96 Reactive Attachment Disorder of Infancy or Early Childhood (313.89)
96 Reactive Attachment Disorder of Infancy or Early Childhood (313.89)
DSM-IV-TR criteria
- A. Markedly disturbed and developmentally inappropriate social relatedness in most contexts, beginning before age 5 years, as evidenced by either (1) or (2):
- (1) Persistent failure to initiate or respond in a developmentally appropriate fashion to most social interactions, as manifest by excessively inhibited, hypervigilant, or highly ambivalent 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).
- (2) Diffuse attachments as manifest by indiscriminate sociability with marked inability to exhibit appropriate selective attachments (e.g., excessive familiarity with relative strangers or lack of selectivity in choice of attachment figures).
- B. The disturbance in Criterion A is not accounted for solely by developmental delay (as in mental retardation) and does not meet criteria for a Pervasive Developmental Disorder.
- C. Pathogenic care as evidenced by at least one of the following:
- Persistent disregard of the child’s basic emotional needs for comfort, stimulation, and affection.
- Persistent disregard of the child’s basic physical needs.
- Repeated changes or primary caregivers that prevent formation of stable attachments (e.g., frequent changes in foster care).
- D. There is a presumption that the care in Criterion C is responsible for the disturbed behavior in Criterion A (e.g., the disturbances in Criterion A began following the pathogenic care in Criterion C).
Specific types: Inhibited Type: if Criterion A1 predominates in the clinical presentation. Disinhibited Type: if Criterion A2 predominates in the clinical presentation.
Associated features
Certain situations may cause parents to develop a way of caring, known as pathological caring. These situations may include things such as long hospitalization of the child, extreme poverty, and the inexperience of the parents or caretaker (DSM-IV-TR, 2000). Pathological care is defined as a parental caring type in which they ignore the child’s basic needs; these needs may be emotional and/or physical needs. Grossly pathological care does not always cause the development of Reactive Attachment Disorder (DSM-IV-TR, 2000). Some children cared for in this manner are still able to form “normal” social attachments. Extreme neglect does however increase the risk for development of Reactive Attachment Disorder. This disorder may also be associated with developmental delays, Feeding Disorder of Infancy or Early Childhood, Pica, or Rumination Disorder (DSM-IV-TR, 2000).
Child vs. adult presentation
Reactive Attachment Disorder typically begins before the child is 5 years of age. Remission of this disorder can occur by receiving proper care and a supportive environment. If such things are not provided, the disorder will follow a continuous course, causing the individual’s inability to form “norm