Diagnosis

A pediatric psychiatrist or psychologist can conduct a thorough, in-depth examination to diagnose reactive attachment disorder.

Your child's evaluation may include:

• Direct observation of interaction with parents or caregivers
• Details about the pattern of behavior over time
• Examples of the behavior in a variety of situations
• Information about interactions with parents or caregivers and others
• Questions about the home and living situation since birth
• An evaluation of parenting and caregiving styles and abilities

Your child's doctor will also want to rule out other psychiatric disorders and determine if any other mental health conditions co-exist, such as:

• Intellectual disability
• Other adjustment disorders
• Autism spectrum disorder
• Depressive disorders

Diagnostic and Statistical Manual of Mental Disorders (DMS-5)

Your doctor may use the diagnostic criteria for reactive attachment disorder in the DSM-5, published by the American Psychiatric Association. Diagnosis isn't usually made before 9 months of age. Signs and symptoms appear before the age of 5 years.

Criteria include:

• A consistent pattern of emotionally withdrawn behavior toward caregivers, shown by rarely seeking or not responding to comfort when distressed
• Persistent social and emotional problems that include minimal responsiveness to others, no positive response to interactions, or unexplained irritability, sadness or fearfulness during interactions with caregivers
• Persistent lack of having emotional needs for comfort, stimulation and affection met by caregivers, or repeated changes of primary caregivers that limit opportunities to form stable attachments, or care in a setting that severely limits opportunities to form attachments (such as an institution)
• No diagnosis of autism spectrum disorder