Dissertations / Theses on the topic 'Reactive attachment disorder'

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.

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.
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.

Common diagnoses have greater emphasis in the Master of Social Work (MSW) Program, yet there is an oversight on other disorders that are just as important to address, such as Reactive Attachment Disorders (RAD). Although researchers have determined a need for additional training and education on RAD, none have measured MSW students’ level of knowledge on RAD and whether or not it influences their perceived preparedness. The purpose of this study was to analyze the perceived preparedness of MSW students to serve children with RAD before and after participating in an educational training. The study consisted of an explanatory quantitative design using pre/post self-administered surveys and an educational training on RAD. Findings determined that participating in the RAD Training significantly increased MSW students’ knowledge and perceived preparedness to serve children with RAD. The study’s findings may influence MSW administration to recognize the significance of implementing additional training on rare disorders.

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.

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–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 “go-to” 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: RAD Teaching Practice.

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.

Aim: To provide a systematic review of the evidence regarding the impact of paediatric brain injury on friendship and social participation. Method: The search used Ovid MEDLINE, Embase, PsychINFO and Web of Science databases and hand searched a key journal. Ten papers met inclusion criteria, five relating to friendship and five to social participation. The methodological quality of the articles was rated using set criteria. Results: Four of the ten papers were rated as high quality. The main results showed that social participation decreased following brain injury and greater injury severity was associated with less participation. Three studies found that friendship networks remained the same; however two papers noted there were changes in friendship quality. Conclusions: Brain injury has a negative impact on social participation in children and young people. Although the results on friendship are mixed, emotional problems amongst the brain injury group may cause difficulties in developing relationships over time. Further longitudinal studies may provide a greater understanding of this issue.

Background: Reactive attachment disorder (RAD) has been described as one of the least researched and most poorly understood psychiatric disorders (Chaffin et al., 2006). Despite this, given what is known about maltreatment and attachment, it is likely that RAD has profound consequences for child development. Very little is known about the prevalence and stability of RAD symptoms over time. Until recently it has been difficult to investigate the presence of RAD due to limited measures for informing a diagnosis. However this study utilised a new observational tool Method: A cross sectional study design with a one-year follow-up explored RAD symptoms in maltreated infants in Scotland (n=55, age range= 16-62 months) and associated mental health and cognitive functioning. The study utilised the Rating of Inhibited Attachment Behavior Scale (Corval, et al., unpublished 2014) that has recently been developed by experts in the field along side The Disturbances of Attachment Interview (Smyke & Zeanah, 1999). Children were recruited as part of the BeST trial, whereby all infants who came in to the care of the local authority in Glasgow due to child protection concerns were invited to participate. The study sample was representative of the larger pool of data in terms of age, gender, mental health and cognitive functioning. Results: The sample was found to be representative of the population of maltreated children from which it was derived. Prevalence of RAD was found to be 7.3% (n=3, 95% CI [0.43 – 14.17]) at T1, when children are first placed in to foster care. At T2, following one year in improved care conditions, 4.3% (n=2, 95% CI [below 0 – 10.16]) met a borderline RAD diagnosis. Levels of observed RAD symptoms decreased significantly at T2 in comparison to T1 but carer reported symptoms of RAD did not. Children whose RAD symptoms did not improve were found to be significantly older and showed less prosocial behaviour. RAD was associated with some mental health and cognitive difficulties. Lower Verbal IQ and unexpectedly, prosocial behaviour were found to predict RAD symptoms. Conclusions: The preliminary findings have added to the developing understanding of RAD symptoms and associated difficulties however further exploration of RAD in larger samples would be invaluable.

Reactive attachment disorder (RAD) is characterised by severely underdeveloped or absent attachment between a child and a caregiver. Adopted children who have experienced adverse early experiences prior to adoption may have lacked opportunities to form selective attachment relationships and, in rare cases, may have a diagnosis of reactive attachment disorder. The needs of adoptive families rearing children with special needs, such as children with a RAD diagnosis, are unique and it is crucial to understand the experiences of the families in order to increase the understanding of how to provide support and adequate services and interventions that respond to the needs of the families. Previous research focusing on adoptive parents’ experiences rearing children with a RAD diagnosis is scarce. Therefore, this systematic literature review aimed to explore their experiences. After a comprehensive literature search, seven articles that addressed the study aim and met the predefined inclusion criteria were included. A thematic synthesis was carried out to combine the results of the included articles. The findings suggest that adoptive families rearing children with a RAD diagnosis experience a wide range of challenges in their everyday lives, such as a lack of social network support and adequate support, services and interventions from professionals and service providers. Some facilitative factors, such as adoptive parents’ willingness to stay committed to their children, were found. Further research is needed to find out effective interventions to address the complex challenges adoptive families and their children with a RAD diagnosis experience. Study limitations and methodological considerations are discussed.

This study uses a multiple regression correlational (MRC) analytic approach to examine the association between witnessing violence and reactive aggression, post-traumatic stress, and insecure attachment. One hundred adult male California State University students were surveyed using the Conflict Tactics Scale, the Adolescent Anger Rating Scale, the Inventory of Parent and Peer Attachment scale, the Child Report of Post Traumatic Symptoms scale, the Conduct Disorder scale, and the Modified Impact of Events scale.

The aims of this cross-sectional case-control study were to explore the social information processing (SIP) patterns of children with reactive attachment disorder (RAD) and their association with behavioural difficulties. The sample consisted of 23 children with RAD aged 4-12 matched by age and gender with a comparison sample of typically developing peers. Children completed an assessment package investigating the encoding, interpretation, response access and response evaluation components of SIP and their intellectual functioning and verbal comprehension, while caregivers completed two instruments measuring child behavioural difficulties. The children with RAD displayed significantly more errors in encoding, interpretation and response evaluation than the comparison group. There was also a tendency for children with RAD to access more aggressive responses than comparison children. In addition, there were strong associations between aspects of SIP and child behavioural difficulties, with the strongest association between encoding and emotional problems. However, both intellectual functioning and verbal comprehension were significantly associated with behavioural difficulties suggesting these variables may impact on the relationship between SIP and behavioural difficulties. The overall findings suggest that children with RAD process social information in a biased manner and this is partially associated with behavioural outcomes. The strengths and limitations of the study are discussed in addition to suggestions for future research.

O presente relatório retrata a experiência de estágio no Centro CADIn Neurodesenvolvimento e Inclusão no ano letivo 2017/2018. Durante o ano letivo tive a oportunidade de acompanhar crianças com idades entre os dois e os 12 anos em três áreas distintas do neurodesenvolvimento: intervenção precoce, apoio psicopedagógico e treino comportamental. O estágio iniciou com um período de observação de sessões, avaliações e consultas, seguido de um progressivo aumento na participação e autonomia nas avaliações e intervenções. Os dois casos selecionados para estudos de caso, e os quais apresentam maior destaque no presente relatório tinham diferentes diagnósticos, sendo estes: Perturbação Reativa da Vinculação e Perturbação do Desenvolvimento da Coordenação Motora. Neste sentido, o relatório organiza-se em duas partes distintas, na primeira é feito um enquadramento à instituição, à sua visão e valores. E na segunda parte são apresentados os objetivos e o funcionamento do estágio, bem como os casos acompanhados, com destaque para os estudos de caso e respetivo enquadramento teórico. É também aqui que apresento os trabalhos complementares realizados durante o estágio na instituição
This report describes the internship experience at the CADIN Neurodevelopment and Inclusion, in the school year 2017/2018. During the school year I have the opportunity to accompany children aged between two and 12 years in three distinct areas of neurodevelopment: early intervention, psychopedagogical intervention and behavioural intervention. The internship began with a period of observation of sessions, assessments and interventions, followed by a progressive increase in participation and autonomy in evaluations and interventions by the trainee. The two cases selected for case studies, and which are more prominent in this report had different diagnostics, these being: Reactive Attachment Disorder and Motor Developmental Coordination Disorder. In this sense, the report is organized in two distinct parts, the first one is a framework for the institution, its vision and values. And the second part presents the objectives and the operation of the internship, as well as the cases followed, highlighting the case studies and their theoretical framework. In this part I also present the complementary work done during the internship at the institution.