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Tests and diagnosis
By Mayo Clinic staffTo be diagnosed with reactive attachment disorder, a baby or child must meet criteria spelled out in the Diagnostic and Statistical Manual of Mental Disorders (DSM). This manual is published by the American Psychiatric Association and is used by mental health providers to diagnose mental conditions and by insurance companies to reimburse for treatment.
The main criteria for the diagnosis of reactive attachment disorder must include:
- Disturbed and developmentally inappropriate social relationships beginning before age 5, not due to developmental delay (mental retardation)
- Failure to respond to or initiate social interactions, or being inappropriately friendly and familiar with strangers
- Failure of early caregivers to meet the baby's or child's emotional needs for comfort and affection, failure of early caregivers to attend to the child's physical needs, or repeated changes in the child's primary caregiver
Psychiatric evaluation
A thorough, in-depth examination by a psychiatrist is necessary to correctly diagnose reactive attachment disorder. This type of evaluation can take 90 minutes or longer.
A thorough evaluation may include:
- Direct observation of the baby's or child's interaction with his or her parents or caregivers
- Details about the baby's or child's pattern of behavior over time
- Examples of the baby's or child's behavior in a variety of situations
- Information about how the baby or child interacts with parents or caregivers as well as others, including other family members, peers and teachers
- An evaluation of the baby's or child's home and living situation since birth
- An evaluation of parenting and caregiver styles and abilities
Your child's doctor will also want to rule out other possible causes of behavior problems or emotional issues. Signs and symptoms of reactive attachment disorder may resemble those related to other disorders, such as:
- Post-traumatic stress disorder (PTSD)
- Anxiety disorders
- Adjustment disorder
- Autism spectrum disorders
- Social phobia
- Conduct disorder
- Attention-deficit/hyperactivity disorder (ADHD)
Disagreement over diagnosis methods
Not all experts agree on the signs and symptoms of reactive attachment disorder, or which tests should be used to diagnose the condition. Some therapists use checklists with numerous signs and symptoms that go beyond the criteria spelled out in the Diagnostic and Statistical Manual of Mental Disorders. Be cautious when trying to interpret checklists that include such signs and symptoms as lack of eye contact, rage, aggression, lying, stealing, hoarding food, an apparent lack of a conscience, nonstop chatter and a desire to wield control. These can be signs and symptoms of a number of mental health conditions.
- Reactive attachment disorder of infancy or early childhood. In: Diagnostic and Statistical Manual of Mental Disorders DSM-IV-TR. 4th ed. Arlington, Va.: American Psychiatric Association; 2000. http://www.psychiatryonline.com. Accessed June 23, 2009.
- Reactive attachment disorder. In: Moore DP, et al.: Handbook of Medical Psychiatry. 2nd ed. Philadelphia, Pa.: Mosby; 2004. http://www.mdconsult.com/das/book/body/145545363-3/0/1243/32.html?tocnode=52436085&fromURL=32.html#4-u1.0-B0-323-02911-6..50032-4_311. Accessed June 23, 2009.
- Newman L, et al. Recent advances in the theories of and interventions with attachment disorders. Current Opinion in Psychiatry. 2007;20:343.
- Haugaard JJ, et al. Recognizing and treating uncommon emotional disorders in children and adolescents who have been severely maltreated: Reactive attachment disorder. Child Maltreatment. 2004;9:154.
- Cornell T, et al. Clinical interventions for children with attachment problems. Journal of Child and Adolescent Psychiatric Nursing. 2008;21:35.
- Hanson RF, et al. Reactive attachment disorder: What we know about the disorder and implications for treatment. Child Maltreatment. 2000;5:137.
- Report of the American Professional Society on the Abuse of Children Task Force on Attachment Therapy, RAD and Attachment Problems. American Psychiatric Association. http://www.apa.org/divisions/div37/RADTaskForceManuscript.pdf. Accessed July 1, 2009.
- Coercive interventions for reactive attachment disorder. Association for Treatment and Training in the Attachment of Children. http://www.attach.org/apsac.htm. Accessed July 1, 2009.
- Child Abuse and Neglect Committee. American Academy of Child & Adolescent Psychiatry. http://www.aacap.org/cs/root/policy_statements/coercive_interventions_for_reactive_attachment_disorder. Accessed June 29, 2009.
