Reactive Attachment Disorder
Reactive Attachment Disorder Reactive Attachment Disorder (RAD) is a disorder that is usually diagnosed during infancy or early childhood (American Psychiatric Association, 2000). Children with this disorder display a disturbed ability to relate to others stemming from pathological care (American Psychiatric Association, 2000; Halgin & Whitbourne, 2010). Behaviors displayed by such children with the disorder are a lack of initiating social interactions or not responding when others initiate social interactions with them. These children may seem avoidant or inhibited and are specified in the DSM-IV as “Inhibited Type” (Halgin & Whitbourne, 2010; American Psychiatric Association, 2000).
Conversely, children specified in the DSM-IV-TR as being “ Disinhibited Type” show completely different symptomology in which they seem to not discriminate between whom they interact with (American Psychiatric Association, 2000). For example, they may treat a complete stranger with more affection than they do with their primary caregiver. In addition, these children are may display hypervigilance and resistance to comfort. The development of RAD is believed to be a product of pathological care perhaps in which the child was unable to develop a secure attachment with his/her primary caregiver or their primary caregiver changed from person to person, disallowing a bond to be formed. The importance of infant attachment to their primary caregiver has been thoroughly researched, most notably by researchers, John Bowlby and Mary Ainsworth whom developed the Attachment Theory.
Bowlby (1988) proposed the idea that, as infants, we begin to develop attachment to adults around us based on responses we receive from alerts signaling we are in need of something (i.e. food, sleep, protection, care, etc.). In the first 3 months of life, newborns behave in ways to ensure they will be close to their primary caregiver such as sucking, rooting, grasping, crying, and gazing (Newman & Newman, 2012). Ideally, in return, caregivers respond to such behaviors by meeting the needs of the child. For example, a child crying after getting hurt is met with their mother picking them up and comforting him/her. After repeated interactions yielding the child’s need being met, the child can internalize the belief that his/her caregiver will meet their need after alerting them and the formation of a trustworthy bond begins. Conversely, pathology may arise if the child’s needs are not met and they are unable to form a trusting bond with their caregiver.
Epidemiological data on RAD are very limited and the disorder seems to be very uncommon (American Psychiatric Association, 2000). There seem to be some predisposing factors that may lend a child to be more vulnerable to this disorder such as extreme neglect, prolonged hospitalization, extreme poverty and being born to an inexperienced parent (American Psychiatric Association, 2000). Laboratory findings also show that malnutrition is often present with children who are diagnosed Reactive Attachment Disorder (American Psychiatric Association, 2000).
The onset of RAD usually occurs in the first several years of life and begins before the age of 5 (American Psychiatric Association, 2000). The diagnosis of RAD must be differentiated from Mental Retardation, Autistic Disorder, Social Phobia, Attention-Deficit/Hyperactivity Disorder, Conduct Disorder, and Oppositional Defiant Disorder. The course the disorder takes varies due to the severity of the disruption in attachment and which form of intervention is applied. Improvement and remission for this disorder is possible for those with this disorder.
Treatment of RAD should be comprised of both individualized therapy as well as Structural Family Therapy. Structural Family Therapy is crucial when treating a family with a child with RAD because many times their parents