Diagnosis Of Reactive Attachment Disorder Research Articles

Child neurodevelopmental disorders in armed conflict country, case of DR Congo: long-term trauma impact on brain development in childhood: review

Child neurodevelopmental disorders in armed conflict country, case of DR Congo: long-term trauma impact on brain development in childhood: review

Reactive Attachment Disorder (RAD) and Disinhibited Social Engagement Disorder (DSED) Symptomatology in a High-Risk Clinical Sample.

Attachment relationships are broadly considered foundational to child development as such attachment disorders, reactive attachment disorder (RAD) and disinhibited social engagement disorder (DSED), pose a severe threat to children's safety and developmental trajectory. This study examined the prevalence of full diagnosis and symptoms of RAD and DSED in a high-risk sample of adopted children (n = 98; mean age: 46.26 months; range: 16.09 months-6.51 years). Consistent with existing literature, a full diagnosis of RAD and DSED was rare, 1% (n = 1) and 8.1% (n = 8), respectively. However, over half of the sample presented with at least one clinically concerning symptom of RAD or DSED. Given the nature of attachment disorders and the level of concern associated with symptoms, these findings emphasize the need for effective mental health screening, sensitivity beyond just a full diagnosis, and early interventions for adopted children.

A-86 Reactive Attachment Disorder in Adulthood: A Neuropsychological Perspective

Abstract Objective The sequelae of poor attachment and trauma on psychological and social functioning is well documented, however, this complex relationship applied to a neuropsychological profile is less understood. The current case uses a neuropsychological assessment to further understand the brain-behavior relationship in a case of poor maternal attachment, multiple traumas, psychiatric comorbidities, and poor social adaptation. Method Patient is a 22-year-old, right-handed, Eastern European woman with fetal alcohol and infant toxic mold exposure, failure to thrive, maternal neglect, adoption and relocation to the United States (age four), posttraumatic stress disorder (PTSD; multiple reported sexual traumas and bullying victimization), and depression. Referred for a neuropsychological evaluation for longstanding inattention, learning difficulties, being socially and emotionally withdrawn, and suspected Autism Spectrum Disorder (ASD). Results Data revealed average intellectual ability, dyscalculia, Attention Deficit Hyperactivity Disorder (ADHD), PTSD, and depression. A self-report measure of ASD revealed a strong perception of ASD, characterized by inability to read verbal cues or other’s emotions, and poor communication and self-expression, however, this diagnosis was not supported by formal assessment and behavioral observations; instead, it was determined a diagnosis of Reactive Attachment Disorder (RAD). Conclusions This case provides an example of the complex interplay of poor maternal–infant bonding coupled by adolescent trauma on adult attachment style and compromised social interactions. More specifically, the case addresses the poly-etiologic and neuropsychological impact of an insecure attachment style and trauma on self-perceptions of social and emotional withdrawal commonly seen in ASD. The case further stresses the overlapping presentations RAD, ADHD, learning disabilities, and psychiatric comorbidities.

Self-esteem in adolescents with reactive attachment disorder or disinhibited social engagement disorder

BackgroundLow self-esteem predicts negative outcomes and mediates the association between childhood adversity and mental health problems in adolescence. Reactive attachment disorder (RAD) and disinhibited social engagement disorder (DSED) are presumably caused by early insufficient care, but their association with self-esteem is unknown. ObjectiveInvestigate global and domain-specific self-esteem in adolescents with RAD or DSED. Participants and settingAll adolescents living in Norwegian residential youth care (RYC) (N = 306; age 12–20) were compared with a sample from the general Norwegian adolescent population (N = 10,480; age 12–20). MethodsSelf-esteem for scholastic competence (SC), social acceptance (SA), athletic competence (AC), physical appearance (PA), romantic appeal (RA), close friendship (CF), and self-worth (SW) was investigated using the revised version of the Self-Perception Profile for Adolescents. ResultsCompared to the general population, adolescents with RAD diagnosis had lower SC (mean difference, MD = −0.30, p = .020) and higher CF (MD = 0.25, p = .021), whereas adolescents with DSED diagnosis had lower SC (MD = −0.42, p = .005), SA (MD = −0.40, p = .015), AC (MD = −0.22, p = .038), PA (MD = −0.33, p = .048), and SW (MD = −0.37, p = .013). Compared to adolescents in RYC without RAD/DSED diagnoses, adolescents with DSED diagnoses had lower SA (MD = −0.42, p = .012) and SW (MD = −0.32, p = .037). More RAD symptoms were associated with lower SA (B = −0.051, p = .013), AC (B = −0.048, p = .028), RA (B = −0.053, p = .007), and CF (B = −0.052, p = .005). More DSED symptoms were associated with lower SC (B = −0.125, p = .038). ConclusionBoth global and domain-specific self-esteem in adolescents with RAD or DSED should be assessed; developmental support and treatment plans should be adjusted accordingly.

Reactive attachment disorder in the classroom

Students with Reactive Attachment Disorder (RAD) often display significant intrusive behaviors and need specific behavioral, social-emotional, and academic supports. Given the background of trauma consistent with a RAD diagnosis, it is imperative that school personnel understand the social-emotional behavioral supports needed to help children with a RAD diagnosis be successful. There is a lack of research to support behavioral interventions for RAD in the classroom, but the clinical/therapeutic literature on supporting children with RAD at home and in the community can be extended to the classroom. This article introduces background for RAD and suggests ways to support children with RAD by exploring common symptomology for children with RAD, including the concepts of attachment and disruption, common symptoms and behaviors, and best practice interventions.

Attachment disorders diagnosed by community practitioners: a replication and extension.

While considered a rare diagnosis, reactive attachment disorder (RAD) is simultaneously the subject of considerable debate. A recent report suggested that RAD is overdiagnosed in community settings and that conduct problems may be used to make a diagnosis of RAD (Woolgar & Baldock, Child and Adolescent Mental Health, 20, 2015, 34-40). This study seeks to replicate and extend these findings. Clinical assessment data from 100 consecutive admissions of maltreated foster and adopted children (ages 3-17) to a specialty treatment clinic in the United States were reviewed. Measures included semi-structured interviews of RAD and disinhibited social engagement disorder (DSED) symptoms and caregiver-report questionnaires of emotional problems, conduct problems, and the quality of the parent-child relationship. Of the 100 cases reviewed, 39 presented with a diagnostic history of RAD, DSED, or 'attachment disorder'. Of these cases, three were diagnosed in-clinic with DSED; no cases met diagnostic criteria for RAD according to DSM-5 criteria. However, analyses found that those diagnosed with RAD by community-based clinicians were significantly more likely to display conduct problems and to be adopted (as opposed to in foster care). These findings confirm those of Woolgar and Baldock (Child and Adolescent Mental Health, 20, 2015, 34-40). It appears that the diagnostic criteria of RAD are commonly being inaccurately applied in general community-based practice. Clarification of diagnostic criteria for RAD in recent revisions of diagnostic taxonomies, the accumulation of empirical data on RAD, and improved instrumentation are either poorly disseminated or inadequately implemented in community-based practice settings.

Management of a Child with Reactive Attachment Disorder in the Dental Clinical Setting: A Case Report

Reactive attachment disorder (RAD) is an early childhood mental health disease characterized by impaired social interactions and communication abilities, and neurological deficits in the child’s developing brain. This disorder can significantly affect the pediatric patient’s behavior in the dental setting. An uncooperative 9-year-old Mexican girl, who was residing in a temporary home, was referred by a general dental practitioner to the Postgraduate Pediatric Dental Clinic with her caretaker, requesting dental examination and treatment. The patient presented with a previous diagnosis of RAD with intellectual/social disability. With the psychiatrist’s guidance, an exhaustive oral prophylaxis was carried out in the initial appointments, followed by diverse restorative treatments under the continuous application of behavioral management techniques. These restorative procedures included resin restorations and pit-fissure sealants, under local anesthesia and rubber-dam isolation, on the first four permanent molars. The entire treatment was completed in six weeks. The patient and her caretaker were provided with detailed educational and motivational strategies for improving the patient´s oral hygiene, and they also received nutritional advice. For control reviews and the reinforcement of preventive habits, future appointments were carefully scheduled. An interdisciplinary pediatric collaboration between the dentist, nurse, and psychiatrist was fundamental for improving the patient’s oral health and general welfare.

Convergence between observations and interviews in clinical diagnosis of reactive attachment disorder and disinhibited social engagement disorder.

Objective:A comprehensive approach is needed for diagnosing disordered attachment behavior due to the multifaceted nature of attachment. Differences between various indicators can pose a challenge for deciding on the proper diagnosis. This study assessed the convergence between clinical interview assessment and observation-based clinical diagnosis, and their linkages with inadequate care.Method:Participating children (N = 55) had intelligence quotients (IQs) between 50 and 85 and were referred for psychiatric consultation. Data were obtained by structured review of medical records, the Disturbances of Attachment Interview (DAI), and the Clinical Observation of Attachment (COA) procedure.Results:Of the 18 children identified using the DAI with Diagnostic and Statistical Manual of Mental Disorders–Fifth Edition (DSM-5) diagnosis of reactive attachment disorder (RAD) and/or disinhibited social engagement disorder (DSED), only 7 received a clinical DSM-5 diagnosis of RAD and/or DSED. Observed maladaptive attachment behavior in the COA was strongly associated with DAI scores and with clinical diagnosis of DSM-5 RAD and/or DSED. There was a significantly higher prevalence of extremes of insufficient care in children who were classified with RAD by DAI or DSM-5 and/or with DSED by DSM-5 compared to those with no attachment disorder.Conclusions:Using structured observation and record assessment leads to more conservative identification of RAD or DSED than using the DAI.

Adopted Children with Reactive Attachment Disorder: A Qualitative Study on Family Processes

Children with histories of early childhood neglect can exhibit a multitude of problematic behaviors, along with the potential for numerous physical and cognitive deficits. In some cases, these children can exhibit behaviors reflective of a diagnosis of reactive attachment disorder (RAD). Families who adopt children with RAD may face unique issues when it comes to addressing problem behavior and providing the child adequate care. This article discusses the results of a study that examined the processes that occur in families who adopt children with RAD. Guided by the principles of grounded theory, this study employed a multi-stage semi-structured interview design. The sample consisted of five adoptive families from the Midwest, and included both adult and child participants. The findings revealed six prominent themes: Parents report difficulty educating others about RAD; obtaining the needed care and services was a constant fight; RAD behavior is socially isolating; and raising a child with RAD is continuously stressful. Older siblings felt compelled to intervene in the care of the child with RAD; and felt increased autonomy from their parents. Implications for social work and clinical practice are discussed.

Treatment of Reactive Attachment Disorder in Young Children: Importance of Understanding Emotional Dynamics

Through an attachment lens, the case study reviews the treatment of a 4-year-old boy in foster care with the diagnosis of Reactive Attachment Disorder. A three-stage treatment was described to illustrate how an attachment informed conceptualization was translated into intricate steps of interventions leading to a successful clinical outcome. The case study emphasizes and highlights the importance to recognize and understand emotional dynamics that are rooted in attachment experiences and expectations. It offers important clinical insight into the emotional and psychological process this boy went through to finally reach the territory of recovery.

A fragile bond: adoptive parents' experiences of caring for children with a diagnosis of reactive attachment disorder

To understand how adoptive parents caring for children with a diagnosis of reactive attachment disorder (RAD) make sense of their life-worlds by establishing the meanings that underlie and structure their experiences of their everyday lives. Reactive attachment disorder is a serious psychosocial disorder of childhood that causes short- and long-term relationship, health and social consequences for children. It is more likely to be observed in children being cared for by foster carers, kinship carers or adoptive parents. Exploration of adoption from parents' perspectives is not well documented, and no previous work has been undertaken to understand the challenges of caring for children with a diagnosis of reactive attachment disorder. The study was guided by Husserl's phenomenology, which aims to uncover the underlying essential meanings intrinsic to a phenomenon. Three concepts are central to this approach: essences, intuiting and eidetic reduction. Semi-structured interviews were conducted with eight adoptive parents. Data were analysed using an adaptation of Colaizzi's method. Four essential elements fundamental to participants' lived experiences of caring for a child with a diagnosis of RAD were uncovered: being profoundly unprepared, being insecure, being assailed by unexpected emotions and being committed. The parent-child relationship is a fragile bond developed at an unexpectedly high personal cost; it is a committed relationship but vulnerable to continual destabilisation. The involvement in the preparation of adoptive parents of child and adolescent mental health (CAMH) staff with expertise in the impact of early neglect or separation on children should be considered. The development of systems to prepare, screen and identify potential challenges and problems prior to adoption might help adoptive parents. Access to a CAMH professional in the pre and postadoption phases might assist potential adoptive parents in making informed decisions around the choice of a child for adoption.

1139 – Reactive attachment disorder: effects and limits on treatment options

The failure to bond with a caring adult can lead to failed bonding in future relationships throughout life. This inability to relate or connect to others may affect the child's development. More and more children are being diagnosed with reactive attachment disorder due to affective instability related to their inability to make secure attachments. The diagnosis is complex and treatments are limited which presents a challenge for providers and patients alike. Describe cases related to reactive attachment disorder. Describe diagnosis of reactive attachment disorder and its limitations. Describe treatment options for reactive attachment disorder. Be familiar with diagnosis of reactive attachment disorder. Be familiar with treatment options. Be familiar with challenges in complex scenarios. Case of a 15 year old black female with history of neglect, legal issues, school truancy, witness to domestic and community violence who presents with escalating aggressive behavior and affective instability. Literature review focusing on treatments options in complex scenarios. Many children are suffering from “maltreatment” and there are difficulties with making an appropriate diagnosis due to co-occurring symptoms and potential differential diagnoses; therefore treatments are limited. The disorder warrants further research especially in addressing the timing and critical period for an intervention. The disorder necessitates a multi-modal approach in particular a collaborative approach involving in home services with the child and caregiver. The disorder becomes even more complex when dealing with patient populations with intergenerational adversity and the patterns of disordered attachment are evident.

Reactive attachment disorder in the general population: a hidden ESSENCE disorder.

Reactive attachment disorder (RAD) is a severe disorder of social functioning. Previous research has shown that children with RAD may have poor cognitive and language abilities; however, findings mainly come from biased, institutionalised samples. This paper describes the characteristics of all children who were given a suspected or likely diagnosis of reactive attachment disorder in an epidemiological study of approximately 1,600 children investigating the prevalence of RAD in the general population. We found that children with RAD are more likely to have multiple comorbidities with other disorders, lower IQs than population norms, more disorganised attachment, more problem behaviours, and poorer social skills than would be found in the general population and therefore have a complex presentation than can be described as ESSENCE. We discuss the clinical and educational implications.

Reactive Attachment Disorder in Adopted and Foster Care Children

A disruption in the initial attachment formed between an infant and a primary caregiver often leads to some type of disordered or disorganized attachment. While research has been conducted on the etiology, symptoms, and effective forms of therapy regarding this disorder, much definitive information remains unknown or unclear. With the increasing use of foster care in America and the frequency of adoption, it is becoming obvious that more attention is needed in the area of how to best appropriately approach a diagnosis of reactive attachment disorder. This article will discuss current trends and implications for mental health professionals working in the field of foster care and adoption settings.

Social use of language in children with reactive attachment disorder and autism spectrum disorders

Children with a diagnosis of reactive attachment disorder (RAD) appear to show difficulties in social understanding. We aimed to compare the pragmatic language functioning of children with (RAD) and autism spectrum disorder (ASD). Assessments were made in three groups of children aged 5-8years, with verbal IQ estimates in the normal range: 35 with a RAD diagnosis, 52 with an ASD diagnosis and 39 with typical development. The Children's Communication Checklist (CCC) was used to compare their pragmatic language skills, and ADI-R algorithms were used to compare autistic symptomatology, according to parent report. According to the CCC, the RAD group demonstrated significant problems in their use of context, rapport and social relationships with a degree of severity equivalent to children in the ASD comparison group. More than 60% of the group with RAD met ADI-R clinical criteria on the Use of Language and Other Social Communication Skills subscale, 46% on the Reciprocal Social Interaction subscale, and 20% had significant repetitive and stereotyped behaviours. Children with RAD appear to be at least as impaired as children with ASD in certain domains of social relatedness, particularly in their pragmatic language skills.

Attached to a Diagnosis

: Alex is a 9-year-old boy brought to you, his primary care provider, for a "fifth opinion." You have cared for Alex since he was adopted from a Romanian orphanage at 3 years of age. He has been physically healthy with normal growth parameters and no evidence of fetal alcohol syndrome. Alex has long-standing history of social difficulties, impulsivity, lying, controlling, manipulative behaviors, violent outbursts at home with subsequent lack of remorse, and excessive chatter. You referred Alex to an interdisciplinary child development clinic 2 years ago, where he was diagnosed with reactive attachment disorder (RAD) and attention deficit hyperactivity disorder (ADHD). He was noted to have normal cognitive and language skills. Attachment therapy, stimulant therapy, and school accommodations for ADHD were recommended.Alex received some individual counseling with the school psychologist for a year after the first evaluation, with little improvement in core behaviors. The following year, Alex established care with a psychiatrist and a private counselor. The psychiatrist prescribed a succession of stimulants, each of which worked for only a short time and then had waning effect. The counselor worked with Alex and his parents on managing Alex's behavior, which the family reports has been somewhat helpful.Alex's parents express great frustration and sadness that parenting Alex has been such an ongoing struggle since he was adopted. They note that Alex is superficially friendly, chatty, and charming, with everyone he encounters, including strangers, but he never progresses past such superficial interaction, even with his adoptive parents. The parents express that they are deeply wounded that Alex is not more loving and is not more appreciative of the fact that they rescued him from the orphanage.His parents asked his pediatric clinician about Autism as they observe Alex's lack of real affection and social connection with parents or peers. They also note that Alex has difficulty verbalizing his feelings and that he lies frequently, chatters tangentially, and he can watch the Discovery channel for hours. A neurologist, to whom Alex was referred to evaluate staring spells, reassured the family that the spells did not seem to be epilepsy and also diagnosed Alex with "Asperger's syndrome." The school psychologist, after 2 years of equivocation, recently made Alex eligible for autism spectrum services.During the interview and examination, Alex is funny, friendly, and a bit silly. He uses normal eye contact, seems to enjoy the neuromotor examination, and is eager to show you his cool, new handshake. He engages in easy banter, using normal vernacular and prosody. After the visit, you call the therapist to express your opinion that the RAD diagnosis is valid after all and to ask whether the family is engaged in attachment therapy. The therapist refutes the RAD diagnosis, endorsing Asperger's syndrome (AS) instead and notes that Alex is making good progress in school and in therapy, where he is learning pragmatic skills and basic social skills with the use of social stories.Where do you head next?

Discrimination between attention deficit hyperactivity disorder and reactive attachment disorder in school aged children

We aimed to determine whether it is possible to discriminate between children with attention deficit hyperactivity disorder (ADHD) and children with reactive attachment disorder (RAD) using standardized assessment tools for RAD. The study involved 107 children: 38 with a diagnosis of RAD and 30 with ADHD were recruited through community child and adolescent mental health services (CAMHS) and specialist ADHD clinics. In addition, 39 typically developing children were recruited through family practice. Clinicians were trained to use a standardized assessment package for RAD using a DVD with brief follow-up support. Discriminant function analysis was used to identify the items in the standardized assessment package that best discriminated between children with ADHD and children with RAD. Clinicians’ ratings of RAD symptoms were reliable, particularly when focusing on eight core DSM-IV symptoms of RAD. Certain parent-report symptoms were highly discriminatory between children with ADHD and children with RAD. These symptoms included “cuddliness with strangers” and “comfort-seeking with strangers”. A semi-structured interview with parents, observation of the child in the waiting room and teacher report of RAD symptoms aided diagnostic discrimination between the groups. Clinical diagnosis of RAD can be made reliably by clinicians, especially when focusing on eight core RAD symptoms. Clear discrimination can be made between children with RAD and children with ADHD.

An exploratory study of the association between reactive attachment disorder and attachment narratives in early school‐age children

To explore attachment narratives in children diagnosed with reactive attachment disorder (RAD). We compared attachment narratives, as measured by the Manchester Child Attachment Story Task, in a group of 33 children with a diagnosis of RAD and 37 comparison children. The relative risk (RR) for children with RAD having an insecure attachment pattern was 2.4 (1.4-4.2) but 30% were rated as securely attached. Within the RAD group, children with a clear history of maltreatment were more likely to be Insecure-Disorganised than children without a clear history of maltreatment. Reactive attachment disorder is not the same as attachment insecurity, and questions remain about how attachment research informs clinical research on attachment disorders.

Reactive Attachment Disorder: Recognition, Action, and Considerations for School Social Workers

School social workers are increasingly faced with students who have attachment issues, those who have been diagnosed with reactive attachment disorder (RAD), as well as the families affected by this disorder. In this article, key features of the RAD diagnosis are presented. Other psychiatric disorders associated and confused with RAD are also discussed. The often ignored family and systemic focus of RAD and its effective treatment are emphasized. Recommendations for social work practice in this area are described.

Reactive Attachment Disorder: The Missing Link in the Causation of Social Exclusion?

Early intervention to prevent social exclusion has produced modest benefits. Conduct disorder is one childhood antecedent of social exclusion, yet child and adolescent mental health service (CAMHS) have, in recent years, decreased their role in prevention and treatment of conduct disorder. Research on the identification of those children with conduct disorder likely to respond to treatment and on demonstrating treatment effects has begun to reverse this trend. Focusing on social relationships rather than conduct symptoms, using the diagnosis of reactive attachment disorder (RAD), may reap greater rewards in understanding and preventing social exclusion, but management of RAD is not seen as a core remit of CAMHS. A research agenda which, like that for conduct disorder, identifies those children most likely to benefit from treatment and tests new treatments may, over the next decade, allow CAMHS, working jointly with other services, to have a greater role in the prevention of social exclusion.