Reactive Attachment Disorder
Page created by a student.
What it is…
Reactive Attachment Disorder (RAD) affects children who have not developed a normal bond between themselves and a primary caregiver. The natural bond between child and caregiver is interfered with for some reason (neglect, abuse, loss of parent), causing severe emotional and physical consequences throughout development.
What the DSM IV defines it as…
Diagnostic criteria for 313.89: Reactive Attachment Disorder of Infancy or Early Childhood
A. Markedly disturbed and developmentally inappropriate social relatedness in most contexts, beginning before age 5 years, as evidenced by either (1) or (2):
(1) persistent failure to initiate or respond in a developmentally appropriate fashion to most social interactions, as manifest by excessively inhibited, hypervigilant, or highly ambivalent and contradictory responses (e.g., the child may respond to caregivers with a mixture of approach, avoidance, and resistance to comforting, or may exhibit frozen watchfulness)
(2) diffuse attachments as manifest by indiscriminate sociability with marked inability to exhibit appropriate selective attachments (e.g., excessive familiarity with relative strangers or lack of selectivity in choice of attachment figures)
B. The disturbance in Criterion A is not accounted for solely by developmental delay (as in Mental Retardation and does not meet criteria for a Pervasive Developmental Disorder.
C. Pathogenic care as evidenced by at least one of the following:
(1) persistent disregard of the child's basic emotional needs for comfort, stimulation, and affection
(2) persistent disregard of the child's basic physical needs
(3) repeated changes of primary caregiver that prevent formation of stable attachments (e.g., frequent changes in foster care)
D. There is a presumption that the care in Criterion C is responsible for the disturbed behavior in Criterion A (e.g., the disturbances in Criterion A began following the pathogenic care in Criterion C).
Specify type:
Inhibited Type: if Criterion A1 predominates in the clinical presentation
Disinhibited Type: if Criterion A2 predominates in the clinical presentation
Student Portrait…
Having a student with RAD in your classroom will be challenging. At a young age, this student may seem withdrawn and may need significant encouragement to participate. As the student gets older, he or she may also be quick to cling to other students whom they’ve just met, but will be unable to maintain effective relationships.This student will try to manipulate his or her environment and the people in it, and may engage in behavior such as lying, tantrum throwing, stealing, and destruction of property, and will be unable to empathize with others. With regards to academics, the student may struggle with cause and effect thinking, may exhibit impulsive behavior, delays in learning due to overall delays in development from an early age, abnormal speech patterns, and destructive or cruel behavior.
Because of some form of trauma during the early stages of infancy and childhood, children with RAD have not learned to trust the people and environments around them. Without having had a healthy attachment to a caregiver early on, these children may see any attempt at connection as a threat to their disordered sense of security.
Prevalence…
Estimates suggest that 1% of all children under 5 have RAD, though children who are orphaned at a young age are much more likely to develop RAD.
Treatment options…
There are many differing opinions about the best way to treat these children. Attachment Therapy is suggested by some as a way to build the attachment between the child and caregiver that was not effectively built in infancy. However, Attachment Therapy (AT) is quite controversial and many believe that it is unethical. AT includes extensive amounts of body contact between the child and caregiver (called “holding sessions”), and proponents believe that the child needs to express the rage they have stored up. Others suggest family, art or play therapy, but it may be ineffective if the child is not able to trust the therapists. As with many disorders, it may take time to find an effective treatment.
The long-term outlook is…
Mixed. The earlier a child is diagnosed, the better chances you have of making improvements in his or her temperament and behavior. With treatment and the continued involvement and investment by emotionally stable parents, children with RAD have a chance at learning how to trust and build healthy relationships, which will affect their ability to perform in school settings.
Resources:
www.minddisorders.com
www.radkid.org
www.quackwatch.org