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Reactive Attachment Disorder

Reactive Attachment Disorder. A Parent’s Role in Reactive Attachment Disorder in children 0-5 years of age . Southern New Hampshire University Laurell Morse Abnormal Child Psychology July 27, 2016. A Parent’s Role in Reactive Attachment Disorder in children 0-5 years of age.

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Reactive Attachment Disorder

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  1. Reactive Attachment Disorder A Parent’s Role in Reactive Attachment Disorder in children 0-5 years of age. Southern New Hampshire University Laurell Morse Abnormal Child Psychology July 27, 2016

  2. A Parent’s Role in Reactive Attachment Disorder in children 0-5 years of age. Reactive Attachment Disorder Attachment Theory Thousands of children every day are diagnosed with Reactive Attachment Disorder (RAD). RAD is a stress-related disorder which can only be caused by social neglect during childhood. Social neglect means the lack of adequate care giving (R.A.D, 2016). RAD is only diagnosed in children during the first five years of life. (DSM-IV, 1998). The syndrome can occur because of severe parental neglect, abuse, or serious mishandling (ICD-10, 2016).  To better understand RAD, it is first necessary to understand attachment; therefore, attachment theory is examined. There are two categories of RAD a inhibited subtype and a disinhibited subtype. Attachment theory is a concept in developmental psychology. It concerns the importance of attachment regarding a child's personal development. The ability for a child to form an emotional and physical attachment to a caregiver gives that child a sense of stability and security. This is necessary for the child to learn how to take risks, branch out, grow and develop as an individual.  Infant attachment behavior is made up of a number of instinctual responses that have the function of binding the infant to the mother. These component responses are sucking, clinging, and following. As well as the signaling behaviors of smiling and crying. These responses mature independently during the first year and become increasingly integrated and focused on a mother figure during the second 6 months. Some therapists believe clinging and following is more important for attachment than sucking and crying.

  3. A Parent’s Role in Reactive Attachment Disorder in children 0-5 years of age. R.A.D and the Brain. A Inhibited Subtype Language and logic are developed in the cerebral cortex. Trauma or lack of bonding during infancy leads to the underdevelopment of the neurotransmitters in that region of the infants brain. As a result, that part of the brain is smaller in abused and neglected children. Infants who have been traumatized secrete high amounts of stress hormones which have adverse and long term effects. It is a good estimation that some of the symptoms of R.A.D is neurological in nature and not disobedience in young children. Children who have R.A.D have elevated levels of ACTH and cortisol. The inhibited subtype of RAD evolved from studies done on children who were maltreated or abused.  Maltreated and abused children are often diagnosed with inhibited RAD (Haggard, 2004). The criteria for inhibited RAD are: • absence of a discriminated, preferred adult. • lack of comfort seeking for distress. • failure to respond to comfort when offered. • Lack of social and emotional reciprocity. • emotion regulation difficulties

  4. A Parent’s Role in Reactive Attachment Disorder in children 0-5 years of age. DisinhibitedRAD  The disinhibitedsubtype of RAD is more prevalent in children raised in institutions (Haggard, 2004). The criteria for disinhibited RAD are: • not having a discriminated, preferred attachment figure • not checking back after venturing away from the caregiver. • lack of reticence with unfamiliar adults • a willingness to go off with relative strangers. Children with RAD may exhibit symptoms of both types of the disorder.

  5. A Parent’s Role in Reactive Attachment Disorder in children 0-5 years of age. Symptoms of R.A.D before age of 5 years. Causes of R.A.D Children with R.A.D express emotionally withdrawn behavior toward adult caregivers . This can include: a consistent pattern of inhibited behavior , rarely or minimally seeking comfort or responding to comfort when distressed, and minimal social and emotional responsiveness toward others. Infants and children experience subtle or intense episodes of unexplained irritability, sadness, or fearfulness that are evident during nonthreatening interactions with adult caregivers (ICD-10, 2016). RAD is only diagnosed in children between the ages of nine months and five years of life. (DSM-IV, 1998) R.A.D is caused when an infant does not bond properly to its primary caregiver. The loss results in ongoing feelings of rage, shame, lack of trust, and a terrible fear of attaching to anyone. It is typically caused by chronic neglect in early infancy followed by years of abuse and instability. Maternal depression, there are two cycles of depression that can cause the disorder to develop in infants(AIRAD, 2016). Withdrawn mothers are disengaged, unresponsive, and do little to support the infant. Infants are unable to attach in this negative state ( Baker, A. J. 2007). The other cycle is an intrusive mother who displays a hostile affect and disrupts the infant's activity this also causes an inability to bond the infant experiences anger and turns away from the mother and begin to learn the angry protective style of coping (M.D.C.D, 2004).

  6. A Parent’s Role in Reactive Attachment Disorder in children 0-5 years of age. Diagnosis. RAD was first described in the DSM-III, it raised an growing awareness of the negative effects of institutionalization and maltreatment in infants and children causing impairment in their psychological development. However, a reliable diagnoses of RAD is still a major problem in part because professionals disagree to the etiology of the disorder (Haggard, 2004).. Diagnosis of the disorder consists of child and parent clinical interviews, global rating scales, attachment-specific rating scales, and behavioral observation. Some of these scales are: The Child Behavior Checklist. The Behavior Assessment System for Children. The EyebergChild Behavior Inventory. 

  7. A Parent’s Role in Reactive Attachment Disorder in children 0-5 years of age. Diagnosis Comorbidy With structured interviews , behavioral rating scales, standardized utilized as part of the assessment of RAD in children, it can be successfully measured in an attempt to get a complete and in-depth diagnosis regarding the child (KayHall, 2005). However there is still much research that needs to be done in order to improve the diagnostic process of RAD and to gain a better understanding of its disorder. Reactive Attachment Disorder is a serious clinical condition. However most studies say RAD is rare. When in truth, it is difficult to know how many children have RAD due to the difficulty of evaluating and treating children with complex psychiatric disorders. Other disorders that are comorbid with RAD are: • Pica. • Developmental delays. • Feeding disorders. • Rumination Disorder. Disorders that can be mistaken for RAD are: • Severe Intellectual Development . • Autism. • ADHD • Oppositional Defiant Disorder. •  Mood Disorders.

  8. A Secondary Role in Reactive Attachment Disorder in children 0-5 years of age. Treatment In the past, attachment therapies such as holding and rebirthing therapies for RAD were used however, numerous mental health professionals and professional societies warn against the use of these therapies. Today the best treatment for RAD is are programs like Parent-Child Interaction Therapy (PCIT), Behavior Management Training  (BMT), and CBT (Mash,2010). PCIT specifically targets preschool-age children and has been shown to improve symptoms. PCIT provides parenting skills they can use to increase compliance decrease disruptive behavior, establish discipline, and provides a support system for parents and children. As they progress, BMT is then used for children of school age to include PICT skills and include improvement of school behavior with a home-based reward system. There is no one medication used to treat RAD. A doctor may use a medication along with treatment to help manage behavioral symptoms. Some medications used are: • methylphenidate, • clonidine, • guanfacine, • sertraline • risperidone Studies have shown that children have significant mood improvement from SSRI therapy, even for the child without depression.

  9. A Parent’s Role in Reactive Attachment Disorder in children 0-5 years of age. Family Dynamics Depression in mothers is a factor in RAD. However, more research is needed to develop a better understanding and improve the diagnosis and treatment options available for these children with depressive mothers. Reactive Attachment Disorder is a serious clinical condition. However most studies say RAD is rare. When in truth, it is difficult to know how many children have RAD due to the difficulty of evaluating and treating children with complex psychiatric disorders. There are more adults in the united states being diagnosed with childhood RAD leading me to believe this disorder is alot more common and is contributing significantly to the chaotic state of mental health care system. We need more clinicians trained in an attachment disorders; we need more accurate diagnosing. These children are frequently misdiagnosed because their symptoms can look like a lot of different disorders.

  10. A Parent’s Role in Reactive Attachment Disorder in children 0-5 years of age. Solution Conclusion There are no simple solutions, prevention and early intervention are the best solutions. However, close and ongoing collaboration between depressed mothers, secondary parents, pre-natal care, and the mental health system will increase the likelihood of a successful outcome. With proper treatment, RAD children can rehabilitate and function well in the family and society.  In conclusion , the successful reduction of problematic behaviors and increases in quality of life exhibited by the child in this case if both parents take an interest in the child. Abuse is used as an utility as a catalyst forthe development of RAD and its associated impairments. Given this evidence, it is recommended that PCIT’s be conducted to evaluate the efficacy of the program concerning RAD Infants. More research is needed in the effectiveness of BMT for the treatment of RAD in school age children.

  11. Resources Attachment Issues and Reactive Attachment Disorder. AIRAD (n.d.). Retrieved July 16, 2016, from http://www.helpguide.org/articles/secure-attachment/attachment-issues-and- reactive-attachment-disorders.htm Attachment Explained - Evergreen Psychotherapy Center. (n.d.). Retrieved July 16, 2016, from http://www.evergreenpsychotherapycenter.com/attachment-therapy/attachment- explained/ Baker, A. J. (2007). Adult children of parental alienation syndrome: Breaking the ties that bind. New York: W.W. Norton &. Brumariu, L. E., Bureau, J. F., Nemoda, Z., Sasvari-Szekely, M., & Lyons-Ruth, K. (2016). Attachment and temperament revisited: infant distress, attachment disorganisation and the serotonin transporter polymorphism.Journal of reproductive and infant psychology, 34(1), 77-89. Diagnostic and statistical manual of mental disorders: DSM-IV (4th ed.). (1998). Washington, DC: American Psychiatric Association. Haggard, J. J., & Hazan, C. (2004). Recognizing and treating uncommon behavioral and emotional disorders in children and adolescents who have been severely maltreated: Reactive attachment disorder. Child Maltreatment: Journal of the American Professional Society on the Abuse of Children, 9, 154-160. Kay Hall, S. E., & Geher, G. (2003). Behavioral and personality characteristics or children with reactive attachment disorder. Journal of Psychology: Interdisciplinary and Applied, 137, 145-162. Maternal depression and child development. (2004). Paediatrics & Child Health,9(8), 575–583. Reactive Attachment Disorder - DSM5 code 313.89. (n.d.). Retrieved July 16, 2016, from http://traumadissociation.com/rad Taft, R., Schlein, C., & Ramsay, C. (2016). Parents of Children with Reactive Attachment Disorder: Experiences of School and Family Communication and Interaction. International Journal of Learning, Teaching and Educational Research, 15(1). ICD-10 Version:2010. (n.d.). Retrieved July 16, 2016, from http://apps.who.int/classifications/icd10/browse/2010/en#/F90-F98

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