Policy Statement on Coercive Interventions for Attachment Disorders
Attachment Disorders (Reactive Attachment Disorder and Disinhibited Social Engagement Disorder) are complex psychiatric illnesses characterized by problems in forming and maintaining emotional attachments with others. These difficulties usually present by five years of age and may be detected during the first year of life. Children with Reactive Attachment Disorder appear detached, unresponsive, inhibited, or reluctant to engage in age-appropriate social interactions, whereas children with Disinhibited Social Engagement Disorder may be overly and inappropriately social or familiar, even with strangers.
Attachment disorders are difficult to diagnose. Most children with attachment disorders have suffered severe disruptions in their early relationships. Many have experienced physical, sexual, or emotional abuse or neglect. Others have experienced multiple traumatic losses or changes in their primary caretaker. Many severely traumatized children present with complex problems and symptoms, including difficulties with attachment, but do not meet diagnostic criteria for attachment disorders. Others presenting with symptoms of attachment disorders are misdiagnosed with other neurological or genetic disorders that may mimic signs of attachment disorders.
Because of these diagnostic difficulties, children who exhibit signs of an attachment disorder require comprehensive psychiatric evaluation and individualized treatment plans developed 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 complicated by self-endangering behavior, time-limited placement in a safe, therapeutic setting may be necessary. Nevertheless, family settings with appropriate supports for caregivers that maximize opportunities for the child to develop selective attachments are usually most helpful.
Some therapists use coercive interventions like "rebirthing techniques" or "compression holding therapy" as treatment. Interventions that include physically coercive methods such as forcibly holding a child to improve attachment, using hunger or thirst, or forcing food or water upon the child, can be dangerous and even deadly.
There is no scientific evidence that such coercive interventions are effective, and deaths associated with these practices demonstrate their danger. These techniques also violate the fundamental human rights of the children subjected to them.
To ensure that children and adolescents with attachment-related disorders receive safe and therapeutic treatment, the American Academy of Child and Adolescent Psychiatry:
- Supports comprehensive psychiatric evaluations and individualized treatment plans developed by experts in the differential diagnosis and treatment of attachment-related disorders and
- Opposes the use of dangerous coercive interventions as treatment for attachment-related disorders.