Reactive attachment disorder

Reactive Attachment Disorder

Taylor Schenk

The theory that when

humans are born they are born extremely immature and are not able to survive without protection. So at birth they are prepared to attach themselves to a caregiver for protection and safety.

Attachment Theory

During this critical time when the child attaches to

the caregiver something disrupted it such as: Death of primary caregiver Switching of caregivers Abuse or neglect of the child

This leaves the child feeling vulnerable and uncomfortable.

doesn’t learn how to form meaningful relationship Lack of that secure base for them to explore the

world.

Applied to RAD

Lack of affection Resists social interactions Would rather be alone Delays in cognitive,

language, and motor skills Behavioral problems

Aggression and violent Inappropriate attaching

Receive comfort from any available adult, even strangers

Anger and irritability

Characteristics of RAD

Criteria A

Consistent Pattern of inhibited, emotionally withdrawn behavior towards a caregiver, manifested by both of the following:1. Child rarely or minimally seeks comfort when

distressed2. Child rarely or minimally responds to comfort

when distressed

DSM-V Criteria

Criteria B:

A persistent social and emotional disturbance characterized by at least two of the following:1. Minimal social and emotional responsiveness to

others2. Limited positive affect3. Episodes of unexplained irritability, sadness, or

fearfulness that are evident even during nonthreatening interactions with caregiver

DSM-V Criteria

Criteria C:

Child has experienced a pattern of extremes of insufficient care as evidenced by at least one of the following:1. Social neglect or deprivation in the form of

persistent lack of having basic emotional needs of comfort, stimulation, and affection met by the caregiving adults

2. Repeated changes of primary caregiver that limits opportunities to form stable attachment

3. Rearing in unusual setting that severely limit opportunities to form selective attachment.

DSM-V Criteria

Criteria D:

Care in criterion C is presumed to be responsible for the disturbed behavior in criterion A

Criteria E: Criteria not met for Autism Spectrum Disorder

Criteria F: Disturbance is evident before age 5

Criteria G: Child has developmental age of at least 9 months

DSM-V Criteria

Effects neglected or abused children

Onset before age 5 Often effects adopted children

If removed from parent within weeks of birth Doesn’t effect every child the same.

Can have 20 in same situation and only 2 have RAD

argued there may be a genetic factor

Etiology

This is unknown, but is rare in clinical settings

Overlapping symptoms Thought to be overdiagnosed in some

situations and underdiagnosed in others No generally accepted procedure for assessing

RAD Doesn’t effect everybody the same. Most common in adopted children and

neglected or abused children. But not in every case. Effects some, but not all (similar to PTSD)

Prevalence

PTSD Anxiety Depression Conduct disorder Personality disorders

Comorbidity

There is no agreed upon treatment for RAD

Treatments usually patient specific.

Holding Therapy (rage reduction, “rebirthing”) Very controversial and unethical Has resulted in death But has a higher success rate than past

treatments Creates more problems than it solves

Treatment

Psychotherapy

Dyadic Developmental Psychotherapy Maintain an affectively attuned relationship

Attachment Therapy Play therapy, paint therapy, child-parent intervention

Behavioral Management Therapy Treats the behavioral symptoms Acts more as a band aid

Treatments

One of the most under researched and least

understood disorder Don’t know where it comes from

Don’t know to effectively treat it

Can’t agreeably diagnose RAD

Critisms