Premature birth, low birth weight, and neonatal intensive care are associated with the risk of being diagnosed with reactive attachment disorder (RAD) showed a study by the Research Centre for Child Psychiatry of the University of Turku, Finland. Reactive attachment disorder causes problems in emotional bonding, social interaction, and expression of emotions, and it can lead to severe and expensive consequences later in life. The disorder will impair child’s ability to function in normal situations and their social interactions and it is connected with later child protection issues, psychiatric and substance use disorders, and social exclusion.
The study showed that children's risk of being diagnosed with reactive attachment disorder increases by three times if their gestational age at birth is less than 32 weeks. The risk was twofold if the birth weight was less than 2.5 kilos, or if the newborn required monitoring in a Neonatal Intensive Care Unit."
Subina Upadhyaya, lead author, researcher
The results acknowledged parental age and psychiatric and substance abuse diagnoses, and mother's socio-economic status and smoking. Therefore, the association between attachment disorder and early preterm birth is not due to differences in these parental background or lifestyle differences between the diagnosed and the control group.
This is the first population study to report perinatal and obstetric risk factors for RAD. Previously, the research group discovered an association between parental mental health diagnosis, parental substance abuse and RAD.
Results support family-centered treatment
According to Professor in Child Psychiatry Andre Sourander from the University of Turku, the results benefit the planning of preventive and early mental health services.
- The fact that premature birth is so strongly associated with reactive attachment disorder is an important finding. It indicates that family-centered support of early parent-infant interactions and need for care should be taken into account when treating premature babies, says Sourander, who led the study.
Sourander says that most of the children in the study were born in the 1990s and early 2000s. Treatment practices have changed since then in many countries.
- The management of premature infants should be multidisciplinary and personalized. Parent-infant interaction and family-centered care have recently received attention, and the care of premature infants has become increasingly comprehensive. The practice of skin-to-skin care is increasingly becoming popular worldwide. Early parental-infant closeness should be encouraged in centers that care for preterm infants.
- In the future, it is important to determine whether the independent relationship of prematurity to RAD has decreased as treatment practices have changed, Professor Sourander concludes.
All the children who were born in Finland between 1991-2012 and diagnosed with RAD were included in the study. There were a total of 614 cases and 2423 controls. The study was part of Inequalities, Interventions, and New Welfare State research flagship funded by Academy of Finland.
Upadhyaya, S., et al. (2020) Perinatal risk factors and reactive attachment disorder: A nationwide population‐based study. Acta Paediatrica. doi.org/10.1111/apa.15156.