Attachment Disorder in Children

Healthy, secure attachment to a caregiver, usually the mother, is crucial to an infant and child's development. Secure attachment is developed as the primary caregiver responds to the baby's needs consistently, thereby creating a bond of trust between the caregiver and the baby. This attachment continues to grow and become stronger if this cycle continues and is not interrupted. Unfortunately, all children do not have the benefit of secure attachment. There are many conditions which can put a child at risk for developing an attachment disorder. Some of these are: sudden separation from primary caregiver, abuse or neglect, frequent moves or placements (foster care or failed adoptions), multiple caretakers, painful or invasive medical procedures, postpartum depression in mother and insensitive parenting. 'The most striking cases of attachment disorder are demonstrated by children who spent a large portion of their infancy in large institutions and orphanages. These children did not receive the basic nurturing human infants need to develop a positive internal working model' (Breazeale, 2001).

The Diagnostic and Statistical Manual of Mental Disorders fourth edition (DSM-IV) gives the diagnostic criteria for diagnosing Reactive Attachment Disorder (RAD) in children as follows:

Diagnostic Criteria for 313.89 Reative Attachment Disorder of Infancy or Early Childhood

A. Markedly disturbed and developmentally inappropriate social relatedness in most contexts, beginning before age 5 years, as evidenced by either (1) or (2):

(1) persistant failure to initiate or respond in a developmentally appropriate fashion to most social interactions, as manifest by excessively inhibited, hypervigilant, or highly ambivalant and contradictory responses (e.g., the child may respond to caregivers with a mixture of approach, avoidance, and resistance to comforting, or may exhibit frozen watchfulness)