When early care goes off course

Reactive attachment disorder, in this account, is not classed as a developmental disorder. It is acquired, and because symptoms can ease when the environment improves, improving that environment is treated as the heart of care. The relationship with a parent has gone off course. A child may offer strong attachment almost at random, or may refuse contact. Growth may slow, and weight may fail to increase. In the first year, severe abdominal pain, reduced feeding, and frequent vomiting may be how the trouble first shows itself. Not distinguishing a stranger is normal up to about eight months; after that, it is treated as a problem. When the condition is serious or found late, and may threaten life, inpatient care is said to be required.

Two patterns are set out. In the disinhibited pattern, attachment is offered vaguely, and the ability to choose an attachment figure is lacking. In the inhibited pattern, the child is always wary and cool, and shows approach and avoidance at the same time. A diagnostic mark given here is trouble forming social relationships from before the age of five. At parting and reunion, a child may turn the eyes away while still coming closer — a contradictory, ambivalent response. The condition may also be linked with delayed development, feeding disorders, pica, and elimination disorders.

A resemblance to autism, and what treatment aims to repair

Because a child may startle at small sounds, avoid eye contact, and not answer when called, the picture can look like autism, and inattention or delayed intelligence and language have led some to speak of similar autism. The distinction drawn here is sharp. Autism is described as congenital. Reactive attachment disorder is described as acquired, from a later failure of the caregiving environment. In the earliest months, the child may still respond as other children do — smiling at peekaboo — and only later lose that response. Perception and the senses are said to develop in a typical way, so that with appropriate treatment a return toward a typical course is more likely.

Causes named include severe postnatal depression or a long hospital stay for the mother, a long stay for an ill or premature infant, very young parents, severe poverty, an emotionally deprived setting, parental psychiatric illness, and neglect, abuse, or mishandling. Left alone, the text warns, the condition can lead later to violent behavior, depression and anxiety, trouble at school, and problems with alcohol or drugs. Treatment is described as proper nutrition, care for physical after-effects, and the offer of stimulation and interaction. If a child is admitted, it is thought better to bring the mother into the process so that she does not feel isolated. If she is depressed, supportive group therapy, psychotherapy, and medication may be used together. Five kinds of help are listed: practical psychosocial support, psychotherapeutic work, education and counseling, close observation of the child's well-being, and, in some cases, a stay away from the parents. The writer adds that diagnoses of attachment disorder may be unusually common in Korea because of resistance to the word autism, and that prevention and loving care matter most. That closing remark is kept as the writer's view. No later official counts are added.

Sources

1. a clinical account of reactive attachment disorder as an acquired condition, with inhibited and disinhibited patterns, a contrast with autism, named causes and lines of treatment, and a writer's remark about diagnosis in Korea kept as that writer's view.

Last updated: 14 November 2026