# Attachment Difficulties: ICD-11 Features in Early Childhood

Canonical: https://pinnacleblooms.org/ask/what-is-attachment-difficulties-and-what-are-its-icd-11-features-in-early-childhood
Publisher: Pinnacle Blooms Network / Bharath Healthcare Laboratories Private Limited

ICD-11 frames Attachment Difficulties as Reactive Attachment Disorder (6B44) and Disinhibited Social Engagement Disorder (6B45), both presupposing grossly inadequate early care. 6B44 features inhibited, withdrawn behaviour and failure to seek comfort, evident before age 5 with a developmental age of at least 9 months, not better explained by autism.

*A young child's earliest relationships are the scaffolding for regulation, exploration and trust — and when that scaffolding is disrupted, the clinical picture is distinctive.*

## In short
**Attachment Difficulties** in ICD-11 are captured under two distinct disorders associated with grossly insufficient or pathogenic early care: **Reactive Attachment Disorder (6B44)** and **Disinhibited Social Engagement Disorder (6B45)**. Both presuppose a history of inadequate caregiving — neglect, repeated changes of primary carer, or institutional rearing — and emerge in early childhood once a child is developmentally capable of selective attachment (typically after ~9 months developmental age). They are not synonymous with autism or intellectual disability, though differential clarity matters.

## The clinical picture
**Reactive Attachment Disorder (6B44)** presents as markedly inhibited, emotionally withdrawn behaviour toward caregivers: the child rarely seeks or responds to comfort when distressed, shows minimal social-emotional reciprocity, and displays unexplained irritability, sadness or fearfulness during ordinary, non-threatening interactions.

**Disinhibited Social Engagement Disorder (6B45)**, by contrast, shows overly familiar, culturally inappropriate approach to unfamiliar adults, reduced checking back with the carer, and willingness to go off with a stranger.

For a 6B44 diagnosis, the disturbance must be evident before age 5, the child must have a developmental age of at least 9 months, and features must not be better explained by autism spectrum disorder.

## The Pinnacle way
Developmental measurement supports care planning; diagnosis requires an appropriately qualified healthcare professional., under qualified clinician care — never from an online tool. Our [clinician-administered AbilityScore®](/ask/what-is-the-abilityscore-and-how-is-it-calculated) profiles social-emotional functioning alongside [behavioural and developmental therapy](/behavioural-therapy) pathways. See the [Attachment Difficulties overview](/attachment-difficulties) for referral guidance.

## Trusted sources
WHO ICD-11 Mortality and Morbidity Statistics (6B44, 6B45); American Academy of Pediatrics guidance on early relational health.

**Next step —** Refer a child with a pathogenic-care history and atypical attachment behaviours to a [Pinnacle centre](https://www.pinnacleblooms.org/enroll-autism-speech-aba-therapies-india) for structured assessment.

This is general information, not a diagnosis — individual assessment and diagnosis require an appropriately qualified healthcare professional.

## Sources
- WHO ICD-11 MMS — Reactive Attachment Disorder: https://icd.who.int/
- American Academy of Pediatrics — early relational health: https://www.aap.org/
- HealthyChildren.org — bonding and attachment in early childhood: https://www.healthychildren.org/

## Connected topics and perspectives
- Conditions: https://pinnacleblooms.org/ask/conditions
- Doctor: https://pinnacleblooms.org/ask/lens/stakeholder/doctor
- Emotional: https://pinnacleblooms.org/ask/lens/domain/emotional
- Definition: https://pinnacleblooms.org/ask/lens/intent/definition
- Screen: https://pinnacleblooms.org/ask/lens/lifecycle/screen
- Special Education: https://pinnacleblooms.org/ask/lens/route/special-education
- Early Clarity: https://pinnacleblooms.org/ask/lens/empowerment/early_clarity

## Related question paths

### Understand the subject
- What is Attachment Difficulties?: https://pinnacleblooms.org/ask/what-is-attachment-difficulties
- ICD-11 Classification for Attachment Difficulties (6B44): https://pinnacleblooms.org/ask/what-is-the-icd-11-classification-for-attachment-difficulties
- What Are Attachment Difficulties in Early Childhood?: https://pinnacleblooms.org/ask/what-is-attachment-difficulties-and-what-does-it-look-like-in-early-childhood
- What Attachment Represents and When Delay Is Clinically Significant: https://pinnacleblooms.org/ask/what-does-attachment-represent-developmentally-and-when-is-a-delay-in-it-clinically-significant
- SNOMED CT concept for Attachment Difficulties: https://pinnacleblooms.org/ask/what-is-the-snomed-ct-concept-for-attachment-difficulties
- How does Attachment Difficulties affect a child's daily life?: https://pinnacleblooms.org/ask/how-does-attachment-difficulties-affect-a-child-s-daily-life
- Is Attachment Difficulties considered a disability?: https://pinnacleblooms.org/ask/is-attachment-difficulties-considered-a-disability
- Is Attachment Difficulties genetic or hereditary?: https://pinnacleblooms.org/ask/is-attachment-difficulties-genetic-or-hereditary
- Common Myths About Attachment Difficulties: https://pinnacleblooms.org/ask/what-are-common-myths-about-attachment-difficulties
- What are the types or levels of Attachment Difficulties?: https://pinnacleblooms.org/ask/what-are-the-types-or-levels-of-attachment-difficulties
- What Causes Attachment Difficulties in Children?: https://pinnacleblooms.org/ask/what-causes-attachment-difficulties-in-children
- Early intervention outcomes for Attachment Difficulties under 7: https://pinnacleblooms.org/ask/what-does-current-research-show-about-early-intervention-outcomes-for-attachment-difficulties-in-children-under-7

### Recognise signs & concerns
- Attachment Difficulties red flags for referral in young children: https://pinnacleblooms.org/ask/what-clinical-red-flags-for-attachment-difficulties-warrant-referral-in-a-young-child
- What early indicators of Attachment Difficulties should a paediatrician watch for?: https://pinnacleblooms.org/ask/what-early-indicators-of-attachment-difficulties-should-a-paediatrician-watch-for
- When to refer suspected attachment difficulties for developmental therapy: https://pinnacleblooms.org/ask/when-should-a-doctor-refer-a-child-with-suspected-attachment-difficulties-for-developmental-therapy
- Can Attachment Difficulties be cured?: https://pinnacleblooms.org/ask/can-attachment-difficulties-be-cured
- Can Attachment Difficulties Be Prevented?: https://pinnacleblooms.org/ask/can-attachment-difficulties-be-prevented
- Do boys show attachment difficulties differently?: https://pinnacleblooms.org/ask/do-boys-show-attachment-difficulties-differently
- Do girls show Attachment Difficulties differently?: https://pinnacleblooms.org/ask/do-girls-show-attachment-difficulties-differently
- How a frontline health worker can spot possible attachment difficulties early: https://pinnacleblooms.org/ask/how-can-a-frontline-health-worker-spot-a-child-with-possible-attachment-difficulties-early
- Should I Be Worried About Attachment Difficulties?: https://pinnacleblooms.org/ask/should-i-be-worried-my-child-might-have-attachment-difficulties
- What are the early signs of Attachment Difficulties?: https://pinnacleblooms.org/ask/what-are-the-early-signs-of-attachment-difficulties
- Early Signs of Attachment Difficulties in a 1-Year-Old Boy: https://pinnacleblooms.org/ask/what-are-the-early-signs-of-attachment-difficulties-in-a-1-year-old-boy
- Early Signs of Attachment Difficulties in a 1-Year-Old Girl: https://pinnacleblooms.org/ask/what-are-the-early-signs-of-attachment-difficulties-in-a-1-year-old-girl

### Explore causes & influences
- Contributing Factors for Attachment Difficulties: https://pinnacleblooms.org/ask/what-are-the-known-contributing-factors-for-attachment-difficulties-in-early-childhood
- Are boys more likely to have attachment difficulties?: https://pinnacleblooms.org/ask/are-boys-more-likely-to-have-attachment-difficulties
- Are girls more likely to have attachment difficulties?: https://pinnacleblooms.org/ask/are-girls-more-likely-to-have-attachment-difficulties
- Early Intervention for Attachment Difficulties & UN Child Rights: https://pinnacleblooms.org/ask/how-does-early-intervention-for-attachment-difficulties-advance-un-child-rights-uncrpd-and-the-sdgs
- What causes Attachment Difficulties in young children?: https://pinnacleblooms.org/ask/what-causes-attachment-difficulties-in-young-children
- Cost-effectiveness of early therapy for attachment difficulties: https://pinnacleblooms.org/ask/what-is-the-cost-effectiveness-of-early-therapy-for-attachment-difficulties-in-young-children
- Attachment Difficulties in India: prevalence and public-health burden: https://pinnacleblooms.org/ask/what-is-the-prevalence-and-public-health-burden-of-attachment-difficulties-among-young-children-in-india

### Understand assessment
- Standardised tools for assessing attachment difficulties: https://pinnacleblooms.org/ask/which-standardised-tools-are-used-to-assess-attachment-difficulties-in-early-childhood
- Recommended assessment pathway for attachment difficulties in children under 7: https://pinnacleblooms.org/ask/what-is-the-recommended-screening-and-diagnostic-pathway-for-attachment-difficulties-in-children-under-7
- How AbilityScore Tracks Progress in Attachment Difficulties: https://pinnacleblooms.org/ask/how-does-abilityscore-track-progress-in-a-child-with-attachment-difficulties
- How Attachment Difficulties Is Assessed in a Young Child: https://pinnacleblooms.org/ask/how-is-attachment-difficulties-assessed-in-a-young-child
- How is Attachment Difficulties assessed in children under 7?: https://pinnacleblooms.org/ask/how-is-attachment-difficulties-assessed-in-children-under-7
- What an AbilityScore of 0–100 Means for Attachment Difficulties: https://pinnacleblooms.org/ask/what-does-an-abilityscore-of-0-100-mean-for-a-child-with-attachment-difficulties
- What an AbilityScore of 100–200 Means for Attachment Difficulties: https://pinnacleblooms.org/ask/what-does-an-abilityscore-of-100-200-mean-for-a-child-with-attachment-difficulties
- What does an AbilityScore of 200–300 mean for a child with Attachment Difficulties?: https://pinnacleblooms.org/ask/what-does-an-abilityscore-of-200-300-mean-for-a-child-with-attachment-difficulties
- AbilityScore 300–400 for Attachment Difficulties: https://pinnacleblooms.org/ask/what-does-an-abilityscore-of-300-400-mean-for-a-child-with-attachment-difficulties
- AbilityScore 400–500 in Attachment Difficulties: https://pinnacleblooms.org/ask/what-does-an-abilityscore-of-400-500-mean-for-a-child-with-attachment-difficulties
- What an AbilityScore of 500–600 Means for Attachment Difficulties: https://pinnacleblooms.org/ask/what-does-an-abilityscore-of-500-600-mean-for-a-child-with-attachment-difficulties
- AbilityScore® 600–700 and Attachment Difficulties: https://pinnacleblooms.org/ask/what-does-an-abilityscore-of-600-700-mean-for-a-child-with-attachment-difficulties

### Explore therapy & support
- Supporting a Child with Attachment Difficulties Day to Day: https://pinnacleblooms.org/ask/as-a-grandparent-or-caregiver-how-can-i-support-a-child-with-attachment-difficulties-day-to-day
- Can a child with Attachment Difficulties attend a mainstream school?: https://pinnacleblooms.org/ask/can-a-child-with-attachment-difficulties-attend-a-mainstream-school
- Can a Child with Attachment Difficulties Attend a Regular School?: https://pinnacleblooms.org/ask/can-a-child-with-attachment-difficulties-attend-a-regular-school
- Can a Child with Attachment Difficulties Live Independently?: https://pinnacleblooms.org/ask/can-a-child-with-attachment-difficulties-grow-up-to-live-independently
- How a Teacher Can Help a Child with Attachment Difficulties Learn: https://pinnacleblooms.org/ask/how-can-a-classroom-teacher-help-a-child-with-attachment-difficulties-take-part-and-learn
- Identifying and Supporting Under-7s with Attachment Difficulties: https://pinnacleblooms.org/ask/how-can-a-district-early-intervention-programme-identify-and-support-children-under-7-with-attachment-difficulties
- Supporting a Child with Attachment Difficulties in a Mainstream Classroom: https://pinnacleblooms.org/ask/how-can-a-teacher-include-and-support-a-young-child-with-attachment-difficulties-in-a-mainstream-classroom
- How to Support Emotional Development with Attachment Difficulties: https://pinnacleblooms.org/ask/how-can-we-support-emotional-development-in-a-child-with-attachment-difficulties
- How therapy helps a child with attachment difficulties make progress: https://pinnacleblooms.org/ask/how-does-therapy-help-a-child-with-attachment-difficulties-make-progress
- How is Attachment Difficulties diagnosed in a child?: https://pinnacleblooms.org/ask/how-is-attachment-difficulties-diagnosed-in-a-child
- How Attachment Difficulties Are Supported Through Therapy: https://pinnacleblooms.org/ask/how-is-attachment-difficulties-supported-through-therapy
- AbilityScore & Attachment Difficulties: Your Next Step: https://pinnacleblooms.org/ask/my-child-with-attachment-difficulties-has-an-abilityscore-of-0-100-what-should-we-do-next

### At home & in everyday life
- How can I support my child with Attachment Difficulties at home?: https://pinnacleblooms.org/ask/how-can-i-support-my-child-with-attachment-difficulties-at-home