
- individual counselling
- classes in parenting skills
- family counselling
- education of caregivers about the disorder
- education of parents about the disorder
NOTE : The DSM IV refers to the inhibited and disinhibited forms of the disorder as : emotionally withdrawn and indiscriminately social/disinhibited subtypes , whilst the DSM 5 refers to them as two separate disorders, namely, reactive attachment disorder and disinhibited social engagement disorder. SEE TABLE BELOW :
David Hosier BSc Hons; MSc; PGDE(FAHE).