In this guide, attachment disorder will be explained along with its two types; reactive attachment disorder and disinhibited social engagement disorder. Causes and treatment are also briefly mentioned.
Most children develop safe emotional attachments at an early age. If the caregiver is missing, they display anxiety which is normal and they relax when the parents care for them. Nevertheless, certain children might develop attachment disorder because their parents could not satisfy their desires. When this happens, the child is not able to bond with caregivers and may struggle to develop emotional attachments of any kind.
Attachment disorder is treatable, but it is necessary to act early. Kids with attachment disorder will endure persistent difficulties throughout their life if their condition is left untreated.
The Importance of Attachment
Repeated positive experiences with a caregiver help to develop a secure and healthy attachment for infants. When a baby cries and an adult responds by feeding, changing, or rocking, the baby learns that she can trust the adult to keep her safe and care for her needs.
The babies who have secure attachments will:
- Explore independently and try new things
- Form relationships with others in a better and healthy way
- When stressed, have less extreme responses
- Be able to solve problems more quickly
Insecure attachment may develop if the infant experiences unpredictable or negative responses from a caregiver. They will be less likely to trust the adults and see them as unreliable.
Insecure children will be likely to:
- Refuse to engage with others
- Show anxiety, anxiety, and fear
- Avoid people
- Exaggerate distress
Types of Attachment disorder
The diagnostic statistical manual of mental disorders fifth edition includes two attachment disorder: Reactive Attachment disorder (RAD) and Disinhibited Social Engagement Disorder (DSED).
Reactive Attachment Disorder (RAD)
This condition can start in infancy and the research on symptoms and signs of reactive attachment disorder is very limited. It is still unclear whether this disorder can occur in children that are older than five years.
Symptoms and signs are:
- When distressed, they do not seek comfort and when comfort is given, they do not show any response
- Restless and sad
- Do not engage in social interactions but watch others
- Do not engage in interactive games
- Failure to smile
- Like other infants, do not ask to be picked up
- Unable to ask for assistance or support
- Unexplained fear, withdrawal, gloominess or irritability
When to see a doctor
Consider getting an examination of the child if he shows any of the above symptoms. The symptoms might occur in children who have no reactive attachment disorder or who have another condition, such as autism spectrum disorder. It is important to have the child assessed by a pediatric psychiatrist or psychologist who is able to determine if such behaviours indicate reactive attachment disorder or some other condition.
Causes of RAD
Children and infants need a secure, loving place to feel safe and build trust. It is important to regularly fulfil their basic emotional and physical needs. For example, when a baby cries because he wants to be fed or needs a diaper change, a healthy emotional response should be shared that may include eye contact, laughing, and caressing.
A child whose needs are neglected or met with a lack of caregivers ‘ emotional response does not form a stable relationship to caregivers or expect support or attention from them.
It is not clear why some children and babies develop reactive attachment disorder and others do not. There are various theories about reactive attachment disorder and its causes, and there is a need for more research to develop a better understanding and improved options for diagnosis and treatment.
The risk factors of developing reactive attachment disorder in children suffering from emotional neglect may include:
- Changing foster homes and/or caregivers
- Living in an orphanage or children’s home
- Because of hospitalization, prolonged separation from parents or caregivers
- Parents with mental health problems like substance abuse or criminal behaviour
It is not necessary that the child will surely develop reactive attachment disorder even if he experiences severe emotional neglect.
Reactive attachment disorder can continue for several years without treatment and can have lifelong consequences.
Some research suggests that some children and adolescents with reactive attachment disorder may display insensitive, unemotional behaviours that may include behavioural problems and abuse to humans or animals.
More research is needed to decide whether problems are related to experiences of early childhood reactive attachment disorder in older children and adults.
While it is not known with certainty whether it is possible to prevent reactive attachment disorder or not but there are ways to reduce the risk of its development. The following suggestions for parenting may be helpful:
- Take parenting classes
- Be actively engaged with the child in play activities
- Learn to interpret when the baby needs nurturing or emotional support
- Provide warm, nurturing interaction during bathing, changing diapers or feeding the child
- Offer both nonverbal and verbal responses like touch, warm facial expressions
Disinhibited Social Engagement Disorder
Children must have at least two symptoms of the following criteria of Disinhibited Social Engagement Disorder taken from the Diagnostic Statistical Manual of Mental Disorders (DSM-5):
- Lack of inhibition or extreme excitement over interacting or meeting with unfamiliar adults or strangers
- Overly talkative, friendly or physical behaviours with strangers that not culturally acceptable or age-appropriate
- Shows no fear in leaving a safe situation or place with a stranger
- lack of interest or willingness to check in with a trusted adult before leaving a safe place or going in a situation that seems unfamiliar or dangerous
These children are at high risk of getting harmed by the hands of others because they willingly connect with strangers. They face trouble when trying to form loving connections with adults or other children.
Causes of DSED
Many factors contribute to causing this condition in children. Especially children experiencing an absence of a solid and long-term relationship with a caregiver. Hence, most of the children that suffer from DSED come from orphanages or institutionalized settings or foster homes where the caregivers are ever-changing and cannot meet the needs of each child properly and on time.
Extreme neglect, abuse or childhood trauma are the other causes of developing DSED, especially when the child does not have a caring adult around to make these experiences bearable.
Risk Factors for DSED
The risk factors and situations include:
- sexual abuse in early age
- raised in a home where the parent was constantly absent or have a substance abuse history
- the death of one or both parents
When to see a doctor
If the above-mentioned symptoms are present, the child should be taken to trained professionals for a thorough assessment of several visits to rule out any other conditions. Diagnosis is only made by a therapist or a psychiatrist. The assessment questions will include
- The emotional development of a child
- child’s mental state
- his current daily life functioning
- medical history and,
- life/developmental history
Based on the age of the child, the physician may use the interaction toys, such as puppets, stuffed animals or paper, and pencils.
The doctor will formulate a highly individualized treatment plan if the child is diagnosed with DSED. The treatment plan will aim to cure the trauma of the child and to refine it to develop meaningful, intimate relationships with others.
Treatment for DSED
Disinhibited social engagement disorder is treated by following methods which typically include an entire family of the child:
- Individual talk therapy and group talk therapy
- Psychotherapeutic treatments including play therapy and art therapy
Tools will be given to the adults who care for the child to help them improve their daily interactions and help the child feel safe and cared for. Learning how to help the child feel safe is needed for the formation of healthy attachments by the caregiver.
Depending on the age and condition of the infant, changes can be seen slowly or rapidly. And though there seems to be a rapid improvement, note that there is no quick fix. Children often regress in behaviour and exhibit anger or other emotions that have been suppressed. Implementing recovery strategies consistently while maintaining a supportive, loving relationship is critical.
Safety for a Child with an Attachment Disorder
For children with attachment problems, safety is the main problem. They are distant and suspicious because they feel insecure in the world. To protect themselves, they keep their guard up, but it also prevents them from accepting love and support. So, before anything else, building up the sense of security of the child is essential. This can be accomplished by setting clear expectations and behavioural rules, and by responding consistently so that the child knows what to expect when they act in a certain way and knows that you can be counted on regardless of what happens.
Following steps can be taken to make the child feel secure and responsible:
- Owning up to mistakes and taking initiative to repair the damage
- Setting limits and boundaries
- Taking charge while remaining calm when the child is misbehaving or throwing a tantrum
- Making and maintaining schedules and routines
- Being immediately available after having a conflict with the child
Making the child with attachment disorder feel loved
It will be difficult for a child who has not bonded early in life to embrace love, especially physical expressions of love. But with time, consistency and repetition one can help them learn to accept love and affection. Confidence and security come from seeing acts of affection, listening to reassuring words and always being comforted.
Following are the ways they can be taught to accept love:
- Respond in accordance with the emotional age of a child
- Play, listen and talk to the child
- Try to identify the things that make the child feel good
- Assist the child in identifying his emotions
- Let them know it is alright to express their needs
Supporting the health of a child with attachment issues
Sleeping, eating, and exercise habits for infants and children are always important, but they are even more important for children with attachment difficulties. Healthy lifestyle practices can go a long way to lower the stress levels of a child and reduce his or her mood swings. When kids with attachment problems are relaxed, well-rested, and feel good generally, handling the challenges of life will be much easier for them.
Anything like food, rest and exercise can make a difference between a good and a bad day for a child who has attachment difficulties. These are the basics that help in ensuring that the brain of the child is ready to connect and healthy.
Reactive attachment disorder therapy usually involves combining therapy, parenting education, and counselling to ensure that the living environment of the child is safe has positive interactions and better relationships with caregivers. Although medicine can be used to treat related conditions such as depression, anxiety, or hyperactivity, no quick fix is possible for such conditions.
Therapist of paediatrician may follow the treatment plan that has:
- Individual psychological counselling
- Play therapy
- Family therapy
- Parenting skills classes
- Special education services
Attachment Disorder is developed when the infants experience a lack of warmth and care from caregivers. Two types of attachment disorder are included in DSM-5: Reactive Attachment Disorder and Disinhibited Social Engagement Disorder. Treatment includes psychotherapy of the child as well as parents.
Frequently Asked Questions
Does my child need Residential treatment?
Residential treatment is for the children who have become extremely destructive at home or in school that they are harmful not only toward themselves but others as well. It is not advised to make this decision alone, weigh the pros and cons, talk to a professional your child is seeking and then choose.
Will my child heal from this disorder?
attachment disorder are very deep-rooted and will need a lot from your part to make them better. If you put in intentional work in making your relationship with your child healthy, they will heal. Take help from a therapist who is experienced in dealing with such disorders.
Please use the comment section below if you have any questions.
Very Well Mind
Attachment, Trauma, and Healing: Understanding and Treating Attachment Disorder in Children and Families
Treating Attachment Disorders, Second Edition: From Theory to Therapy
A Short Introduction to Attachment and Attachment Disorder (JKP Short Introductions)
Building the Bonds of Attachment: Awakening Love in Deeply Traumatized Children
Understanding Attachment and Attachment Disorders: Theory, Evidence and Practice (Child and Adolescent Mental Health)