Etiology (Biopsychosocial Model)

Biological: Possible early neurodevelopmental vulnerability.

Psychological: Lack of early attachment formation.

Social: Neglect, frequent changes in caregivers, institutional rearing.

Prevalence

Found in ~20% of severely neglected children; rare in general population.

Symptoms & Diagnosis (Mnemonic: CARE)

• C - Clings or approaches unfamiliar adults indiscriminately
• A - Absence of hesitation or checking back with caregiver
• R - Reduced or absent reticence in unfamiliar settings
• E - Experience of neglect, institutionalization, or frequent caregiver changes
• Symptoms must persist for 9+ months and start before age 5

Treatment

• Trauma-informed therapy (e.g., attachment-based interventions)
• Stable caregiving environment
• Psychoeducation for caregivers