Reactive Attachment Disorder - PowerPoint Presentation

Reactive Attachment Disorder
Reactive Attachment Disorder

Reactive Attachment Disorder - Description

Causes Diagnosis Treatment Basic Trust vs Mistrust Erikson Infants are totally helpless and dependent on parentscaregivers If needs are met consistently the child learns to trust others and the foundation for a secure attachment is laid ID: 695277 Download Presentation


rad attachment dsm child attachment rad child dsm disorder amp caregivers children dsed behavior social comfort disorders year cycle

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Reactive Attachment Disorder


Basic Trust vs. Mistrust (Erikson)

Infants are totally helpless and dependent on parents/caregivers.If needs are met


, the child learns to trust others, and the foundation for a secure attachment is laid

.If needs are not met consistently, the child becomes fearful and learns not to rely on others.Slide3

The Attachment Cycle: First YearSlide4

The Attachment Cycle: 2nd Year

The 2


year attachment cycle cannot be started until the first year secure attachment cycle has been met.

Children with insecure attachment do not progress to this 2nd year

Unhealthy Attachment & the Brain

Dr. Allan N. Schore’s 2001 article detailing the effects of traumatic attachment on the development of the right hemisphere changed the way RAD

is conceptualized and treated.

Traumatic attachment results in periods of “

hyperarousal and dissociation,” which interferes with the developing autonomic nervous system & limbic system of the right brain.

The structural changes in the brain lead to ineffective stress coping mechanisms in the child.

What results is




Early intervention with


programs is crucial to altering the process. Slide6

RAD as a diagnosis

First talked about in 1980 as part of DSM- IIIConsidered a controversial diagnosis at the timeSome disagreement as to whether it is separate from Ainsworth’s disorganized attachment or basically the same thing.

Current thinking is that it is a subcategory of disorganized attachment

Disorganized attachment is also considered a risk factor for RAD.Slide8

Changes from DSM IV to DSM 5

DSM-IV listed RAD as having two subtypes: --Emotionally withdrawn/inhibited--Indiscriminately social/


DSM 5 turned the two subtypes into separate disorders:

--Reactive Attachment Disorder (RAD)--Disinhibited Social Engagement Disorder (DSED)Slide9

Category placement of RAD/DSED

DSM 5 places both disorders in the general category of trauma & stress-related disorders.Included in this group (besides RAD and DSED) are


Adjustment disorders

Acute stress disorderSlide10


Same etiological pathway for bothRAD has dampened positive affect (depressive symptoms) and is more internalized; equivalent to a lack of or improperly formed attachment to caregivers.DSED resembles ADHD more closely. Marked by externalized behavior and



Social neglect during childhood is a diagnostic requirement for both conditions, but a child with DSED may have secure attachments.Diagnoses differ in correlates, causes, and responses to intervention and are therefore considered separate disorders in DSM 5.Slide11

DSM 5 criteria for RAD

A. Consistent pattern of inhibited, emotionally withdrawn behavior toward adult caregivers, manifested by both of the following:

--Rarely/minimally seeks out comfort when distressed

--Rarely/minimally responds to comfort when distressed

B. A persistent social & emotional disturbance characterized by at least 2 of the following: --Minimal social & emotional responsiveness to others

--Limited positive affect

--Episodes of unexplained irritability, sadness, or fearfulness that are evident even during nonthreatening interactions with caregiversSlide12

DSM Criteria (cont.)

C. The child has experienced a pattern of extremes of insufficient care as evidenced by at least 1 of the following:1. Social neglect or deprivation in the form of persistent lack of having basic emotional needs for comfort, stimulation, and affection by



2. Repeated changes of primary caregivers that limit opportunities to form stable attachments (e.g., frequent changes in foster care).3. Rearing in unusual settings that severely limit opportunities to form selective attachments (e.g., institutions with high child-to-caregiver ratios).Slide13

DSM criteria (cont.)

D. The care in Criterion C is presumed to be responsible for the disturbed behavior in Criterion A (e.g., the disturbances in Criterion A began following the lack of adequate care in Criterion C).E. The criteria are not met for autism spectrum disorder.F. The disturbance is evident before age 5.

G. The child has a developmental age of at least 9 months.Slide14


Specify if:Persistent: The disorder has been present for more than 12 months.Specify current severity:

RAD is specified as


when a child exhibits all symptoms of the disorder, with each symptom manifesting at relatively high levels.Slide15

Key Diagnostic Features

Absent or extremely underdeveloped attachments between the child and caregiving adults.No comfort-seeking behavior or responses to comfort when child is distressed.

Diminished or absent positive emotions when interacting with caregivers

Evidence that emotional regulation is compromised; negative emotions of fear, sadness, and irritability that are not easily explained.Slide16

Older vs. Young Children

It is unclear whether older children show the same symptoms as younger children do or if the disorder even presents in older children.Diagnosis should be made with caution in children older than age 5. Slide17

Signs and Symptoms of RAD

In Infants Withdrawn, sad, listless appearance

Failure to smile

Failure to follow others with eyes

No interest in interactive games (peek-a-boo) or toysWon’t hold out arms to be picked upSelf-soothing behaviorCalm when left alone

In Toddlers & Children

Withdrawing from others

Aggressive behavior

Avoiding or dismissing comfort

Watching others closely but not getting involved

Obvious & consistent awkwardness or discomfort

Failing to ask for assistance

Masking feelings of anger or distressSlide18

Treatment of RAD

No standard treatmentIndividual and family counseling is typical.Behavior therapy is sometimes used.No pharmacological treatment exists.


is a promising new research & treatment area.

Three Crucial Ingredients by Caregivers:SecurityStability


Beware of “Attachment Therapy”

Based on the idea that the child must release pent-up rage in order to become emotionally healthy“Rebirthing”—has been linked to several deathsHolding therapy“Strong sitting”

Forced eye contact


therapySome attachment therapists are quick to diagnose RAD based on vague symptoms; they do not follow the DSM’s diagnostic criteria and charge thousands of dollars for their “therapy.”

BethThomas—original RAD kid (1989)


HBO documentary

Child of Rage.

Shom More....
By: alida-meadow
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Type: Public

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