Reactive Attachment Disorder Symptoms Research Articles

Reactive attachment disorder, disinhibited social engagement disorder, adverse childhood experiences, and mental health in an imprisoned young offender population

BackgroundA high proportion of young people in prison have a history of abuse and neglect, and/or of neurodevelopmental or psychiatric conditions. Despite this, the only two conditions specifically associated with abuse and neglect, Reactive Attachment Disorder (RAD) and Disinhibited Social Engagement Disorder (DSED), have never been included as part of a comprehensive prevalence study. MethodsA cross sectional study, in 110 male inmates aged 16 to 23, examined the prevalence of, and associations between, adverse childhood experiences (ACEs), neurodevelopmental and mental health conditions, including RAD and DSED. OutcomesVirtually all of the young men (96 %) had one or more lifetime neurodevelopmental or mental health conditions, 85.5 % had a current condition, yet less than 3 % reported having received a mental health assessment in prison. High rates of RAD and/or DSED symptoms were found (53.6 %) and 74.5 % had experienced some form of abuse or neglect. InterpretationThere is a high prevalence of ACEs, RAD/DSED, neurodevelopmental and other mental health conditions within this population. Comprehensive clinical assessments are required to ensure appropriate support and staff training is needed to ensure that the full implications of the high prevalence of neurodevelopmental and mental health conditions are understood as part of trauma informed care.

Attachment Behaviour, Attachment Representations, and Symptoms of Reactive Attachment Disorder and Disinhibited Social Engagement Disorder in Foster Children With Different Preplacement Experiences

Foster care offers children a safe family environment and is effective in buffering the negative effects of early adversity. Specifically, foster care has been found to facilitate secure attachment to foster parents. However, there are limited data on attachment development in children entering foster care after the first year of life. In this study, we examined attachment behaviour and representations as well as symptoms of reactive attachment disorder (RAD) and disinhibited social engagement disorder (DSED) in 3–6 year-old foster children. We studied two subgroups of foster children with different preplacement experiences (Group 1: children entering foster care after living in institutions; Group 2: children entering foster care after living with their biological families) and compared them with a community sample. The results revealed that children in both foster care groups showed significantly lower attachment security at the behavioural level, higher hyperactivation and disorganization at the representational level, and significantly more symptoms of RAD and DSED than the children in the control group. Analyses did not indicate significant differences between the foster care groups. Moreover, no significant associations were found between attachment-related variables and preplacement experiences. This may be an indication that in long-term foster care, the quality of foster care becomes the major factor affecting a child’s attachment development. Thus, foster parents need supportive services and interventions with a focus on attachment development.

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.

Neural correlates of face familiarity in institutionalised children and links to attachment disordered behaviour.

One of the most well-documented sequelae of early maltreatment and institutionalisation is attachment problems, including behaviours under the labels of reactive attachment disorder (RAD) and disinhibited social engagement disorder (DSED). Despite growing evidence of the neurobiological effects of institutionalisation, the neural correlates of these behavioural patterns are largely unknown. The current study examined effects of both institutionalisation in general and attachment disordered behaviour, in particular, on brain-based markers of face processing, in 100 Portuguese children (70 currently institutionalised, 30 continuously raised by their families). Children's neural processing of caregiver's and stranger's faces was assessed with Event-Related Potentials (ERPs). Compared to children from the community, institutionalised children showed smaller amplitudes in the N170, to both stranger and caregiver faces. Amongst the institutionalised group, living in a setting with a higher children-to-caregivers' ratio was associated with smaller P400 amplitudes. The display of DSED symptoms was associated with a smaller P1 to both faces, as well as a reduced differentiation between faces in P400 amplitudes and smaller P400 to the stranger's face. In contrast, RAD symptoms were not associated with any ERP measures. Results replicate previously reported hypoactivation in institutionalised children, in a less-globally deprived setting than past work, indicating that such a pattern is associated with lack of individualised care and increased symptoms of DSED.

Preparing and standardizing a scale for assessing symptoms of Reactive Attachment Disorder in Children in the pre-school stage (Egyptian environment)

Preparing and standardizing a scale for assessing symptoms of Reactive Attachment Disorder in Children in the pre-school stage (Egyptian environment)

Children in foster care with symptoms of reactive attachment disorder: feasibility randomised controlled trial of a modified video-feedback parenting intervention.

Looked-after children are at risk of suboptimal attachment patterns and reactive attachment disorder (RAD). However, access to interventions varies widely, and there are no evidence-based interventions for RAD. To modify an existing parenting intervention for children with RAD in the UK foster care setting, and test the feasibility of conducting a randomised controlled trial (RCT) of the modified intervention. The intervention was modified with expert input and tested on a case series. A feasibility and pilot RCT compared the new intervention with usual care. Foster carers and children in their care aged ≤6 years were recruited across nine local authorities, with 1:1 allocation and blind post-treatment assessments. The modified intervention was delivered in-home by trained mental health professionals over 4-6 months. Children were assessed for RAD symptoms, attachment quality and emotional/behavioural difficulties, and foster carers were assessed for sensitivity and stress. Minimal changes to the intervention programme were necessary, and focused on improving its suitability for the UK foster care context. Recruitment was challenging, and remained below target despite modifications to the protocol and the inclusion of additional sites. Thirty families were recruited to the RCT; 15 were allocated to each group. Most other feasibility outcomes were favourable, particularly high numbers of data and treatment completeness. The revised intervention was positively received by practitioners and foster carers. A large-scale trial may be feasible, but only if recruitment barriers can be overcome. Dedicated resources to support recruitment within local authorities and wider inclusion criteria are recommended.

The expected and the unexpected in recovery and development after abuse and neglect: The role of early foster carer commitment on young children's symptoms of attachment disorders and mental health problems over time

BackgroundWhilst we know that foster care is better than institutional care for abused and neglected children, we know less about the specific qualities of foster care that are important for their development and recovery from maltreatment effects. ObjectiveThis is the first study to investigate the effects of foster carer commitment on symptoms of Attachment Disorders (AD) and mental health problems in young children post-maltreatment. Participants & setting144 children, age 0–5, recently accommodated into foster care as part of an ongoing Randomised Controlled Trial. MethodsChildren were assessed using the Disturbances of Attachment Interview and the Strengths and Difficulties Questionnaire, then followed up 15 months and 2.5 years thereafter. Commitment of the foster carer was measured by ‘This Is My Baby’ interview. Multiple regression was used to analyse the data. ResultsHigher initial foster carer commitment, measured shortly after entry to care, was associated with a reduction in Reactive Attachment Disorder symptoms 15 months after placement, with a modest (non-significant) association persisting 2.5 years later. Initial commitment was not associated with symptoms of Disinhibited Social Engagement Disorder at any follow-up time point, nor with symptoms of mental health problems at 15 months. However, higher initial commitment was unexpectedly associated with higher mental health symptom scores at 2.5 years post-accommodation. ConclusionsThis study highlights the complex and non-linear development of children in committed foster care, underscoring the need to examine multiple time-points and to consider symptoms of Attachment Disorders separately from those of other mental health problems.

Effectiveness of Theraplay on Reactive Attachment Disorder in Children Aged 8-12 Years

Aim: The aim of this study was to determine the effectiveness of attachment-based play therapy method (Thera-play) on reactive attachment disorder in children aged 8 to 12 years. Method: The research method was quasi-experimental with pre-test, post-test and follow-up design. The statistical population included all children aged 8 to 12 years in Tehran who had expressed interest in the call through cyberspace. From the mentioned community, 32 children were selected and divided into two groups of experiments and controls. The intervention was presented as a weekly attachment-centered play therapy (Thera-play) (Peacock, 2020). Participants completed the Attachment Disorder Questionnaire (Randolph, 2000) before the beginning and after the sessions and repeated the post-test three months later. Data were analyzed by SPSS software using two-factor ANOVA statistical method. Results: The results of data analysis confirmed the significant effect of attachment-centered play therapy (Thera-play) on the symptoms of reactive attachment disorder (antisocial behaviors, impulsivity and coercion) (P<0.05). Conclusion: According to the results obtained in this study, the use of attachment-based play therapy approach (Thera-play) can be used as effective treatments in reducing the symptoms of reactive attachment disorder appropriate to the child's condition.

Changes in Attachment Disorder symptoms in children internationally adopted and in residential care

BackgroundA high incidence of Reactive Attachment Disorder (RAD) and Disinhibited Social Engagement Disorder (DSED) has been reported for children with experiences of trauma and other forms of adversity. ObjectiveThe present study aims to explore symptoms of RAD and DSED in children in two protection alternatives (international adoption and residential care) after experiences of early adversity. Participants and settingThe participants were 146 children: 40 children adopted into Spanish families from Russia, 49 children in residential care in Spanish institutions (40.8% in long-term foster centers) and 57 community comparison children. MethodsThe Relationship Problems Questionnaire was used to explore both RAD and DSED. All adoptive parents and institutional caregivers retrospectively reported the problems at time of placement (Wave 0), as well as the symptoms observed at the time of the study, with children aged 4–8 years old (Wave 1). At this stage, the assessment of the community comparison group was added. ResultsAdopted and children in residential care presented high levels of RAD and DSED symptoms at placement. For adoptees, previous experiences of abuse and neglect were marginally associated with the initial presence of RAD symptoms and a significant recovery was observed after an average of three years in their families, with a certain level of longitudinal continuity between initial and later assessments. In children currently placed in long-term residential centers in Spain, DSED symptoms worsened from W0 to W1. ConclusionsAdoption appears to be an effective intervention that promotes recovery of RAD and DSED symptomatology after early adversity, whereas institutionalization causes negative effects.

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.

The effect of phosphatidylserine administration on cognition and symptoms of reactive attachment disorder ‐ a randomized, double‐blind, placebo‐controlled clinical trial in adolescents

BACKGROUND Reactive Attachment Disorder (RAD) occurs in 1% of the general population and is caused by a disregard for a child's emotional or physical needs, or a repeated change in caregivers. Children with RAD display persistent social and emotional disturbances resulting in underperforming at school. Phosphatidylserine (PS) is a naturally occurring phospholipid that is most concentrated in the brain and has unique regulatory and structural functions. Supplementation with PS beneficially influences numerous neurotransmitter systems such as acetylcholine, dopamine, serotonin and norepinephrine. PS improves the cognitive response to physical or mental stress, and has been shown to improve memory and cognition in healthy individuals. In addition, PS has previously been shown to improve symptoms of attention-deficit hyperactivity disorder (ADHD) and short-term auditory memory in children with ADHD. HYPOTHESIS We hypothesized that PS supplementation results in favorable changes in cognition and RAD symptoms in adolescents. METHODS Thirty male and female adolescents (PS: n=14 (11 male, 3 female), 17.7±3.3 years; PLA n=16 (13 male, 3 female), 19.4±2.4 years) from Showa Gakuen school (Tokyo, Japan) ingested 200mg of PS (LIPAMINE-PS, Healthy Navi Co., Ltd., Japan) in form of a cocoa flavored chewable tablet or a matching placebo for two months in a randomized, double-blind, parallel design in accordance with the Basic Principles of the Declaration of Helsinki. Main outcome measures included: (i) RAD symptoms based on DSM-IV-TR; (ii) cognitive tests to evaluate memory, attention and concentration: short-term auditory memory (Digit Spin Forward), working memory (Digit Span Backward), attention and working memory (Serial Subtraction Test: Serial Sevens), visual-motor integration skills (Beery-Buktenica Developmental Test), processing speed, mental flexibility and language skills. Subjects were randomized into groups based on their baseline working memory scores. Statistical analysis was performed using STATCEL 2 (Oms-Publishing, Saitama, Japan). A p-value of <0.05 was considered statistically significant. RESULTS PS administration resulted in a statistically significant decrease in RAD symptoms (-65%) and an increases in sort-term auditory memory (+26%), working memory (+30%), calculus performance (+48%), Visual-Motor Integration (+32%), and processing speed (+32%), p<0.01, as well as language skills (+28%, p<0.05), compared to baseline, while the placebo group showed an improvement in processing speed (+24%, p<0.05). CONCLUSIONS PS supplementation can be an important nutritional strategy to improve RAD symptoms and cognition in adolescents.

Reactive attachment disorder symptoms and prosocial behavior in middle childhood: the role of Secure Base Script knowledge

BackgroundChildren with attachment disorder show prosocial behavior problems. Children with a reactive attachment disorder show inhibited and emotionally withdrawn behavior. Consequently, these children typically display prosocial behavior problems. However, the underlying mechanism between reactive attachment disorder and prosocial behavior problems is still unclear and findings in literature are mixed.MethodsThe current study investigated the role of children’s attachment representations in this association. Attachment representations reflect knowledge about a cognitive script regarding the attachment figure as a source for support (Secure Base Script). We tested whether secure base script knowledge 1) mediates or 2) moderates the link between reactive attachment disorder and prosocial behavior problems in 83 children (6–11 years; 83.1% boys) recruited from special education schools for children with behavioral problems. Children completed a pictorial Secure Base Script Test. Their reactive attachment disorder symptoms were assessed during an interview with the primary caregivers. Primary caregivers and teachers filled out a prosocial behavior questionnaire about the child.ResultsResults did not support the mediation hypothesis, but evidence for the moderation hypothesis was found. Secure base script knowledge attenuated the negative association between attachment disorder symptoms and prosocial behavior.ConclusionsThese findings contribute to the discussion about the link between attachment representations and attachment disorders.

Can reactive attachment disorder persist in nurturing placements? A systematic review and clinical case series

Reactive Attachment Disorder (RAD), is characterized by failure to seek and accept comfort in maltreated children. This lack of activation of the attachment system has profound developmental disadvantages yet, in early childhood, usually resolves quickly after placement in nurturing care. Persistence of RAD into middle childhood has been demonstrated in children reared in Romanian Institutions but, in family-reared children older children, there is controversy regarding whether RAD-like behaviors are genuinely attachment-related and stable from early childhood or are, in fact, related to PTSD. We conducted two pieces of research to investigate this: 1. a systematic review to examine persistence/resolution of RAD and 2. a case series of three boys whose RAD symptoms persisted despite living in placements judged by both social and child health services to be of good quality. Our systematic review revealed a paucity of longitudinal data. Except in atypical institutionalized samples, RAD had not been evidenced beyond pre-school. All three boys in the case series met DSM 5 criteria for RAD in late childhood/early adolescence and had stable RAD symptoms since before age 5. Qualitative interviews with their families revealed common themes of family strain, frustration and resentment at the lack of support from services. This paper provides the first opportunity to generate testable hypotheses about environmental circumstances and coexisting symptomatology that may influence RAD trajectories. Persistence of RAD has profoundly negative implications for children and their families. Recognition of RAD symptoms is challenging but crucial in order to improve care of these children and their families.

Stability and change of attachment disorder symptoms and interpersonal problems in foster children

This paper focuses on the longitudinal examination of perceived reactive attachment disorder (RAD) symptoms and indiscriminate, insecure and pseudomature behavior in foster children, many of them having experienced maltreatment and neglect in the family of origin. A total of 84 foster children - aged between 2 and 7 years - and 146 biological children (comparison group) participated across three assessments, with approximately six months between each assessment. At the first measurement, foster children had been living about 18 months on average in the current foster family. The child's RAD symptoms and interpersonal problems were assessed by parent reports (usually completed by the mother) on the Relationship Problems Questionnaire (RPQ) and the Assessment Checklist for Children (ACC), respectively. Foster parents reported substantially more RAD symptoms and further interpersonal problems than biological parents across all assessments. RAD symptoms and interpersonal problems declined over time in both, the foster care and the comparison group. The symptoms showed high rank-order stabilities and moderate to high intercorrelations among each other. To conclude, our findings indicate a high persistency of behavioral and emotional interpersonal problems in young foster children.

Development and Examination of the Reactive Attachment Disorder and Disinhibited Social Engagement Disorder Assessment Interview.

The fifth edition of the Diagnostic and Statistical Manual (DSM) categorizes reactive attachment disorder (RAD) and disinhibited social engagement disorder (DSED) as two separate disorders, and their criteria are revised. For DSED, the core symptoms focus on abnormal social disinhibition, and symptoms regarding lack of selective attachment have been removed. The core symptoms of RAD are the absence of attachment behaviors and emotional dysregulation. In this study, an international team of researchers modified the Child and Adolescent Psychiatric Assessment for RAD to update it from DSM-IV to DSM-5 criteria for RAD and DSED. We renamed the interview the reactive attachment disorder and disinhibited social engagement disorder assessment (RADA). Foster parents of 320 young people aged 11 to 17 years completed the RADA online. Confirmatory factor analysis of RADA items identified good fit for a three-factor model, with one factor comprising DSED items (indiscriminate behaviors with strangers) and two factors comprising RAD items (RAD1: failure to seek/accept comfort, and RAD2: withdrawal/hypervigilance). The three factors showed differential associations with clinical symptoms of emotional and social impairment. Time in foster care was not associated with scores on RAD1, RAD2, or DSED. Higher age was associated with lower scores on DSED, and higher scores on RAD1.

Inhibited symptoms of Reactive Attachment Disorder: links with working models of significant others and the self

ABSTRACTTo better understand Reactive Attachment Disorder (RAD), the current study tested whether emotionally and behaviorally disordered children with versus without RAD differ with regard to the quality of their interpersonal behavior during interactions with teachers and with regard to their representations of self and others. Therefore, 77 children were screened for RAD symptoms and 22 likely cases of inhibited RAD were identified. To measure quality of the interactions with teachers, we observed children’s trust and positive affect in dyadic interactions with teachers. For the representations of others, we measured self-reported trust in parents and teachers. For the representations of the self, two self-esteem assessments were individually administered. Results showed that, compared to children with other emotional and behavior disorders, RAD children’s behavior reflected less trust in their teachers. At the level of representations, children reported less trust in teacher care. Instead, no links were found with self-report measures focusing on representations of parents and of self. These findings will be discussed in light of the ongoing discussion about whether or not attachment disorder and insecure attachment are associated concepts.

Development and validation of an observational measure of symptoms of Reactive Attachment Disorder

ABSTRACTReactive Attachment Disorder (RAD) is presumed to be a consequence of social neglect and deprivation of the kind particularly associated with institutional care. Despite its clinical relevance there is a lack of assessment tools for RAD based on the direct observation of child–caregiver interaction.Here we describe the development and validation of such a tool for use with preschool children, the Rating of Inhibited Attachment Disordered Behavior (RInAB). The RInAB is composed of 17 ratings grouped in three subscales assessing (1) Attachment, (2) Exploratory, and (3) Socioemotional behavior.Participants were 134 institutionalized preschool children (M = 54.84 months; SD = 10.83; 60% boys) and their caregivers.Adequate reliability was found for RInAB subscales and total score. Confirmatory factor analyses documented the three aforementioned RInAB subscales. Correlational analyses documented: (i) construct validity via positive and significant associations with caregiver sensitivity and quality of child–caregiver relationship; (ii) convergence validity via association evidence with some emotionally/withdrawn inhibited items of the Disturbed Attachment Interview (DAI), as well as, with Child Behavior Checklist (CBCL)’s somatic complaints and withdraw syndrome scales; and (iii) discriminant validity via nonsignificant or negative associations with DAI-indiscriminate subscale, Rating of Infant and Stranger Engagement (RISE) and CBCL-externalizing problems. Discussion highlights the contributions complementary roles of RInAB for a comprehensive assessment of child RAD-related functioning.

Attachment Disorder behavior in early and middle childhood: associations with children’s self-concept and observed signs of negative internal working models

ABSTRACTMost research on attachment in childhood is based on observation. In contrast, research on reactive attachment disorder (RAD) is mainly based on caregiver reports. Moreover, little is known about self-concept or internal working models (IWMs) of self and others in children with RAD. The present study examined whether caregiver reports and the frequency of observed signs of RAD reveal differences between children at risk for developing RAD symptoms and healthy controls in middle childhood. In addition, children’s self-concept, observable signs of negative IWMs, and mental health were assessed. Results revealed that the RAD risk group showed increased reported and observed signs of RAD, a more negative self-concept, and more signs of negative IWMs compared to healthy controls. Signs of RAD in middle childhood were expressed trans-relational to both caregivers and strangers. Moreover, RAD symptoms were associated with negative self-concept, observed signs of negative IWMs, and poor mental health.

The socio-behavioral development of children with symptoms of attachment disorder: An observational study of teacher sensitivity in special education

BackgroundChildren with Reactive Attachment Disorder (RAD) have serious socio-behavioral problems and often rely on socially abnormal, aggressive, and manipulative forms of communication. Little is known, however, about the influence of teachers on the socio-behavioral development of children with symptoms of RAD. AimsThis longitudinal study examined the influence of teacher sensitivity on the socio-behavioral development of children with symptoms of RAD across one school year. MethodThe sample included 85 Belgian children and 70 teachers from special education schools. In the previous school year, teachers rated Inhibited and Disinhibited RAD symptoms. In the next school year, teacher Sensitivity was observed in interactions with individual children in the first trimester. Teacher-rated Overt aggression, Relational aggression, and Prosocial behavior was assessed in the first, second, and third trimester. ResultsWe found no effects of Sensitivity on Prosocial behavior. Also, no effects were found for children with Disinhibited RAD symptoms. For children with Inhibited RAD symptoms, increases in Overt and Relational aggression were observed when Sensitivity was low, whereas decreases were observed when Sensitivity was high. Conclusions and implicationsThe results suggest that teacher sensitivity is associated with the socio-behavioral development of children with Inhibited RAD symptoms but not with the socio-behavioral development of children with Disinhibited RAD symptoms. What this paper addsChildren with Reactive Attachment Disorder (RAD) exhibit socio-behavioral problems that hinder their school adjustment. These socio-behavioral problems appear relatively stable and it is not known what influence special education teachers might have on the development of these problems across a school year.This study suggests that teacher sensitivity is associated with changes in the socio-behavioral development of children with Inhibited RAD symptoms. Whereas high sensitivity was associated with improvements, low sensitivity appeared to exaggerate the socio-behavioral problems of these children.As children with Inhibited RAD symptoms have difficulties communicating their needs and wishes in socially adaptive ways, it may not be easy for teachers to understand these children. Teachers may misinterpret a child’s behavior and consequently will fail to respond to the child’s underlying needs. This may reinforce the child’s socio-behavioral problems and increase the child’s reliance on egocentric and aggressive means in interactions with others. This study therefore highlights the need to support teachers in interactions with children with Inhibited RAD symptoms in order to help them understand how the children’s observable behaviors in the classroom may convey their underlying socio-emotional needs and how they can respond to these needs.Importantly, teacher sensitivity was not associated with the socio-behavioral development of children with Disinhibited RAD symptoms (e.g., indiscriminate friendliness). Consistent with previous research, this study suggests that children with Inhibited RAD symptoms are more susceptible to the quality of the caregiving environment than children with Disinhibited RAD symptoms and extends this finding to the school context.

Reactive Attachment Disorder in Orphans and Vulnerable Children (OVC) Affected by HIV/AIDS: Implications for Clinical Practice, Education and Health Service Delivery

Background: Orphans and vulnerable children (OVC) affected by HIV/AIDS frequently experience placement/ residential changes, inconsistent caregivers, abuse, neglect, disruptions in their lives and several mental health problems. This may lead to a disorder of emotional functioning, reactive attachment disorder (RAD), where the child exhibits wary, watchful, and emotionally withdrawn. Despite its clinical importance, nothing is known about RAD among OVC. This study investigated: (1) whether RAD symptoms can occur in children affected by HIV/AIDS; (2) association between RAD and other psychiatric symptoms; (3) possible aetiological or contextual factors for high RAD symptom; and (4) any interactive, cumulative effects between the aetiological or contextual factors (both risks and protective) for higher RAD symptoms. Method: In a cross-sectional survey, caregivers of 191 OVC and 100 non-OVC completed questionnaires on mental health problems including RAD and contextual variables. Results: The results demonstrated that RAD is present in OVC and that RAD symptoms may be as a result of environmental factors. The study also found high levels of RAD comorbidity with other disorders including depression, conduct problems and hyperactivity. Finally, the results indicate that experiencing more neglect and psychological abuse among OVC increases their likelihood of exhibiting RAD symptoms five-fold. Conclusion: The paper discusses the clinical implications of these findings for service development for this vulnerable group in the community and concluded that among children affected by HIV/AIDS, RAD was not rare.