When children are reared in a loving and caring environment, they develop healthy, secure attachments to their parents or caregivers. Attachment issues can arise; however, if children experience multiple traumas or severe neglect of their needs. This can negatively affect how the child develops and functions physically, socially, and emotionally.
Attachment disorders may be rare, but they are serious conditions that can have emotionally and socially debilitating effects. The child's best possible outcome is achieved when the disorder is identified and treated as early as possible. What follows is an in-depth look at these disorders, from types, causes, and symptoms to diagnosis, treatment, and outlook for affected children.
We will also highlight some conditions that tend to occur alongside an attachment disorder and tips for caregivers to help children build secure and nurturing attachment bonds. Steps that can prevent attachment disorders from developing in babies and young children will also be looked at.
However, we will begin by explaining the attachment theory, and the role attachment plays in normal child development.
The Attachment Theory
The Attachment Theory was first proposed by John Bowlby, a British psychologist, psychiatrist, psychoanalyst, and child development specialist. The theory suggests that an infant who is loved, has their needs attended to in a timely fashion, and feels a sense of security, will naturally develop an attachment to their primary caregiver (in most cases, a parent).
Attachment to a primary caregiver typically occurs in infancy, before the child reaches their first birthday. When attachment occurs, the child dislikes being separated from the primary caregiver and may cry in protest when this happens. They also display what is considered to be a healthy level of stranger anxiety around people with whom they are unfamiliar.
The child sees the caregiver as a reassuring constant in their life and comes to expect that that person will always be there to provide care, attention, and protection from harm. This, in turn, helps to build the child's confidence in exploring and experiencing the world. Secure attachment bonds help the child in developing positive self-esteem and self-reliance. They also contribute to the child's future ability to build healthy relationships and regulate their emotions in others' interactions.
What Are Attachment Disorders?
Attachment disorders occur when a child experiences severe or prolonged emotional and physical neglect. An attachment disorder can also arise when the child experiences trauma or abuse or when a child has no consistent caregiver early in life. Attachment disorders prevent a child from forming loving and trusting emotional attachment bonds with a primary caregiver.
Attachment disorders have adverse effects on a child's moods, emotions, ability to socialize normally, decision-making ability, and behavior. Signs that an attachment disorder is present are usually evident from around the age of 9 months. Depending on the child's symptoms, their attachment disorder may be diagnosed as one of two distinct types: Reactive Attachment Disorder (RAD) or Disinhibited Social Engagement Disorder (DSED).
The Two Types Of Attachment Disorders
NOTE: Although this article deals exclusively with the two attachment disorders in children, it must be emphasized that attachment issues can affect adults, as well. Generally, Adult Attachment Disorder (AAD) is the result of an untreated childhood attachment disorder.
A child with RAD displays inhibited (reserved and withdrawn) behaviors toward their primary caregiver, other adult caregivers, and adults in general. They typically will not reach out to others to start social relationships and may appear to be lacking in empathy toward others.
As suggested by its name, Disinhibited Social Engagement Disorder causes a child to be overly familiar or overly friendly with strangers. Since a child with DSED has no inhibitions around strangers and shows no preference for a caregiver's company over that of a stranger, there is a valid concern that this puts the child's safety at risk.
In the past, both RAD and DSED were categorized into two forms of a single condition called reactive attachment disorder. The first was Reactive Attachment Disorder - Inhibited Type, and the second was known as Reactive Attachment Disorder - Disinhibited Type or Disinhibited Attachment Disorder (DAD). They have since been reclassified as two separate conditions requiring separate diagnoses. The first retains the name Reactive Attachment Disorder, while the second was assigned the name Disinhibited Social Engagement Disorder.
What Causes Attachment Issues In Children?
The root causes of attachment disorders are not, as yet, fully understood. For instance, research is still ongoing into why, in the same or similar situations, one child develops an attachment disorder while another child does not; and why one child develops RAD while the other develops DSED.
Mental health professionals have, however, identified several contributing factors to the development of an attachment disorder. These include:
As pointed out earlier, not all children exposed to the situations described here will develop an attachment disorder. Child psychiatrists and psychologists point out that children, in general, are very resilient, and the vast majority of children who face any or some of the hardships described above will not go on to develop an attachment disorder.
Institutionalization As A Risk Factor For Developing Attachment Disorders
Children in institutions such as children's homes and orphanages are at the greatest risk of developing an attachment disorder. This does not mean that all children in these institutions will have attachment issues or that attachment disorders are common.
Research has discovered that while attachment disorders are extremely rare in the general population, their occurrence in institutionalized children is comparatively high.
What Effects Can Attachment Disorders Have On A Child Now And In The Future?
The onset of an attachment disorder happens `before the age of five but, if left untreated, its effects can last through adolescence and into adulthood. Commonly seen effects include:
What Are The Symptoms Associated With Attachment Disorders?
Attachment disorders are disorders of social functioning. As such, most of the symptoms are seen in how the child reacts to and behaves around others. These symptoms vary greatly depending on whether the child has RAD or DSED.
Here are the symptoms caregivers will typically see in each case.
A child With Reactive Attachment Disorder
A child With Disinhibited Social Engagement Disorder
The symptoms displayed in RAD and DSED can be viewed as adaptations or coping mechanisms. The infant or young child develops them in response to the stressful situation, which prevented them from securely bonding with an adult. For this reason, attachment disorders are sometimes compared to post-traumatic stress disorder (PTSD).
Distinguishing Attachment Disorders from Normal Behavior
Children may seem to prefer their own company for long periods while another child often does not display much reservedness around strangers. These alone do not mean that an attachment disorder is present. They could be indications that one child is naturally introverted while the other is naturally outgoing.
Also, delayed development alone is not sufficient for a diagnosis of an attachment disorder. A child may appear to be a delay when, in fact, they are hitting their skills and behaviors milestone within the specified window of time, just not as quickly as another child is doing.
How Are Attachment Disorders Diagnosed?
The diagnosis for RAD or DSED can be made when the child is at least nine months old. Furthermore, the diagnosis is not made after the child reaches five years old unless it is based on present symptoms before the child's fifth birthday.
The caregiver will often take the child in to see a doctor once they notice worrying symptoms. After reviewing the child's medical history, the doctor may conduct tests to rule out physical illness or medication to cause the child's symptoms. Once these have been eliminated, the doctor will likely refer the child to a psychiatrist or psychologist to assess a possible mental health condition.
That evaluation normally takes place throughout several visits and includes observation of caregiver-child interactions, interviews with the child and caregiver, and the use of specially designed evaluation tools. These will help the mental health professional to ascertain:
The psychiatrist or psychologist may compare the information gathered with the guidelines set out in the American Psychiatric Association's DSM-V. This comprehensive diagnostic tool details all the criteria which must be met before a diagnosis of any recognized mental health condition can be made.
Conditions With Symptoms Similar To Those In Attachment Disorders
Use of the DMS-V is important to avoid a misdiagnosis. That is because several other conditions have symptoms similar to those displayed in an attachment disorder. These include
Comorbidities - Other Issues Which Typically Occur With Attachment Disorders
Research has shown a high incidence of comorbidity of mental illnesses in children in high-risk situations such as being institutionalized. Furthermore, although attachment disorders are rare, a high percentage of children with an attachment disorder is also diagnosed with a comorbid condition.
ADHD has been shown as the condition most likely to occur alongside an attachment disorder. Other common comorbidities with attachment disorder include:
Treatment For Attachment Issues
Treatment for attachment disorder focuses on the child and the family, aiming to strengthen the caregiver-child attachment bond and help the child develop healthy attachments with others. Attachment disorders are not treated with medication. However, a doctor might prescribe medication for a condition arising from or comorbid with the child's RAD or DSED, such as problems sleeping, mood imbalance, or depression.
Treatment is highly individualized and may include:
Controversial Treatments For Attachment Disorders
Several non-traditional techniques have been used in the past as therapy for attachment disorders. Examples include "rebirthing" and "holding" strategies, which involve physical restraint of the child. Their use is controversial, especially after they have resulted in children's deaths, and at least one, rebirthing, has been banned in several US states. And its use condemned by the US Congress.
Furthermore, both the American Psychiatric Association (APA) and the American Academy of Child and Adolescent Psychiatry (AACAP) warn against the use of physically coercive therapies in children. The AACAP also labels as "dangerous" the use of "hunger or thirst or forcing food or water upon the child" as a therapy for attachment disorders.
Outlook - What Are The Likely Results Of Treatment?
Caregivers can be reassured that approved attachment disorder therapy provided by a trained mental health professional works - even in cases where the child has faced extreme neglect or has never had a stable primary caregiver. With therapy, children develop trust, become more open, and learn to display age-appropriate behaviors in their interactions with adults.
How quickly a child shows, improvement will depend on several factors, such as the child's age, living situation, and comorbidities the child may be experiencing, as well as caregiver issues, which may affect how readily they implement the recommended strategies. It is also not uncommon for a child to initially show improvement then become resistant and regress before improving again and moving toward overcoming the disorder.
Caregivers are encouraged to be diligent and persist in using the nurturing techniques they are exposed to strengthen the attachment between them and their child.
Preventing The Development Of Attachment Issues In Children
Caregivers can reduce a child's risk of developing an attachment disorder by providing opportunities for a loving and trusting relationship to grow between them. They can do this by:
Tips For Developing Healthy Bonds With A Child Who Has An Attachment Disorder
If you are already dealing with a child who has been diagnosed with an attachment disorder, you can help build attachment in the following ways:
Watching a child struggle with an attachment disorder or any other kind of mental health issue can be deeply distressing for parents and caregivers. Attachment disorders are preventable, but if they do develop, they are quite treatable. They will not go away or improve on their own but implementing interventions as soon as possible after symptoms are noticed in response to treatment. There are mental health professionals and support services to reach out to for help. You and your child can begin building the loving and trusting relationship you deserve.
Frequently Asked Questions (FAQs)
What are the symptoms of attachment disorders?
Young children develop attachment disorders when their parents or primary caregivers cannot meet their emotional or physical needs. There are various types of attachment disorders, and they stem from attachment issues during early childhood. The symptoms of attachment disorders are dependent on the type and the unique situation surrounding each case. Children with attachment disorders exhibit some signs that include extreme clinginess, lack of eye contact, anger or control issues, withdrawal or self-isolation, bullying, uncontrolled impulsiveness, failure to smile, self-destructive behaviors, etc.
What are attachment issues?
Attachment issues refer to a spectrum of attachment problems ranging from mild to severe issues such as reactive attachment disorder, RAD, and disinhibited social engagement disorder DSED. These attachment disorders are recognized by the diagnostic and statistical manual of mental disorders as the only types of attachment disorders. Attachment issues may arise due to emotional or physical neglect, incidences of trauma or abuse, separation from parents, or lengthy hospitalization during early childhood. This negatively affects young children's ability to build and establish secure connections or attachments in the future. The symptoms of attachment disorders can be identified early childhood and addressed to avoid more devastating problems in the young child and adolescent years. If these attachment issues aren’t addressed in young children, they may develop other mental disorders or give rise to relationship issues during the teen and adolescent age and adulthood. The difference between reactive attachment disorder and disinhibited social engagement disorder symptoms and treatment vary slightly. Due to the teen child and adolescent age they affect, these attachment disorders are treated by the American Academy of Child and Adolescent registered psychiatrists.
How do you help a child with attachment issues?
There are various ways to help children with attachment disorders. However, patience, perspective, and understanding are necessary factors that are needed to help children with attachment disorders effectively. To help children with attachment disorders, either as a parent or primary caregiver, you need to exercise patience and understand and see things from the young child's perspective. You can also work to ensure the young children keep up with the treatment plan, remain calm and connect, develop a good sense of humor, have realistic expectations, take care of yourself, see a child and adolescent psychiatrist, and ask for support when needed. Helping children with attachment disorders can be tasking, but with a little patience with yourself and the young child, you can raise a young child and adolescent with secure connections. This way, you not only help children with attachment disorders, but you help yourself and contribute meaningfully to the community. Helping one child with reactive attachment disorder RAD is as good as helping others out there.
Does my child have an attachment disorder?
The best way to determine if you have children with attachment disorders is through diagnosis based on the manual of mental disorders. Children psychologists and other qualified healthcare givers make their diagnosis based on the diagnostic and statistical manual of mental disorders. However, before diagnosis, specific symptoms can serve as indications in children with attachment disorders. Based on the manual of mental disorders, some of these symptoms a child and adolescent exhibit include refusal to interact with primary caregivers or peers, failure to smile, anger issues, lack of empathy, and more. In early childhood or infancy, symptoms may include inconsolable crying, lack of coo sounds and eye contact, lack of eye-tracking, etc. Once these symptoms are noticed in your young child, it is crucial to immediately seek professional help from child and adolescent health caregivers. Early diagnosis in children with attachment disorder is key to effective treatment. However, if children with attachment disorders are left untreated, they become adults with disruptive attachment disorder symptoms and may end up raising children with attachment disorders.
How do I know if my child has a secure attachment?
Secure attachment is built and established between young children and their primary caregivers or parents when their emotional and physical needs are met during early childhood. This provides young children with a good foundation for mental and relationship development to reach the teen child and adolescent age and adulthood. You know your young child has a secure attachment when they smile back, interact effectively, respond to comforting and affection, respond to discipline, show empathy, etc. It is relatively easy to identify young children with secure attachments. A teen child and adolescent aged ward with a secure attachment will most likely do better in relationships, communication, and life generally, thereby not need treatment or professional help from a child and adolescent psychiatrist.
What are the signs of disinhibited attachment disorder?
Disinhibited reactive attachment disorder is a subtype of reactive attachment disorder. The signs and symptoms of disinhibited reactive attachment disorder are only slightly different from that of the disinhibited social engagement disorder. Some of the similar symptoms include overfamiliarity with strangers over parents or primary caregivers, social indiscrimination, and more. Child and Adolescent psychiatrists registered with the American Academy of Child and adolescent psychiatry can offer treatment options to primary caregivers and children with Disinhibited reactive attachment disorder and disinhibited social engagement disorders, and inhibited reactive attachment disorder. These treatment options for a child and adolescents tend to be similar as they stem from similar causes.
Can a child with reactive attachment disorder be cured?
There are several treatment options for children with RAD and a child and adolescent with other attachment disorders. Although these treatment options reduce the symptoms in children with RAD, it doesn't completely cure it. However, children with RAD can lead everyday lives in the future if the right treatment and adequate love and concern are given. The treatment options for children with RAD may vary depending on the severity of the mental disorder, age, and other factors. The treatment given can significantly reduce the symptoms of children with attachment disorders. It is worthy to note that children with RAD tend to have accompanying mental conditions, which may complicate the treatment options and outcomes. The treatment options for reactive attachment disorder may also be applied to disinhibited social engagement disorder in some cases. However, highly experienced and informed child psychiatrists are the best health caregivers for children with reactive attachment disorders RAD or disinhibited social engagement disorder. These children and adolescent health caregivers can provide various treatment options for children with attachment disorders and give reliable advice on which treatment is best for each child and adolescent.