Attachment Disorder in Children: Causes, Types, and Signs

An attachment disorder is a condition that stems from an infant’s inability to establish a secure bond with his or her mother or primary caregiver at a time when he or she is totally dependent on them to meet his or her basic needs. The young child internalizes the way these needs are met or not, which in turn has a profound impact on his or her mental, social, and emotional development.

A nurturing attachment provides the child with a secure base from which to explore his or her environment and engage with others, whereas a little one who repeatedly feels  abandoned or uncared for will learn that he or she can’t depend on others, and grow up with fear and trust issues that lead to difficulty forming healthy attachments and relationships later in life (Bowlby).

Possible causes of attachment disorder in children.

• Constant disregard of the baby’s emotional needs. No one responds or offers comfort when he or she cries.
• No one talks to or smiles at the baby.
• Constant disregard of the baby’s physical needs. Delayed response when he or she is hungry or needs a diaper change.
• The infant is abused or traumatized in some way.
• The infant’s parent or primary caregiver is emotionally unavailable because of substance abuse, depression, or chronic illness.
• Repeated changes of caregivers as a result of the loss of a parent or being placed in foster care, for example, which prevents the baby from forming stable attachments.
• Inconsistent, unpredictable care. Sometimes the baby’s needs are met and sometimes not, so he or she never knows what to expect.
• Prolonged separation from parents or primary caregiver due to hospitalization.

Types of attachment disorder in children.

The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) lists two forms of attachment disorder in children: Reactive Attachment Disorder (RAD) and Disinhibited Social Engagement Disorder (DSED). Both these conditions manifest before the age of five, with symptoms appearing as early as nine to twelve months of age.

The most important intervention is to establish a nurturing home environment, with a stable, reliable, loving caregiver sensitive to the child’s needs, who is physically and emotionally available to him or her, and who can help him or her develop an internal sense of security.

Reactive Attachment Disorder (RAD). Children with reactive attachment disorder rarely seek or respond to comfort when distressed. They have difficulty managing their emotions or connecting to others, and may push them away or act out aggressively if they try to get close. RAD is often the result of serious neglect due to the mother or primary caregiver’s failure to respond to their child’s basic needs during the first few months of his or her life.

Disinhibited Social Engagement Disorder (DSED). Unlike children with RAD who fear interactions with others, children with disinhibited social engagement disorder seem friendly and outgoing. In fact, their main symptom is a lack of wariness of strangers, which can put them at increased risk of harm due to their willingness to approach and wander off with unfamiliar people.

They show little to no concern for the whereabouts of their parent or primary caregiver, even in unfamiliar settings, and may look for comfort or affection from adults they don’t know. DSED is typically the result of social neglect and/or the lack of a long-term primary caregiver during the first two years of life.

Early warning signs of insecure attachment.

Insecure attachment is rooted in infancy. The earlier you spot the symptoms, the easier it is to correct them. Following are some common warning signs.

• Your baby doesn’t turn to you when he or she feels upset.
• Your baby doesn’t smile, coo, follow you with his or her eyes, or reach out to be picked up.
• Your baby cries inconsolably.
• Your baby shows no interest in playing peek-a-boo or other interactive games.

Common signs of attachment disorder in children.

An aversion to being touched. Children with reactive attachment disorder may perceive physical affection as a threat rather than a comfort.

Control issues. Children with reactive attachment disorder often try to avoid feeling helpless by being defiant, disobedient, or argumentative.

Anger issues. A child with reactive attachment disorder may be prone to tantrums or acting out.

Inability to show genuine care or affection. Children with disinhibited social engagement disorder tend to act inappropriately friendly and affectionate with strangers while showing little or no affection towards their parent or primary caregiver.

Lack of inhibition. A child with disinhibited social engagement disorder tends to be inappropriately talkative, intrusive, or physical with strangers.

Parenting a child with attachment issues.

Have realistic expectations. Focus on taking small steps and celebrate every sign of success.

Be patient. Being patient and focusing on small improvements will help your child feel safe.

Set boundaries. Setting boundaries helps children know what is expected of them and what will happen when they break the rules. It adds stability to their environment and helps them behave appropriately.

Maintain predictable routines. As much as possible, try to maintain predictable routines and schedules. Children with attachment disorders tend to feel threatened by inconsistency, and a familiar routine or schedule can be comforting during times of change.

Keep your cool. Remain calm when your child misbehaves, and follow through with the consequences you established and that your child knows well, to discipline him or her.

Reconnect after a conflict. When you have to discipline your child, be ready to reconnect as soon as he or she is ready. This will help develop your child’s trust in your consistency and love.

Show consistent love and affection. Do things with your child that show him or her your love, like reading to them, playing with them, rocking them, giving them hugs, or telling him or her how special they are.

Find things to laugh about. Joy and laughter can dissipate tension and help repair some attachment issues.

Seek professional help. The earlier the better. The extra support can make a dramatic difference.

Treatment options.

Individual therapy

During individual counseling sessions the counselor will address issues that are affecting the relationship and preventing secure bonding between the child and his/her parents or primary caregiver. The focus will be on identifying problem areas and reducing the unhealthy behaviors that are causing the child’s attachment issues.

Family therapy

Family therapy helps the child’s family members understand the nature of the disorder, the importance of stability, and how best to interact with the child to make him or her feel cared for and safe. The focus is on developing healthy patterns that will strengthen the attachment bond between the child and his parents or primary caregiver.

Play therapy

Play therapy can help your child learn how to interact with others and handle social situations. It is also a technique that allows the child and his or her parent or caregiver to express their thoughts, fears, and needs within the safe context of play.

If you have concerns about your child’s mental health, please give us a call today. We would be happy to answer your questions and/or set up an appointment to meet with you.