Reactive Attachment

Disorder
 Diagnostic Criteria

 Consistent inhibited, emotionally withdrawn behavior towards adults and

caregivers.
 Rarely or minimally seeks or responds to comfort, when distressed.
 Persistent social and emotional disturbance and responsiveness to others,
 Limited positive affect,
 Child has experienced extreme insufficient care or lack of basic emotional need,
 Repeated changes in primary caregivers or rearing in an unusual settings.
 Onset and development age is atleast 9 months to 5 years.
 Differential Diagnosis

Autistic Spectrum Disorder

 Autism and R.A,D is distinguished on the basis of differential `Histories of

neglect`. R.A.D cases have suffered a history of severe social neglect, while
Autism will rarely have a neglect history.
 In Autism, impairment in social communication is deliberate. While in
R.A.D, Children show communicative functioning according to their
overall level of intellectual functioning.
 Differential Diagnosis

Depressive Disorder

 Reduction in Positive Affect in both depression and R.A.D. But children

with depressive disorder does not have impairment in attachment and they
still seek and respond to comforting efforts by caregivers.
 Comorbidity

 Cognitive delays, language delays and Stereotypies i.e conditions associated

with neglect can co-occur with reactive attachment disorder.
Risk And Prognostic Factors

 The only known risk factor for this disorder is `Serious Social Neglect`, and
it is a diagnostic requirement.
 Suggested Treatments

 Enhanced and Normative care giving environments can be a remedy for

symptomatic recovery.
 Providing consistent Positive stimulating and interactive environment and
being responsive, caring and and nurturing.