Attachment theory proposes that infants are born in an immature state requiring care and protection from a caregiver. Disruption to this attachment through events like abuse, neglect, or caregiver changes can result in reactive attachment disorder (RAD) characterized by inhibited or emotionally withdrawn behavior from caregivers. The DSM-V criteria for RAD include inconsistent seeking of comfort from caregivers when distressed and disturbances in social/emotional responsiveness. While effects are most common in neglected/abused children, RAD presentation and prevalence are not fully understood and treatments remain controversial with no single agreed-upon approach.

1. Taylor Schenk

2. 
 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

3. 
 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

4. 
 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

5. 
 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 Consistent Pattern of inhibited, emotionally withdrawn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 distressed
2. Child rarely or minimally responds to comfort when
distressed
DSM-V Criteria

6. 
 Criteria B:
 A persistent social and emotional disturbance characterized
by at least two of the following:
1. Minimal social and emotional responsiveness to others
2. Limited positive affect
3. Episodes of unexplained irritability, sadness, or
fearfulness that are evident even during nonthreatening
interactions with caregiver
DSM-V Criteria

7. 
 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

8. 
 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

9. 
 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

10. 
 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

11. 
 PTSD
 Anxiety
 Depression
 Conduct disorder
 Personality disorders
Comorbidity

12. 
 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

13. 
 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

14. 
 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