What is Reactive Attachment disorder?

In this blog we will discuss what reactive attachment disorder is. 

We will also briefly discuss the prevalence rates and diagnostic criteria for reactive attachment disorder according to the DSM 5 as well as the causes and treatments available for this disorder. 

What is Reactive Attachment disorder?

Reactive attachment disorder (RAD) is a mental disorder that is usually grouped under attachment disorders that involves difficulties in forming healthy attachment with other people. 

Reactive attachment disorder is relatively rare and it is recognised and diagnosed in children and teenagers who have difficulty in developing health attachment, most often due to traumatic and negative life events- neglect or abuse.

Children who have RAD do not form nurturing bonds with a parent or a caregiver and are unable to form emotional bonds and might also develop behavioural problems. 

This particular disorder is observed when the child has experienced neglect and abuse from the hands of a caregiver or parent, and grows up in an overcrowded orphanage where there are no chances of developing healthy bonds.

In other cases, RAD develops in children and babies who had to change caregivers often, had a parent who had physical and mental health issues that barred them from developing bonds, experiences long hospitalisations, and were taken away from caregivers early on. 

RAD is diagnosed in childhood- quite early on because of observable behaviours that are often seen as abnormal in terms of how children react to other people, such as avoiding attention seeking. 

It is possible that Reactive attachment disorder might be resolved with adequate treatment and care but it can also extend into adulthood and impact their relationships with others.

What is the prevalence of Reactive attachment disorder?

This particular disorder is quite rare compared to other disorders and some research suggests that there is a prevalence rate of 1 to 2 percent of the population that struggles with this disorder.

When it comes to risk factors, there seems to be no variation amongst genders meaning that both male and female populations report similar rates of reactive attachment disorders. 

When it comes to race, African American and multi-racial children are believed to be predisposed to a higher risk for Reactive attachment disorder because they are more likely to experience higher rates of child maltreatment.

What are the diagnostic criteria for  Reactive Attachment disorder?

The fifth edition of DSM, the Diagnostic and Statistical Manual 5th Edition (DSM-5) classifies reactive attachment disorder as a trauma- and stressor-related condition in children or in early childhood. 

The DSM recognizes this disorder to be a result of social neglect or maltreatment of these children by caregivers leading to the child’s emotional and physical needs not being met.

Individuals with this disorder appear to have trouble forming emotional bonds with other people and appear to have a difficulty in experiencing positive emotions. 

A marker behaviour of this disorder is the fact that children do not and cannot seek or accept physical or emotional closeness even when they are distressed. 

In fact, it is possible that they may react negatively when they are subjected to or given physical and emotional closeness such as hugs or consolation. 

The DSM-5 gives the following criteria for reactive attachment disorder:

There is a pattern of being emotionally withdrawn and inhibited which manifests in behaviours where the child rarely seeks or responsive to comfort when distressed. 

Individi Ausl show behaviours related to social withdrawal and lack of responsiveness to others, negative affect, episodes of irritability, fearfulness, or sadness which are inappropriate or out of proportion to the stress they face.

The individual has had a history of insufficient care include:

  • deprivation or neglect of basic emotional needs, comfort, and affection by caring caregivers
  • Frequent and constant change caregivers which limited their chances at forming bonds.
  • Growing up in an unusual setting such as orphanages

The child does not meet the diagnostic criteria for autism spectrum disorder.

Symptoms appear before the age of 5 years and the child must be at a developmental age of at least nine months to be diagnosed.

What are the symptoms of  Reactive Attachment disorder?

The various symptoms that are observed in children with this disorder include:

They have issues related to working memory and executive functioning such as planning, decision making, logical reasoning- all of which appear to be shunted. 

They have poor social skills and are unable to emotionally form bonds with other individuals, especially with other caregivers. 

They often respond to change in aggressive and violent ways. 

They react very violently, aggressively, and with fear when other individuals try to form bonds with them including physical and verbal displays of affection and comfort. 

Individuals with thai disorder also experience somatic symptoms of distress such as restlessness and stereotypic movements, such as rocking back and forth.

Their moods tend to fluctuate and they have a strong need to control their environment which makes it difficult for them to process change or control or parenting or disciplining from other individuals. 

What are the causes of  Reactive Attachment disorder?

Reactie attachment disorder is beleieved to e casued by a traumatic experience in early childhood related to severe emotional neglect and child abuse by caregivers, 

It is often observed in children who have not been given proper care and have not been able to form bonds with consistent caregivers. For example, the caregiver did not respond to the child;s cries for food and love. 

Another probable cause is separation from the caregiver before bonds were formed and this separation was traumatic for the child. For example, the parent was incarcerated and the child had to live with relatives or in orphanages and foster care where they were more or less neglected. 

It is also observed in children whose parents are mentally or physically ill due to which they were not able to form bounds, have interactions, or seek confrontation with their caregivers or another adult. 

Parents had serious substance use related disorders due to which the children were abused and neglected. 

The parent or caregiver were not able to meet the needs of their child due to lack of awareness, lack of education, or because they were incapable of tending to their child’s needs. 

Physical and emotional abuse by the parent or caregiver. 

What are the treatments available for  Reactive Attachment disorder?

When it comes to the treatment of Reactive attachment disorder, the treatment has to be a multi-pronged approach that involves both the parent or caregiver and the child. 

In terms of the parents, there needs to be special focus and education related to parenting and child elements to help the parents understand what the needs of the child are and what they can do as caregivers to meet these needs. 

Along with meeting needs of the child, there also needs to be training done in terms of behavioural management of the child as well as how they can build on the quality of the relationships with their child. 

The focus here is to help the parents or the caregivers understand what they can do and in what ways they can work on the problem together with the child through a family oriented approach. 

As for the child, the treatment will also closely include the parents where the child will have to learn coping strategies, learn how to develop bonding and healthy attachment with the parents and also build trust as a family unit. 

Treatment will most likely include a psychiatric evaluation, after which the physician or the psychiatrist will ensure that the child is removed from abuse and neglect and is in a safe environment with safe people.

Next, the effort will be directed towards improving the relationship between the child and the parent or caregiver where classes will be directed towards improving parenting and through a familiar counselling approach work to building trust.

If there is need for more support in terms of the child;s academic needs, special education services will also be considered. 

In the case that the child also has anxiety and depression, medications for these disorders will be prescribed mostly for older children and treatment will also be geared to include these conditions. 

According to clinical observations, the prognosis of the treatment is often positive. Most of the children with thai disorder,with adequate care can go on to develop health bonds well into their adult lives. 

Conclusion

In this blog we have discussed what reactive attachment disorder is. 

We have also briefly discussed the prevalence rates and diagnostic criteria for reactive attachment disorder according to the DSM 5 as well as the causes and treatments available for this disorder. 

What are the two types of reactive attachment disorder?

There are two main types of reactive attachment disorder include

  • Inhibited reactive attachment disorder
  • Disinhibited reactive attachment disorder. 

Is reactive attachment disorder a personality disorder?

No Reactive attachment disorder is not a personality disorder. The fifth edition of DSM, the Diagnostic and Statistical Manual 5th Edition (DSM-5) classifies reactive attachment disorder as a trauma- and stressor-related condition in children or in early childhood.

It is a mental disorder that is usually grouped under attachment disorders that involves difficulties in forming healthy attachment with other people. 

How do you treat RAD?

Treatment strategies for Reactive attachment disorder include:

  • Treatment will most likely include a psychiatric evaluation, after which the physician or the psychiatrist will ensure that the child is removed from abuse and neglect and is in a safe environment with safe people.
  • Next, the effort will be directed towards improving the relationship between the child and the parent or caregiver where classes will be directed towards improving parenting and through a familiar counselling approach work to building trust.
  • If there is need for more support in terms of the child;s academic needs, special education services will also be considered. 

Is RAD treatable?

Though there is no cure for Reactive attachment disorder, it is treatable. The focus here is to help the parents or the caregivers understand what they can do and in what ways they can work on the problem together with the child through a family oriented approach. 

As for the child, the treatment will also closely include the parents where the child will have to learn coping strategies, learn how to develop bonding and healthy attachment with the parents and also build trust as a family unit. 

References

Kandola.A. What is reactive attachment disorder? Medicalnewstoday. Retrieved on 11th February 2022. https://www.medicalnewstoday.com/articles/reactive-attachment-disorder

Morin.A.What Is Reactive Attachment Disorder? Verywellmind. Retrieved on 11 feb 2022. https://www.verywellmind.com/what-is-reactive-attachment-disorder-4136080#toc-treatment

Underwood.C. Reactive Attachment Disorder of Infancy or Early Childhood. Healthline. Retrieved on 11th Feb 2022. https://www.healthline.com/health/reactive-attachment-disorder-of-infancy-or-early-childhood

Ellis EE, Yilanli M, Saadabadi A. Reactive Attachment Disorder. [Updated 2021 Aug 6]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK537155/

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