CHEARS

Reactive attachment disorder is comparetively rare but investigators establish this condition to be serious, in which the neonate (new born within first 28 days after birth) or an infant (upto 1 year after birth) or toddler (upto 3 years of age) does not have a well established healthy attachments with their parents or caregivers. Reactive attachment disorder will be developed in children when the minimum fundamental requirements of comfort and affection are not fulfilled and the love and caring atmosphere with stable attachments with others aren't furnished in the early days or months of their birth.

During the growth of newborns, they develop a special cling to attach with people around them. They tend to honor their grown-ups who cover and guard them and calm them when they're crying or feeling stressed.

Attachment theorists upon evident research have identified that attachment and bond formation between the people is the basis for developing empathy. If a newborn does not get the chance to connect to a caretaker, they do not tend to learn how to empathize. The ability to empathize and connect to people around is also thought to be a major requirement for the development of a conscience.

When the newborn babies struggle to form a healthy connections with their family and edlerly care giver, they may face the condition of reactive attachment disorder. This can lead to a significant negative impact on the child's overall mental development and future bondings.

The American Psychiatric Association (APA) published its fifth edition of Diagnostic and Statistical Manual of Mental Disorders (DSM-5), which included the characteristic criteria for reactive attachment complaint as the persistent lack of meeting the emotional demands for comfort, stimulation and affection that are not offered by caregivers, or repeatedly changing of the primary caregivers that limit chances to form stable attachments of the newborns. RAD can come off in any of the two forms, it can reflect in a child to either avoid associations entirely or to strive exorbitantly to seek attention of other.

Reactive attachment disorder condition can start in infancy (below 1 month from the date of birth). There is only a little exploration on signs and symptoms of reactive attachment disorder in the early youth, and it still remains uncertain to confirm whether it occurs in children aged than 5 times.

Signs and symptoms may include

• Unexplainable fear, sadness or perverseness.

• Failure to express or smile.

• Restless and tired appearance.

• Not seeking comfort or displaying no response when comfort is given.

• Behaves unpredictable or awkward in social situations.

• Watching others keenly but not engaging in social relation.

Possible risk factors-

• The threat of developing reactive attachment disorder from serious social and emotional neglect or the lack of opportunity to develop stable attachments may increase in children who

• Live in a children's home or other institution.

• Again and again change the foster homes or caregivers .

• Have extended separation from parents or other caregivers due to hospitalization.

• Have a mother with postpartum depression.

• Are part of a nuclear family where both the parents are working and are unable to spend adequate time with their child due to their occupational schedules.

• Are part of an commonly large family, similar that maternal time is scarce or available unevenly or little due to other household responsibilities.

Psychiatric evaluation -

• In depth examination by a pediatric psychiatrist is necessary to diagnose the existence of reactive attachment disorder, evaluation process may include

• A series of direct observation of interaction with parents or their caregivers.

• A detailed supervision about the pattern of behaviour actions of the child over certain period of time.

TREATMENT

• There is no specific approved standard medicinal treatment for reactive attachment disorder but for the betterment of the child's intellectual and behavioral status there have to be a combimed involvement of both the child and their parents or primary caregivers. Early identification of this condition appears to enhance the positive results.

Aims of treatment

• To ease a safe and stable living surroundings of the child.

• To develop positive relations with parents, caregivers and further with the society.

Life style remedies or strategies may include

• Encouraging the child's functional development by being nurturing, caring and pampering.

• Delivering with a harmonious caregivers to promote a stable attachment for the child.

• Delivering warm, nurturing interaction with the child during feeding, bathing or changing diapers.

• Being diligently engaged with the child by lots of playing, talking, making eye contact, and smiling along with them.

Other measures that may advantage the child and the family include

• Individual and family counseling.

• Furnishing a positive, stimulating and interactive atmosphere around the child.

• Providing effective counseling sessions about the post delivery care and neonatal and infant care.

• Learning to interpret the baby's cues, identifying different types of cries effectively.

• Education of parents and caregivers about the symptomatic condition of the child.

• Addressing the child's medical, safety and housing needs.

Conclusion :

To feel safe and develop trust, new born babies and young children need a stable, caring, relabel surroundings. Their underlying emotional, mental and physical demands must be constantly fulfilled. Reactive attachment disorder is rare. Signs and symptoms can also pass in children who do not have reactive attachment disorder or who have other conditions similar as autism or ADHD (Attention deficit hyperactivity disorder. It is more important to have child evaluation by a pediatric psychiatrist who can diagnose whether the unusual actions indicate a more serious problem or not. Children who are diagnosed or identified to be suffering with reactive attachment disorder are believed to have the capacity to form attachments, but this competency has been turned off or compromised by the experiences they face in early days of their life. The best approach of treatment for a child with this complaint is a positive, loving, stable, caring atmosphere, adoring caregiver along with psychological counseling and education to the parents and care givers. With effective life style changes and needful measures, children with reactive attachment disorder may develop more stable and healthy connections with caregivers and other people. These steps could make a significant positive impact on the new born and can promote psychological strength along with the mental and social well being of the child in the future years of life.