What are Attachment Disorders?

During infancy, children start forming relationships and bonds with their caregivers. Secure attachment involves developing a trusting relationship with caregivers (often parents) who provide comfort and safety, so that exploration of surroundings is possible. When children have caregivers who are unreliable, harsh, non-attentive, absent, abusive, or neglectful, they may develop attachment problems. Two types of attachment disorders are Reactive Attachment Disorder and Disinhibited Social Engagement Disorder.

What is Reactive Attachment Disorder?

Reactive Attachment Disorder is when children are consistently emotionally withdrawn, avoidant, or indifferent to their caregivers. For example, if they are in distress they will not bother to seek comfort from a caregiver, or they will minimally respond to comfort that is offered. They may also demonstrate a lack of social or emotional interest in others, show few positive emotions, or show signs of unpredictable irritability, sadness, or fear when in the presence of a caregiver.

What is Disinhibited Social Engagement Disorder?

Disinhibited Social Engagement Disorder is when a child ages 9 months or older, willingly approaches strangers or unfamiliar adults in a manner that shows little reluctance, or in an overly familiar manner that violates social norms (e.g., hugging or kissing a stranger right away), or involves lack of checking in after wandering away, or little or no hesitation to go off with an unfamiliar adult. These behaviours are related to impulse control (e.g., children with ADHD), but reflect a lack of social-emotional boundaries.

What causes Reactive Attachment Disorder or Disinhibited Social Engagement Disorder?

These disorders can develop over a period of time where care from adults has been insufficient to meet the child’s needs. For example if…

  • Emotional needs are neglected: not enough comfort, stimulation, or affection is given
  • Lack of stability: if caregivers change often (eg in foster care), there may be little opportunity to build stable relationships with someone
  • Unusual settings where there are many children and not enough caregivers, so a child cannot access an adult in a stable and consistent manner, in order to form a secure attachment

How can therapy help?

Therapy can involve working with children directly, and with their caregivers too. Therapy can help parents learn how to foster stable, reliable, and loving relationships, so that healthy attachments can form, optimizing children’s social and emotional development.

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