Parents' mental health problems increase the risk of reactive attachment disorder in children

Children's risk of being diagnosed with reactive attachment disorder (RAD) increases if parents are diagnosed with any type of mental health disorder, discovered researchers from the Research Centre for Child Psychiatry of the University of Turku, Finland. Particularly parents' alcohol and drug addiction and mother's depression were associated with reactive attachment disorder in children. The nationwide population-based study is the most extensive study on the risk factors of RAD.

Reactive attachment disorder is a disorder of social functioning where the child's ability to form normal attachment relationships is disrupted. RAD is characterised by ambivalence about seeking comfort from a caregiver, emotional withdrawal, lack of social approach, reduced positive affect, and unexplained fear or irritability. If left untreated, the disorder will affect the course of the child's entire life, ability to function, and later relationships.

The study showed that, if both parents had a psychiatric diagnosis, the child's risk of RAD diagnosis was 51 times higher than that of children whose parents were not diagnosed with a disorder. Mother's mental health diagnosis increased the child's risk of RAD by nine-fold and father's diagnosis by six-fold.

"The most common combination of psychiatric diagnoses in parents whose children were diagnosed with RAD was both parents diagnosed with alcohol and drug addiction or abuse, which was among 20 percent of RAD cases. The second common combination was mothers' diagnosed with depression and fathers' diagnosed with alcohol and drug addiction or abuse, met in approximately 17 percent of RAD cases," says lead author Subina Upadhyaya from the Research Centre for Child Psychiatry.

All the 614 children diagnosed with RAD in Finland between 1991–2012 participated in the study. In earlier studies, the association of reactive attachment disorder with risk factors has generally been studied in unusual circumstances, such as children in institutional or foster care or in maltreated children.

"Our results are in line with the previous studies with a more limited data. Furthermore, we discovered in our population-based study that RAD is connected with maternal smoking during pregnancy, single motherhood, and advanced paternal age," says Upadhyaya.

Screening and Low-threshold Care Needed for Substance Abuse and Mental Health Problems during Pregnancy

Even though the disorder affects under a percent of the entire population, it is a significant and expensive problem according to Professor in Child Psychiatry Andre Sourander.

"The disorder is connected with later child protection issues, other psychiatric disorders, and social exclusion. The treatments are exacting and expensive and the evidence of their effectiveness is very limited," says Professor Sourander from the Research Centre for Child Psychiatry of the University of Turku.

He leads a research group focusing on risk factors during pregnancy which are associated with mental disorders.

"When compared with our earlier results in several other psychiatric disorders associated with parents' psychiatric diagnoses or substance abuse, the connection is unusually strong in reactive attachment disorder. This means that RAD is strongly associated with prenatal brain development and being subjected to intoxicants," Sourander explains.

He says the results should be taken into consideration when planning mental health care services. Parents' substance abuse and mental health disorders should be actively screened during pregnancy and low-threshold services based on research results should be developed for treating these disorders.