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Attachment Disorders

Children living in institutions from an early age, who are rarely touched or spoken to, and don’t receive much cuddling, affection and reassurance, may fail to learn how to connect to their primary caregiver. They may subsequently display attachment problems with their adoptive families. This is particularly true of children adopted when they are older.

Here is an overview of how to recognize two different attachment disorders. Please seek qualified professionals for help to address these issues.

Reactive Attachment Disorder

DSM-5, the diagnostic tool published by the American Psychiatric Association to help diagnose psychiatric issues, defines Reactive Attachment Disorder as:

  1. A consistent pattern of inhibited, emotionally withdrawn behavior toward adult caregivers, manifested by both of the following:
    • The child rarely or minimally seeks comfort when distressed.
    • The child rarely or minimally responds to comfort when distressed.
  2. A persistent social or emotional disturbance characterized by at least two of the following:
    • Minimal social and emotional responsiveness to others
    • Limited positive affect (limited ability to experience joy)
    • Episodes of unexplained irritability, sadness or fearfulness that are evident even during non-threatening interactions with adult caregivers.

Disinhibited Social Engagement Disorder

DSM-5 defines this as a pattern of behavior in which a child actively approaches and interacts with unfamiliar adults and exhibits at least two of the following:

  • Reduced or absent reticence in approaching and interacting with unfamiliar adults.
  • Overly familiar verbal or physical behavior (that is not consistent with culturally sanctioned and with age-appropriate social boundaries).
  • Diminished or absent checking back with adult caregiver after venturing away, even in unfamiliar settings.
  • Willingness to go off with an unfamiliar adult with little or no hesitation.

These behaviors usually manifest under 5 years of age and are techniques for coping with unreliable caregivers.

To develop attachment skills, your child will need:

  • extra compassion and kindness
  • appropriate rules, structure and boundaries
  • consistency in application of rules
  • varied exercise and sensory enrichment activities
  • cuddling, feeding and rocking
  • building trust and increasing feelings of safety
  • focus on building connections with adoptive parents
  • limit interactions with extended family for a while, if necessary
  • lessons in treating people with kindness and respect

The following are signs of healthy attachment:

  • A newborn or infant will soothe when hearing your voice, will look for you when he/she is anxious, and get excited when he/she sees you and will reach out to be held by you
  • A toddler or child will seek you out for affection and play, prefer being with you, goes to you for help and accepts soothing from you

If you feel your child has an attachment disorder, please seek our therapists who are skilled in adoption challenges.


  1. “Reactive attachment disorder and adoption” (parents.com)
  2. Book: “The Connected Child” – Karyn Purvis, David Cross and Wendy Sunshine (2007)
  3. Book: “Nurturing Adoptions: Creating Resilience after Neglect and Trauma” – Deborah Gray (2007)

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