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Parental psychopathology increases risk for reactive attachment disorder in children

Children whose parents were both diagnosed with a psychiatric illness were at 51-times higher risk for developing reactive attachment disorder than those whose parents were not diagnosed with a disorder, according to a nationwide population-based study in Finland.

“Reactive attachment disorder has mostly been studied in high-risk populations,” Subina Upadhyaya, MPH, from the Research Center for Child Psychiatry, University of Turku, Finland, and colleagues wrote. “[Reactive attachment disorder] needs to be distinguished from other psychopathologies that involve hypervigilance and behaviors associated with autism spectrum disorders.”

The researchers reported findings from the first nationwide register-based study evaluating specific parental psychiatric diagnoses linked to offspring reactive attachment disorder (RAD). In the study, they also examined some parental risk factors linked to offspring RAD (ie, maternal smoking during pregnancy, socioeconomic status, marital status, living in an urban area and parental age). Using the Finnish Care Register for Health Care, the investigators identified more than 600 children diagnosed with RAD then matched each case with four controls.

Analysis revealed that all the psychiatric disorders in both the mothers and fathers were linked to reactive attachment disorder in children.

The results showed that risk for the disorder was significantly greater when both parents had any psychiatric disorders (OR = 51.47; 95% CI, 31.5-84.11) compared with only mothers or only fathers (P < .001 for both). In addition, there was an increased risk for RAD when only mothers received a psychiatric disorder diagnosis (OR = 8.82; 95% CI, 5.87-13.26) and only fathers received a psychiatric disorder diagnosis (OR = 5.6; 95% CI, 3.56-8.82).

Upadhyaya and colleagues also found that maternal smoking during pregnancy (OR = 2.34; 95% CI, 1.67-3.28), single motherhood (OR = 2.18; 95% CI, 1.29-3.66) and advanced paternal age (OR = 2.85; 95% CI, 1.32-6.14) were associated with higher odds of RAD.

Some other important findings from the study include:

• 20.03% of children with RAD had both parents with alcohol and drug addiction/abuse;
• 17.43% had mothers diagnosed with depression and fathers with alcohol and drug addiction/abuse; and
• 10.75% had both parents with depression.

“The mechanisms behind these associations can be explained by genetic factors, adversities related to parenting and parental risk behavior exposing the fetal brain to substance use. It is likely that these factors interact with, and strengthen, each other,” the researchers wrote. “As secure attachment during early childhood is considered to be one of the key elements for good mental health later in life, it is important to identify and help parents with psychiatric problems to develop a positive environment for their child as early as the antenatal period.” – by Savannah Demko

Disclosure: The authors report no relevant financial disclosures.