Psychiatric Illness: Reactive Attachment Disorder

Reactive Attachment Disorder (RAD) was first introduced just over 20 years ago, with the publication of DSM-III (American Psychiatric Association, 1980). In the DSM-IV. The disorder is defined by aberrant social behavior that appears in early childhood and is evident cross contextually(1994). The disorder describes aberrant social behaviors in young children that are believed to derive from being reared in caregiving environments lacking species-typical nurturance and stimulation, such as in instances such as maltreatment or institutional rearing. (First, M., & Tasman, A. 2010) . In cases of RAD two major types of abnormalities have been cited; these include an emotionally withdrawn/inhibited type and an indiscriminately social/disinhibited pattern (First, M., & Tasman, A. 2010).Conditions in in foreign orphanages and institutions such as, multiple caregivers, maltreatment, abuse, neglect, and others contribute to the inability for internationally adopted children to form secure attachments. All of these factors contribute to internationally adopted children being at a higher risk to develop attachment disorders such as RAD and other behavioral problems.

Reactive Attachment Disorder is a common infancy/early childhood disorder. Reactive attachment disorder is located under the trauma- and stressors-related disorder section of the Diagnostic and Statistical Manuel of Mental Disorders (DSM-5), Fifth Edition. It is normally diagnosed when an infant or child experience expresses a minimal attachment to a figure for nurturance, comfort, support, and protection. Although children diagnosed with reactive attachment disorder have the ability to select their attachment figure, they fail to show behavioral manifestation because they had limited access during the early developmental stage. Some disturbed behaviors include diminished or absence of positive emotions toward caregiver. In addition,

attachment relation can help orphan overcome their adaptive problems.” (Laing , 2007) In a situation as tragic as childhood abandonment one can only hope that a child finds this positive guidance. Children who are brought up with this attachment styles grow up to be adults with healthy relationships and do not fear interactions with others and do not block others out emotionally. Adults who were raised with secure attachment styles feel comfortable with standing on their own and not depend on relationships to determine their self-worth.

Reactive Attachment Disorder is a psychological disorder which effects children and adults in the United States. Reactive Attachment Disorder or “RAD”, “is a rare but serious condition in which an infant or young child doesn't establish healthy attachments with parents or caregivers” (Mayo Clinic Staff, 2014). Adolescents suffer from reactive attachment disorder in the United States due to a lack of appropriate parent care which can be cured through seeking the assistance of professionals.

This paper is a review of how attachment disorders were first defined in the Diagnostic Statistical Manual of Mental Health Disorders (DSM) in 1980, and how the descriptions have evolved over the past 30 years of research efforts which have provided new insights into the disorder. The main attachment disorder discussed is Reactive Attachment Disorder (RAD), that has recently been expanded to include a new diagnosis term called DSED – Disinhibited Social Engagement Disorder. In order to provide effective therapeutic interventions to children who may suffer from RAD, the professionals they come in contact with on a regular basis must be provided the skills to recognize the common indicators of the disorder as early as possible in a child’s development. RAD, if left undiagnosed, can have devastating effects throughout the lifespan for the individuals who suffer from it.

Imagine one moment you’re outside playing football in the yard with your little brother, then in a split second something triggers him and fills him with an uncontrollable rage that will have you scared of someone in your own family. This is because my little brother Ty suffers from Reactive Attachment Disorder and like many other foster kids Ty was neglected by his birth parents and then did not establish an appropriate bond with a caregiver. To people unaware of Ty’s mental illness he may seem like a normal 16 year old that spends time with his family and enjoys working on his dirtbikes. What the people don’t see is the anger that fills him from when things don’t play out the way he wants them to. Ty’s triggers usually come from when something doesn’t go the way he wanted them to, in his mind things need to play out exactly how he wants them to and if they don’t then the result is not a pleasant sight.

Although the study is thorough in describing findings among those who are adopted from institutions, specifically orphanages, the study falls short of describing attachment patterns with children who are adopted at birth and had no experience with institutions. Therefore, I do not believe that the study conducted by Marcovitch et al. (1997) describes attachment among all adopted children, but it does describe how children who spend a considerable amount of of their first year of life in orphanages are more likely to have issues later in life since attachment theorist believe that attachment or lack thereof can affect cognitive, emotional, and behavioral development (Broderick & Blewitt, 2015). In fact, the outcomes of children who spend a majority of their early years in an institutional setting can be attributed to the “lack of an attachment figure” (Marcovitch et al., 1997, pp. 19).

Reactive Attachment Disorder is classified under Trauma- and Stressor- Related Disorders under the new Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5; American Psychiatric Association, 2013). The following mental disorders are also classified under Trauma- and Stressor-Related Disorders: Disinhibited Social Engagement Disorder, Posttraumatic Stress Disorder, Acute Stress Disorder, Adjustment Disorders, Other Specified Trauma- and Stressor-Related Disorder, and Unspecified Trauma- and Stressor-Related Disorder (DSM-5; American Psychiatric Association, 2013). Reactive Attachment Disorder is a fairly uncommon mental disorder where the child (onset is usually before age five) has severe disturbances in social relatedness with others (Seligman & Reichenberg, 2014). This results in the child not turning to a primary caregiver (e.g. mother) for comfort, protection, or support. This behavior of not seeking support from a primary caregiver is related to the main diagnostic feature of the disorder, which is underdeveloped attachment (DSM-5; American Psychiatric Association, 2013). As a result of underdeveloped attachments with the primary caregiver, the child will display aggressive and hostile towards the mother an may even seek attachment with strangers (Seligman & Reichenberg, 2014; Speltz, McClellan, DeKlyen, & Jones, 1999).

Abstract: Children entering into the foster care system more than likely have been neglected or abused. This paper will detail a common disorder associated with foster children. Attachment Disorder (AD) is not commonly discussed before placement, however it becomes obvious within the first two months of placement. A myriad of signs or symptoms can be related to AD and there is debatable literature and discussion regarding the validity of this disorder. This paper will also discuss the difference between AD and RAD (Reactive Attachment Disorder). The goal of this paper is to inform potential foster families of behavioral difficulties and the assistance that is available.

Attachment disruptions occur with adults in relationships, however, they can have roots in childhood experiences. Attachment is vital to social and emotional growth in early developmental years (Zeanah & Smyke, 2008). Attachment disorders were a part of the third Diagnostic and Statistical Manual of Mental Disorders (DSM-III; American Psychiatric Association, 1980). Reactive Attachment Disorder with two subtypes, RAD and disinhibited social engagement disorder is still included in the DSM V (American Psychiatric Association, 2013). An increased risk for anxiety disorders, substance abuse and personality disorders has been demonstrated for children exhibiting insecure attachments, primarily

The first one a child forms in their life is between themselves and their mother, which soon becomes the foundation and is representative of how the child will form relationships with the world around them. Reactive Attachment Disorder is a condition in which a child has difficulty forming lasting relationships and forming attachments’ with caregivers. “They often show nearly a complete lack of ability to be genuinely affectionate with others. They typically fail to develop a conscience and do not learn to trust. They do not allow people to in control of them due to this trust issue” (American Academy of Child/Adolescent Psychiatry, 2012, Causes of Reactive Attachment Disorder, para 1). They also state that, “if a child is not attached- does not form a loving bond with the mother- he does not develop an attachment to the rest of mankind.” There are two types of behavior that a child with RAD can inhibit. Some children have symptoms of just one type, while others exhibit both types of

Shi, L. (2014). Treatment of Reactive Attachment Disorder in Young Children: Importance of Understanding Emotional Dynamics. American Journal Of Family Therapy, 42(1), 1-13. doi:10.1080/01926187.2013.763513

Thanks for posting about Reactivate Attachment Disorder (RAD). Most of the time children with RAD, the child’s biggest source or their comfort is also the biggest source of their pain. Eventually, they feel defeated and begin to develop the RAD traits as a defense mechanism. Therefore, it is difficult for them to take risks with forming attachment. Matter of fact, many of these children want an attachment figure. However, their outcome is determined by whether or not they can find what they feel like a stable living environment. Therefore, caregivers must provide stability with consistent routines and rituals. They must also show unconditional love toward these children and show them that you have faith in them. This needs to be done by

Given that the life of an adopted child is often filled with separation and loss it is not surprising that behavioral and psychiatric issues are common in these children. Early interruption or poor quality of attachment often underlies many of the behavioral problems of adopted children (Henry). Attachment is the ability of a child to form an emotional bond with a primary caregiver. Secure attachment allows children to explore their environment, develop relationships, and form a positive self-image. Children with attachment disorders may show overly vigilant behaviors towards adults, or they may not demonstrate attachment to any adults. These disordered attachments can lead to other adverse outcomes that, left untreated, can persist into adulthood

The course of reactive attachment disorder is not well studied, but through reviewing literature, it is evident that a larger amount of individuals diagnosed with reactive attachment disorder are children who have experienced serious forms of neglect or abuse, or have been brought up in institutional settings, and consequently exhibit signs of reactive attachment disorder (Boris & Zeanah, 2005). The prevalence of reactive attachment disorder that has been studied in the general population was found to be prevailing in 1.4%. Being that this is a relatively higher number found within the general population, it is crucial to understand the additional needs of these children (Pritchett, Pritchett, Marshall, Davidson, & Minnis, 2013).