Academic literature on the topic 'Reactive attachment disorder (RAD)'

<p> Reactive Attachment Disorder (RAD) is a potential consequence of pervasive neglectful and unpredictable caregiving behaviors, and has extensive psychological and daunting consequences on the vulnerable and developing young brain. Current treatment strategies for RAD are conspicuously lacking, relying on indiscriminately targeted psychopharmacological therapies with pharmacokinetic and pharmacodynamic complications due to developmental vulnerabilities, and the unavailability of evidence based psychotherapeutic interventions. At present, there is an acute demand for innovative research into more developmentally sensitive and neurobiologically targeted treatment strategies for this population, and as a result, Vagus Nerve Stimulation (VNS) is being proposed as a potentially efficacious treatment for children with RAD due to the targeted effects on limbic system structures and neurotransmitter systems that are directly implicated in the neurobiology of RAD. Rationale for the use of VNS in the pediatric RAD population is based upon evidence from the safety and efficacy of VNS in the pediatric epileptic population, in conjunction with the fairly consistent observed anxiolytic and mood stabilizing effects reported in multiple clinical studies.</p>

Abstract : The diagnostic criteria for Reactive Attachment Disorder (RAD) have remained fairly constant over the last few decades. However, the most recent change in the fifth version of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5; American Psychiatry Association; APA, 2013) is fairly significant, as the inhibited and disinhibited types of RAD that were found in the previous versions of the manual have been removed. RAD has been replaced with a definition that resembles in some ways the previous inhibited type. Diagnosed in early childhood, this disorder interferes with the child’s ability to form secure relationships with their attachment figures and others. One of the criteria that remain constant is that deprivation in the quality of early care is a risk factor for developing RAD. Although physical abuse and extreme neglect may be easier to identify, emotional neglect is more challenging as a variable to understand. There has been less research on RAD regarding the subtle interactions between mother and child. The theory of mentalization explores some of the complications that arise in attachment and relationships to others that are aggravated by neglect, abuse, and trauma (Bateman & Fonagy 2004). The infant relies on the sensitive attunement and capacity to mentalize of the primary caregiver to help him understand what he is experiencing. The first article uses mentalization and object relations theory applied to children with RAD, in order to facilitate an understanding of these children psychologically as well as certain aspects of the relationship with their mothers. The second article presents two case studies of mother-child dyads of children who have been diagnosed with RAD. The mother and child were evaluated with instruments that provided information regarding the mother’s capacity to mentalize and the child’s attachment representations. The objective of the case studies were meant to reveal how these instruments could be utilized for the specific scores, but also to illustrate what is transpiring psychologically in the relationship between mother and child. The capacity to mentalize of the mothers was measured with the Addendum to Reflective Functioning Scoring Manual (Fonagy, Steele, Steele, & Target, 1998) applied to the Parent Development Interview-Revised (PDI-R; Slade, Aber, Berger, Bresgi, & Kaplan, 2005). The results of the mother’s scores for mentalization were in the low and questionable range. The attachment representations of the children were evaluated through the use of the Attachment Focused Coding System (AFCS; Reiner & Splaun, 2008) applied to the Attachment Story Completion Task (ASCT; Bretherton, Ridgeway, & Cassidy, 1990). The results of the instrument revealed that the two children with RAD (inhibited and disinhibited type) had lowered scores for Supportive Mother and a tendency for Avoidant Attachment Behaviour and Communication. The notions of mentalization and attachment representations were shown to provide a more profound understanding of the mother and child dyad. These evaluation methods support considering a larger study to explore the link between the mother’s capacity to mentalize and the child’s attachment representations in children diagnosed with RAD.<br>Résumé : Les critères diagnostiques du trouble réactionnel de l'attachement (TRA) sont demeurés relativement stables au cours des dernières décennies. Toutefois, la cinquième version du Manuel diagnostique et statistique des troubles mentaux (DSM-5; American Psychiatric Association; APA, 2013) propose un seul type de TRA, qui correspond au type inhibé de la quatrième version révisée (DSM-IV-TR; APA, 2000), au lieu de distinguer entre deux types, soit inhibé et désinhibé. Diagnostiqué dans la petite enfance, le TRA interfère avec la capacité de l'enfant à former des relations sécurisantes avec ses principales figures d'attachement qui demeure un des critères diagnostiques et un facteur de risque pour le développement du TRA. Bien que l’abus physique et la négligence extrême soient plus faciles à identifier, la négligence au plan affectif est plus subtile et difficile à comprendre. Peu de recherches portent sur les interactions subtiles entre les mères et les enfants ayant reçu un diagnostic de TRA. La notion de mentalisation explore les complications qui peuvent survenir dans la relation aux principales figures d’attachement et dans les interactions sociales dans un contexte d’abus et de négligence (Bateman & Fonagy 2004). Pour être en mesure de comprendre ce qu’il vit, l'enfant nécessite des figures d’attachement sensibles et capables de mentaliser. Dans le premier article, les théories relatives aux notions de mentalisation et des relations d’objet sont utilisées pour comprendre le fonctionnement psychologique des enfants et la relation qu’ils entretiennent avec leurs mères chez des jeunes présentant un diagnostic de TRA. Dans le second article, deux études de cas de dyades mère-enfant ou l’enfant a reçu un diagnostique de RAD sont présentés. Les études de cas avaient pour objectif d’illustrer que les notions de mentalisation et de représentation d’attachement ainsi que les instruments permettant de les mesurer pourraient être utilisé pour approfondir ce qui passe entre la mère et l’enfant aux plans psychologique et relationnel. La capacité de mentalisation des mères participant à l’étude a été mesurée à l’aide de l'Échelle du fonctionnement réflexif (Addendum to Reflective Functioning Scoring Manual; Fonagy et al., 1998) appliquée à l’Entrevue sur le développement du parent (Parent Development Interview-Revised; PDI-R; Slade et al., 2005). Les résultats de la capacité de mentalisation des mères se situent dans les catégories faible ou questionnable. Les représentations d'attachement des enfants ont été évaluées en utilisant le Système de cotation centré sur l’attachement (Attachment Focused Coding System. (AFCS; Reiner & Splaun, 2008) appliqué aux Histoires d’attachement à compléter (Attachment Story Completion Task, ASCT; Bretherton, Ridgeway, & Cassidy, 1990). Les enfants participant à l’étude, ayant respectivement un TRA de type inhibé et désinhibé, ont obtenus des scores faibles dans les échelles Mère soutenante et Évitement des comportements et des communications relatifs à l’attachement. La théorie et la recherche concernant la notion de mentalisation permettent de mieux comprendre les difficultés rencontrées chez les dyades mère-enfant dont les jeunes présentent un diagnostic de TRA. Les notions de mentalisation et de représentations d’attachement ont permis d’approfondir la compréhension des dyades mère-enfant. Les méthodes d’évaluation utilisées dans la présente étude pourraient être utilisés pour explorer le lien entre la capacité de mentalisation de la mère et les représentations d'attachement de l'enfant au sein d’un échantillon plus large d’enfants présentant un diagnostic de TRA.

Adopted children with special needs can experience a multitude of developmental, emotional, and behavioral issues as a result of pre-adoption maltreatment. On rare occasions, maltreated children can display behaviors severe enough to fit the criteria of reactive attachment disorder (RAD). Children with RAD are known to engage in self-destructive behavior, talk of killing others or themselves, verbal and physical aggression toward peers and adults, and a lack of discernment between parental figures and strangers. Given the uniqueness of these behaviors, the rarity of the disorder, and the lack of research in this area, further exploration is warranted. Therefore, the purpose of this study is to explore the effects an adopted child with reactive attachment disorder (RAD) has on family functioning. Due to their being little research on RAD in the context of families, an exploratory approach was determined to be the best fit for this study. Kathy Charmaz's constructivist grounded theory guided this qualitative inquiry. Her approach, coupled with the use of semi-structured interviews, allowed for rich, descriptive information to be obtained, while allowing the researcher to include aspects of his experience in working with children with RAD. The relevant data collected included five families from the Midwest, and consisted of a total of 28 participants, with 14 adults and 14 children. The adopted children's mental health assessments, individual education plans, and the researcher's field notes were also included. Data analysis consisted of the constant comparative method. RAD behaviors were found to manifest themselves on a developmental continuum, with two dominant forms of thinking and behaviors identified. These behaviors are characterized as control-based, and are often perpetuated by high levels of anxiety. When this anxiety becomes unmanageable for the child, it is released in the form of rages toward those caregivers who are deemed as safe and for whom the child as the strongest relational bond. Traditional child therapies and behavior modification techniques were found to do little to change the course of these behaviors. Since children with RAD had no physical sign of a disorder, this commonly led the public to perceive their behaviors as being the result of parental incompetency. Parents who continually experienced public criticism found themselves purposefully withdrawing from society. This withdrawal was related to an increased sense of isolation, which was related to increased levels of stress, somatic complaints, and marital discord. Possible neurobiological factors involved in the development of RAD are discussed, along with practice and policy implications for families who adopt children with RAD.

<p> Research on Reactive Attachment Disorder (RAD) is minimal and is limited primarily to describing its nosology and clinical treatment practices. This qualitative, multi-case, case study identified school-based academic and emotional&ndash;behavioral interventions and factors which contribute to or hinder progress by conducting open-ended, semistructured interviews with high school students with a diagnosis of RAD and with school personnel who worked directly with them. Participants were from two neighboring school districts in a relatively large western state. Participants included five high school students with a diagnosis of RAD and four school personnel who worked directly them. One staff member had two students who participated in the study and thus interviewed specifically regarding both students. Data is reported holistically, as well as in paired student-staff responses to demonstrate the similarities and differences in the perceptions in relation to interventions and factors which contributed to or hindered student academic and emotional-behavioral progress. Five themes emerged in this study which led to specific implications for professional best practice including: 1) necessity for additional training, 2) development of support systems in the school setting, 3) providing a &ldquo;go-to&rdquo; person, 4) provide direct instruction in why and how emotional-behavioral progress will be monitored, and 5) provide direct instruction in how to build and maintain trust. As not all of these practices are currently implemented or intuitive it led to the development of a new theoretical explanation: <i>RAD Teaching Practice.</i></p>

Parent-Child Interaction Therapy is a probably efficacious, evidenced-based treatment, which has been proven to decrease problem behaviors of children, as well as improve parent-child interactions. The first phase is the Child-Directed Interaction (CDI), which allows the child to lead the play session, while parents are taught to interact without giving demands, asking questions, or providing criticism. According to the DSM-IV-TR, Reactive Attachment Disorder is a rare diagnosis. Many attachment therapists indicate that traditional approaches to treatment have not been demonstrated as being effective with these children. This study will examine the CDI phase of Parent- Child Interaction Therapy as a potential treatment option for children diagnosed with Reactive Attachment Disorder.

Reactive attachment disorder (RAD), a disorder marked by a severe disruption in developmental attachment, is most often diagnosed in youth who have received substandard or negligent care from their primary caregiver. Such youth have increased risk of behavioral and emotional issues as well as future relationship problems; they generally do not respond to traditional evidence-based practices of therapy. The present study examined the use of the biofield energy practice of Healing Touch (HT) as a viable therapeutic option for improved quality of life for youth diagnosed with RAD. A quantitative, quasi-experimental research study using secondary data was conducted. Eligible participants were 40 children between the ages of 6and 21 residing at a residential facility and having the diagnosis of RAD. Half of the participants received HT therapy while the other half did not. Dependent variables of frequencies of seclusion, aggression, self-injury/self-harm, property damage in excess of $50, and running away from the facility were assessed at set intervals before and after implementation of HT therapy. Findings from a 2 x 2 mixed factorial design using mixed ANOVAs lacked statistical significance; therefore, the alternative hypotheses were not supported. However, the potential remains for positive social change. Clinical importance was evidenced in several variables demonstrating improvement in behaviors for many participants. In addition, while statistical significance was not obtained, the study contributes to the knowledge base regarding the use of HT therapy for future studies.