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What is Reactive Attachment Disorder?

Reactive attachment disorder is a condition demonstrated by children between the ages of 9 months and 5 years who show a consistent pattern of inhibited, emotionally withdrawn behavior toward adult caregivers. The child rarely or minimally either seeks comfort or responds to comfort when distressed.
A diagnosis of reactive attachment disorder is characterized by at least two of the following symptoms:

  • Minimal social and emotional responsiveness to others.
  • A limited positive demeanor.
  • Episodes of unexplained irritability, sadness or fearfulness during nonthreatening interactions with adult caregivers.

In addition, the child has experienced a pattern of insufficient care as evidenced by at least one of the following:

  • Social neglect or deprivation in the form of persistent lack of having basic emotional needs for comfort, stimulation and affection met by caregiving adults.
  • Repeated changes of primary caregivers that limit opportunities to form stable attachments (e.g., frequent changes in foster care).
  • Growing up in unusual settings that severely limit opportunities to form close relationships with adults (e.g., institutions with high child-to-caregiver ratios). The pattern of insufficient care is presumed to be responsible for the inhibited or withdrawn behavior toward adult caregivers.

What is Disinhibited Social Engagement Disorder?

Disinhibited social engagement disorder is a pattern of behavior in which a child approaches and interacts with unfamiliar adults and demonstrates at least two of the following:       

  • Little or no shyness in approaching and interacting with unfamiliar adults  
  • Overly familiar verbal or physical behavior that is not consistent with cultural and age-appropriate social boundaries.
  • Diminished or absent checking back with adult caregiver after venturing away, even in unfamiliar settings.
  • Willingness to go off with an unfamiliar adult with minimal or no hesitation.
    The child has experienced a pattern of insufficient care as evidenced by at least one of the following:
  • Social neglect or deprivation in the form of persistent lack of having basic emotional needs for comfort, stimulation and affection met by caregiving adults.
  • Repeated changes of primary caregivers that limit opportunities to form stable attachments (e.g., frequent changes in foster care).
  • Growing up in unusual settings that severely limit opportunities to form close relationships with adults (e.g., institutions with high child-to-caregiver ratios).
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Mental Health Library Sources:

Information included in all topics of the Mental Health Library comes from the Desk Reference to the Diagnostic Criteria From DSM-5 and Kaplan & Sadock’s Concise Textbook of Clinical Psychiatry. Complete diagnostic and treatment information may be found within these publications.

Disclaimer:

Information within the Mental Health Library is not intended to be used for self-diagnosis purposes. Rather, it is provided as a public educational service to make people aware of mental health conditions. Please consult a qualified mental health professional for a diagnosis of any suspected mental health illness.

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