Reactive Attachment Disorder
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Reactive Attachment Disorder

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    Reactive Attachment Disorder Reactive Attachment Disorder Presentation Transcript

    • Reactive Attachment Disorder
      Shayna Ross
      Advanced Child Psychology
      11-20-08
    • History of the attachment theory
      John Bowlby developed the attachment theory in the 1960s
      Focused on the early relationship the child has with their primary caregiver
      Infants are vulnerable and depend on adults for care which ensures the bond will be formed
      Attempt to maintain physical proximity to attachment figure and will go to the attachment figure for support when doing an individual task
      Four types: secure, avoidant, resistant-ambivalent, and disorganized
      Lyons, H. (2007).
    • Clinical Literature Definition of Reactive Attachment Disorder (RAD)
      Severe and relatively uncommon attachment disorder that can affect children
      Children do not form a bond with parent or caregiver
      Lyons, H. (2007).
    • DSM IV Definition of RAD
      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)  (Source: DSM IV)
    • Signs and Symptoms of RAD
      Pediatricians are usually the first professional to raise suspicion of RAD
      Infants 18-24 months may show non-organic failure to thrive or they may have abnormal responses to stimuli
      The child will look for attention and comfort from any available adult, even strangers
      The child will not initiate or accept comfort and attention from familiar people especially when the child is in distress
      Hall, S. and Geher, G. (2003)
    • Signs and Symptoms of RAD
      RAD is likely to occur with children who are neglected or abused, but just because the child is abused/neglected doesn’t mean they will be diagnosed with RAD without other symptoms or signs. The reason for this is children can still develop stable attachment and relationships regardless of neglect/abuse.
      Hall, S. and Geher, G. (2003)
    • Causes of RAD
      Failure to form normal attachments to primary caregivers in early childhood
      Neglect, abuse, sudden separation, frequent change of caregiver, lack of responsiveness from caregiver
      Not every child who experiences these will be diagnosed with RAD
      Also you need to take into consideration children are able to form stable attachment and social relationships even if they were abused/neglected
      Chapman, Sue. (2002).
    • Causes Continued…
      Based on problematic history of care and social relationships
      Abnormal parenting
      Traumatic experiences
      Temperament of the child may cause unstable relationships with caregivers
      Chapman, Sue. (2002).
    • Assessment Tools
      There is no universal diagnostic measure used for RAD yet
      A range of different measures are used
      The strange situation (Mary Ainsworth)
      Preschool Assessment of Attachment
      Observational Record of the Caregiving Environment
      Stem stories, puppets, pictures
      Interviews: Child Attachment Interview and the Autobiographical Emotional Events Dialogue
      Recently the Disturbances of Attachment Interview has been used. It was developed by Smyke and Zeanah in 1999.
      Hall, S. and Geher, G. (2003).
    • Diagnosis of RAD
      RAD is one of the least researched disorders
      It is very poorly understood
      It is difficult to diagnose because there is no specific course the disorder takes. There are no stages.
      Initial evaluations can be conducted by psychiatrists, specialist Licensed Clinical Social Workers, psychiatric nurses, and psychologists.
      Hall, S. and Geher, G. (2003).
    • AACAP’s Opinion on Diagnosing Children With RAD
      The American Academy of Child and Adolescent Psychiatry (AACAP) states each child who exhibits symptoms of RAD or are diagnosed with RAD need an individualized plan of action
      The AACAP also suggests against labeling the child with RAD without comprehensive evaluations. They feel there needs to be several tests done and several observations before stating the child has RAD. The child’s relationship with it’s caregiver/parent needs to be looked at numerous times before making a diagnosis.
      Also a diagnosis needs to see the child’s attachment patterns
      Requires observation of how the child reacts with unfamiliar adults
      A comprehensive history of the child’s caregiving environment from a very young age (Pediatricians, teachers, caseworkers, daycares)
      The AACAP hasn’t resolved the question – can attachment disorders reliably be diagnosed in older children and adults
      Lyons, H. (2007).
    • Diagnostic Criteria
      There are two classifications of RAD; inhibited and disinhibited.
      Both types include:
      Disturbed and inappropriate social relatedness
      Disturbance isn’t accounted for by developmental delay or a developmental disorder
      Onset before 5 years old
      History of significant neglect
      Lack of identifiable preferred attachment figure
      Lyons, H. (2007).
    • Inhibited RAD
      Failure to initiate or respond to social interactions, in developmentally appropriate ways
      Child may respond to caregiver in very undecided ways. Very indecisive on how to react to caregiver
      Infants not seeking comfort when in danger, alarm or upset
      Don’t feel a need to maintain proximity to caregiver
      Hall, S. and Geher, G. (2003).
    • Disinhibited RAD
      Child does not exhibit appropriate selective attachments
      Child develops close relationships with strangers
      Child doesn’t develop relationships with caregivers
      Hall, S. and Geher, G. (2003).
    • Treatment
      Treating parents for mental illness, family therapy, individual therapy
      Should the child be removed and placed in a safe situation
      Help for the family such as financial aid, housing aid, social work
      Training for parenting skills and child development
      Monitoring the child’s safety within their home/family environment
      Therapy which increases the responsiveness of the child to their caregivers
      Hall, S. and Geher, G. (2003).
    • Hall and Geher Study
      Participants: Caregivers of children with RAD, caregivers of non-RAD children, children with RAD.
      The parents provided information about the behavior and personality characteristics of their children measured by the RAD scale
      Hall, S. and Geher, G. (2003).
    • Results
      Showed children with RAD display more violent and detrimental behavior than those children without RAD
      Children with RAD have more general behavior problems , social problems, withdrawal, anxiety, depression, attention problems, delinquent behavior.
      Hall, S. and Geher, G. (2003).
    • Tobin, Wardi-Zonna, Yezzi-Shareef Study
      Interviews with children and adolescents diagnosed with RAD, about their earliest recollections
      The children and adolescents were audio taped
      Tobin, D., Wardi-Zonna, K., Yezzi-Shareef A. (2007).
    • Results
      Found all the recollections were negative about the caregiver
      None of the children or adolescents felt they were loved
      Some examples of the early recollections:
      We had fun finger-painting at school; I got grounded for four days because I got paint on my white shirt
      I did not get up. I wet the bed, and my mom was mad at me
      We got taken away from the babysitter because my mom didn’t come home that night
      Tobin, D., Wardi-Zonna, K., Yezzi-Shareef A. (2007).
    • References
      Chapman, Sue. (2002). Reactive Attachment Disorder. British Journal of Special Education. Volume 29, No.2.
      Hall, S. and Geher, G. (2003). Behavioral and Personality Characteristics of Children with Reactive Attachment Disorder. The Journal of Psychology. 137(2), 145-162.
      Lyons, H. (2007). Attachment Theory and Reactive Attachment Disorder: Theoretical Perspectives and Treatment Implications. Journal of Child and Adolescent Psychiatric Nursing. Volume 20, No. 1, Page 27039.
      Minnis, H. and Keck, G. (2003). A clinical/research dialogue on Reactive Attachment Disorder. Attachment & Human Development. Volume 5, No. 3, 297-301.
      Minnis, H., Marwick, H., Arthur, J., and McLaughlin, A. (2006). Reactive attachment disorder- a theoretical model beyond attachment. Child Adolescent Psychology. Page 336-341.
      Schwartz, E., Reed, S., Davis, A. (2006). Reactive Attachment Disorder: Implications for School Readiness and School Functioning. Psychology in the Schools. Volume 43(4).
      Shaw, S. and Paez, D. (2007).Reactive Attachment Disorder: Recognition, Action, and Considerations for School Social Workers. National Association of Social Workers. Page 69-95.
      Tibbits-Kleber, L. and Howell, R. (1985). Reactive Attachment Disorder of Infancy (RAD). Journal of Clinical Child Psychology. Volume 14, No. 4, Page 304-310.
      Tobin, D., Wardi-Zonna, K., Yezzi-Shareef A. (2007). Early Recollections of Children and Adolescents Diagnosed with Reactive Attachment Disorder. The Journal of Individual Psychology. Volume 63, No. 1.
      Weir, Kyle N. (2007) Using Integrative Play Therapy with Adoptive Families to Treat Reactive Attachment Disorder: A Case Example. Journal of Family Psychotherapy. Volume 18.
      Wingert, P. and Nemtsova A. (2007). When Adoption Goes Wrong. Newsweek. Volume 150, Issue 25.