Attachment Disorders (Disinhibited Social Engagement Disorder and Reactive Attachment Disorder) and Related Relationship Problems Ages 0–5 CLINICAL PEARLS • Although attachment disorders are relatively uncommon, relationship problems between an infant or young child and the caregiver happen frequently. • Primary care clinicians are important in early identification of relationship problems due to the ability to observe an infant or young child and caregiver over time. • There are no medications to treat attachment disorders or relationship problems; however, there are effective evidenced-based therapy modalities that have been shown to be effective. Effective treatment requires the participation of a primary caregiver. • Evaluations for attachment disorders should be done by an infant mental health trained clinician. Evaluations include specific relationship assessments. • Treatment focuses on building the relationship of the infant or young child with the primary caregiver. • It is important that the child has a consistent, safe attachment figure in order to improve. • Congregate care can lead to a worsening of symptoms of attachment disorders and relationship problems. • The Oklahoma Warmline (888-574-5437) is available to help find treatment providers for infants and young children. RATING SCALES • There is no primary care screening tool for attachment disorders. There are relationship questions and environmental safety questions below that the clinician can use for decisions about referrals. These should be combined with observations made in the clinic of relationship concerns between the child and the parent. ￮ Survey of Well-Being of Young Children Screens three domains – developmental, emotional and behavioral, and family context, including attachment and safety questions. https://www.floatinghospital.org/The-Survey-of-Wellbeing-of-Young-Children/Overview ￮ Ages and Stages Social Emotional Developmental Screening (ASQ-SE) Social emotional developmental screening tool Free for Oklahomans through www.sproutsdevelopment.com/
M E D I C I N E . O K S T A T E . E D U
9
