Signs & Symptoms

The physical and emotional milestones of children with Reactive Attachment Disorder deviate from expected developmental norms. Many of the children appear significantly malnourished. They may show a pattern of inhibited, hypervigilant or ambivalent reactions (e.g., frozen watchfulness, resistance to comfort, or a mixture of approach and avoidance). Dullness, listlessness or apathy with a lack of spontaneous activity and reciprocity with the caregiver are often seen. Some children look sad, unhappy, joyless or miserable. Older infants show minimal curiosity about their surroundings and little exploratory behavior. They may show delayed responsiveness to a stimulus that might elicit fright or withdrawal in other children. Some may shrink from contact; others may exhibit indiscriminate attachments.

There are two major subtypes of Reactive Attachment Disorder:

  1. Inhibited type—the child's predominant disturbance is the persistent failure to initiate and to respond to most social interactions in a developmentally appropriate way.
  2. Disinhibited type—the child's predominant disturbance is indiscriminate sociability or a lack of selectivity in the choice of attachment figures.

Co-Occurring Disorders

Reactive Attachment Disorder may resemble other disorders. It may be associated with developmental delays, Feeding Disorder of Infancy and Early Childhood, Pica or Rumination Disorder. Laboratory findings consistent with malnutrition may be present. Physical examination may document medical conditions, such as growth delay or evidence of physical abuse, that might contribute to, or result from, difficulties in caring for the child.

Related Disorders

Reactive Attachment Disorder must be distinguished from Severe Mental Retardation, Autistic Disorder or other Pervasive Developmental Disorders. Unlike Reactive Attachment Disorder, however, these other disorders usually occur in the context of a reasonably supportive psychosocial environment whereas Reactive Attachment Disorder is due to a grossly deprived environment. Autistic Disorder and Reactive Attachment Disorder may seem similar; however it is important to note that a child with autism has a neurologically based disability which impedes expected development in social relationships whereas a child with Reactive Attachment Disorder has the capacity to comprehend social relationships, but does not function appropriately. Neglect, not a neurological difficulty, is the causal factor.