Coercive Interventions for Reactive Attachment Disorder

Approved by Council November, 2003
Reviewed May, 2008
To be reviewed May 2013

Developed by the Child Abuse and Neglect Committee

Reactive Attachment Disorder is a complex psychiatric illness that is characterized by problems in forming and maintaining emotional attachments with others. These difficulties are usually present by 5 years of age, and may be detected during the first year of life. These children may appear detached, unresponsive, inhibited or reluctant to engage in age-appropriate social interactions. Alternatively, some children with Reactive Attachment Disorder may be overly and inappropriately social or familiar, even with strangers.

Reactive Attachment Disorder can be difficult to diagnose. Most children with Reactive Attachment Disorder have had problems or severe disruptions in their early relationships. Many have been physically, sexually or emotionally abused or neglected. Others have had multiple traumatic losses or changes in their primary caretaker. Many severely traumatized children present with complex problems and symptoms, but only partially meet diagnostic criteria for Reactive Attachment Disorder. Reactive Attachment Disorder is sometimes confused with Pervasive Developmental Disorder or other neurological disorders including deafness, and genetic disorders that may mimic signs of Reactive Attachment Disorder.

Because of these diagnostic difficulties, children who exhibit signs of Reactive Attachment Disorder require comprehensive psychiatric evaluation and individualized treatment plans by professionals who are expert in the differential diagnosis and treatment of these complex disorders. Treatment usually includes both individual and family interventions. In extreme cases of Reactive Attachment Disorder that are complicated by self-endangering behavior, placement in a safe, therapeutic setting may be necessary. Nevertheless, family settings that maximize opportunities for the child to develop selective attachments are usually most helpful.

Some therapists have used so called “rebirthing techniques” or “compression holding therapy” as treatments. These and other interventions that include physically coercive methods like adults forcibly holding a child to improve attachment, using hunger or thirst, or forcing food or water upon the child, can be dangerous. At least six documented child fatalities have occurred related to the use of these methods.

There is no scientific evidence that such coercive interventions are effective. The growing number of deaths associated with these practices demonstrates their danger. These techniques also violate the fundamental human rights of the children subjected to them. The AACAP therefore urges that these coercive, dangerous and ineffective practices be discontinued.