Reactive attachment disorder ... Health Article

Definition

In reactive attachment disorder, the normal bond between infant and parent is not established or is broken. Infants normally "bond" or form an emotional attachment, to a parent or other caregiver by the eighth month of life. From about the second through the eighth month, most infants will respond to attention from a variety of caregivers, if the caregivers are familiar. By the eighth month, however, normal infants have established a strong emotional preference for one or two primary caregivers. They are distressed if separated from these caregivers for even a few hours, even if another familiar person is present. If this bonding process is interfered with, it can have severe emotional and physical consequences for the child.

Reactive attachment disorder is sometimes called a post-traumatic disorder.

Description

In reactive attachment disorder, an infant or young child has not formed an emotional bond with a parent or other caregiver. This affects the child's ability to interact normally with others. The child may have severe emotional and social problems that extend into adulthood. There may be learning problems and physical problems such as slow growth and failure to develop as expected.

Causes

An infant does not know how to form an emotional attachment to another person, any more than it knows how to feed or clean itself. Bonding is a necessary developmental step in a baby's growth. It occurs as the infant is cared for, talked to, played with, and comforted consistently. This helps the infant feel like it knows what will happen every time it sees a certain person. When this process is interfered with, the infant may never learn how to trust or love.

Many things can interfere with the bonding process:

• Loss of parents. The most common cause of reactive attachment disorder is being orphaned or put in foster care at a very early age. The infant may receive care from many people or be moved from place to place often. A bond to a single consistent caregiver cannot be formed.
• Neglector impaired caregiving. If the infant is not cared for consistently, it will not learn to trust. This includes emotional neglect, where the caregivers may keep the baby clean and fed, but do not allow time for play and bonding. Very often this occurs when the parent or caregiver has a problem that prevents him or her from giving adequate, consistent attention to the infant. Such problems include major depression, psychosis, drug or alcohol abuse, mental retardation, physical illness, and poverty. The parent may also have been a neglected child or may be very young themselves and simply not know how to parent adequately.
• Abuseor pain. Even if an infant is getting love and attention some of the time, it may not learn to attach if it comes to expect pain on occasion from the caregiver. Illness or pain that the caregiver cannot ease can have the same effect.

In disrupted families with more than one child, one child may have reactive attachment disorder while others do not. It is not clear what role personality plays in this problem.