Reactive Attachment Disorder: Literature Review

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,

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 In cases of RAD two major types of abnormalities have been cited; these include an emotionally withdrawn/inhibited type and an indiscriminately social/disinhibited pattern (First, M., & Tasman, A. 2010).Conditions in in foreign orphanages and institutions such as,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.

Ainsworth (1978) developed the Strange Situation Theory, which is how one is able to view the different levels of attachment (Groh, Roisman, Booth-LaForce, Flaley, Owen, Cox, & Burchinal, 2014). The first attachment is secure attachment, which is when a child is able to greet and seek out contact with the caregiver upon arrival after a stressful separation (Haltigan & Roisman, 2015). The next is anxious-avoidant/resistant (insecure) attachment, when the child has no want to contact with the caregiver while showing signs of resistance upon the return (Haltigan & Roisman, 2015). The last and the most crucial to child development is disoriented/ disorganized attachment; conflicting responses from the child which show hostile and aggressive behavior toward the caregiver (Haltigan & Roisman, 2015). All of these attachements show the different types of ways that a child can communicate with their caregiver. These actions are the representations of their early attachment and experiences with the caregiver (Siebert & Kerns, 2015). If there are no changes toward the environment, the attention

My act of courage is when I found out that i had Reactive Attachment Disorder. You can get this from being abused when you were a little kid or a baby. Well in my case I was abused by my mom for two years. She abused me since the day I came home from the hospital till the I was almost three years old and got put into foster care so I got away from the person who was abusing me for a couple of month's. I just found out on January tenth, 2017 at a meeting that I had to go to that I had Reactive Attachment Disorder. You can also get this from being separated from your parents for a while and I was whenever I was put into foster care I was separated from my real mom for the rest of my life and my sister's and brother's dad died when I was

Attachment theories provide a framework to understanding and assessing BPD etiology. Psychologists John Bowlby and Mary Ainsworth completed the first attachment studies in the mid 1900’s. Bowlby defined attachment as “an affectional bond that a person forms with a differentiated and preferred individual or an attachment figure who is approached in times of distress”. According to Bowlby, the quality of childhood relationships with caregivers results in mental representations or “internal working models” of self and others. These representations include beliefs of self and others are believed to organize personality development, and subsequently, direct and shape future relationships.

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.

In the Newman, Newman book two types of expressions are defined, emotional withdrawn/inhibited type and indiscriminately social/uninhibited type. These expressions were defined in the Diagnostic and Statistical Manual-IV. In the new Diagnostic and Statistical Manual-5 (DSM-5), reactive attachment disorder is found under the Trauma-and Stress-related disorders section. The two expressions are now categorized as distinct disorders, reactive attachment disorder and disinhibited social engagement disorder. Both of these disorders are the result of social neglect or other situations that limit a young child’s opportunity to form selective attachments. Although sharing this etiological pathway, the two disorders differ in important ways. Because of dampened positive affect, reactive attachment disorder more closely resembles internalizing disorders; it is essentially equivalent to a lack of or incompletely formed preferred attachments to caregiving adults. In contrast, disinhibited social engagement disorder more closely resembles ADHD; it may occur in children who do not necessarily lack attachments and may have established or even secure attachments (American Psychiatric Association,

Reactive attachment disorder, also known as RAD, is characteristic of children who have developmentally inappropriate attachment behaviors. As mentioned in the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (2013), “The essential feature (of reactive attachment disorder) is absent or grossly underdeveloped attachment between the child and putative caregiving adults” (p. 266). This underdeveloped attachment is in response to a child being neglected or deprived of emotional and social comfort (American Psychiatric Association, 2013). In the following section, the diagnostic criteria for reactive attachment disorder will be discussed.

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.

Reactive attachment disorder is a unique disorder in its onset, impact on all aspects of life, and diversity of subtypes. In the Diagnostic and Statistical Manual – IV (DSM- IV), reactive attachment disorder was characterized by two subtypes; the disinhibited and the inhibited subtypes. The inhibited subtype was identified as being withdrawn, unemotional, and having difficulty forming any sort of significant relationship with others. The disinhibited subtype’s most defining characteristic was indiscriminate friendliness, and overwhelming trust for strangers. While the two subtypes seem like completely different disorders that have no relation, the reason they were originally put together in the DSM-IV was their origins. These disorders originate from severe maltreatment in childhood, and are fairly rare because of the level of severity necessary for the disorder to develop. Their common origin hints at a problem within the attachment relationship as a potential source of difficulties. The name itself is derived from a reaction to pathogenic care in early childhood.

The family’s main problems can be understood from the theoretical perspective Attachment Based Family Therapy (ABFT). The client that was referred is Mia. She is a 17 year old second generation Chinese-American girl. She is currently a junior in high school and is preparing to take the SAT’s next year. Mia’s teacher referred her due to mild symptoms of depression. This perspective is important because a child depends on his/her parents being available and protective which causes a secure attachment. However, if parents are not available and protective it increases the possibility of their children having an insecure attachment which is associated with depression. It is highly encouraged that Mia’s parents are apart of the

Attachment disorder refers to disorder of mood, behavior or social relationships. It occurs due to failure in a normal attachment to care givers in early childhood that results in behavioral disturbances and problems. Some factors could be neglect, abuse and abrupt separation. In Sam’s case the abrupt separation would be the main factor of the attachment disorder. Emotional and behavioral disturbances are found in young children of school age. However, it can happen in adult age people as well. Two theories about the definition and diagnosis of attachment disorder are known. One is known as an attachment theory that is based on scientific inquiry and the other is clinically based called pseudospecific theory (Berlin,

Howe (2009 cited in Jowett and Spray 2012) discusses how attachment can be a feature in the ambivalent stage as children can display challenging behaviours. This was evident on my home visits as I observed the older child displaying aggressive behaviours. I also observed boundaries or routines were not a feature in the home, this caused me concern as one the children would be approaching school age and I questioned how N would cope. This may have relevance to Erikson’s trust versus mistrust stage (1959 cited in McLeod (2013). This theory implies if the care received is harsh or inconsistent the child may not develop confidence in their future abilities. Fonagy et al (1991) concludes parent’s attitudes to attachment can affect their behaviour