Reactive attachment disorder

Loving, peace-filled parents are the healing prescription

By Debi A. Grebenik, PHD

When attachment is interrupted or incomplete, resulting in behavioural responses that meet specified criteria, the diagnosis of reactive attachment disorder may be given. According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR, Fourth Edition, Text Revision), reactive attachment disorder is a disorder caused by a lack of attachment to any specific caregiver at an early age, and it results in the inability of the child to form normal, loving relationships with others. Because reactive attachment disorder results from an interruption in the bonding cycle, the interruptions may be caused by various factors such as in-utero substance abuse, parental neglect and physical abuse. Additional factors include maternal ambivalence, depression or illness, which all alter the baby's growth and development.

Adopted children are more likely to exhibit emotional, behavioural and educational problems than children who are raised by their biological parents.1 This is due to the fact that, on average, they have experienced an interruption in attachment. For example, having a greater number of caregivers may have prevented them from having that crucial experience of forming a strong, secure attachment in infancy.

But whether adopted or not, any child may experience stressors such as abuse, neglect or trauma, prenatally or during the first years of their lives. The most damage or benefit is realized during the first 36 months of a child's life, during which time the human brain develops to 90 per cent of its adult size. This is also the time when the brain builds the systems and structures that will lay down future tracts for social, emotional, behavioural and intellectual responses.2

It is during this crucial period of brain development that a child can be scarred significantly. When the primary needs for survival are not met consistently and appropriately, the effects are significant, even if those effects may take some time to become apparent. As the behaviours surface, a therapist should assess if the child meets the threshold for a diagnosis of reactive attachment disorder. The child must meet the criteria as identified by the Diagnostic and Statistical Manual of Mental Disorders. Children may experience attachment challenges, but it is only when the attachment challenges begin to affect the child's life negatively that it is considered a disorder.

It is important to note that when a child experiences significant neglect, holes are created in the brain, interfering with a child's ability to think consequentially. (For more information, see The beauty is that these holes can be healed (over time) through restorative and regulated relationships with parents who are calm, peaceful and committed. This peace comes from more than just an emotionally healthy life. Ultimately, it comes through Jesus Christ our Lord. As He promises in John 14:27, "Peace I leave with you; My peace I give you. I do not give to you as the world gives. Do not let your hearts be troubled and do not be afraid." Typically (but not always), healing takes about 15 to 18 months to occur.

While most families want their attachment-challenged child to be in therapy – and it's true that therapy is beneficial – keep in mind that the child's most effective therapists are the parents, guided by God, the loving Father. This healing can be a slow, evolving process; however, be encouraged that some progress can be seen early on. Parents need to remember that parenting an attachment-challenged child is a marathon, not a sprint. Parents, with the support of a specially trained Christian therapist, can give the child the loving, calm and consistent environment needed to bring about the child's emotional and spiritual healing.

It is also important to remember that parenting will bring up our own fears: Am I doing the right thing? How can I keep my child safe? What if my child acts out in church? In public? What will others think? How will this affect my other children? My marriage? Do I have what it takes? Once again Scripture points us down the right path in 1 John 4:18, "There is no fear in love. But perfect love drives out fear, because fear has to do with punishment. The one who fears is not made perfect in love." Those fears can be mitigated within the context of relationship. These relationships include friends, family and church. Within these relationships fears can be expressed, processed and understood.

Armed with understanding, parents will not be crippled by their own fears. Most of us know the value of "venting" our emotions to a good friend, spouse, pastor or therapist. This venting provides a therapeutic opportunity to express our emotions that prevents us from becoming emotionally frozen or handicapped.

The key here is to bask in the perfect love of the Father, while realizing that His love will fill the spaces where fear formerly resided. When we live this way, we can parent our children from a place of love, not of fear, responding to their needs before they even know they have a need, rather than reacting from a place of fear.

Next article in series: Promoting Healthy Attachment
First article in series: Attachment and Bonding

1. S. E. Kay Hall and G. Geher, "Behavioral and Personality Characteristics of Children with Reactive Attachment Disorder," Journal of Psychology: Interdisciplinary and Applied, 2003

2. Bruce Perry, MD, Bonding and Attachment in Maltreated Children (, 2001