Reactive Attachment Disorder

Parvinder Udayan






Attachment disorders issues fall on a spectrum, from mild problems that are easily addressed to the most serious form, known as reactive attachment disorder (RAD). Reactive attachment disorder is a condition in which a child is unable to establish healthy attachment with their parent or primary caretaker. This can lead to difficulty in children, in connecting with others and managing their emotions thus resulting in a lack of trust and self-worth, a fear of getting close to anyone, anger, and a need to be in control. A child with an attachment disorder feels unsafe and alone.

Children with RAD have been so disrupted in early life that their future relationships are also impaired. They may experience difficulty relating to others and are often developmentally delayed. Reactive attachment disorder is common in children who have been abused, bounced around in foster care, lived in orphanages, or taken away from their primary caregiver after establishing a bond.

In "Reactive Attachment Disorder: A Disorder of Attachment or of Temperament?" Wood raised many valid arguments for this new disorder, which is not yet completely understood. The disorder itself is new and is fairly undefined. It is generally difficult to diagnose infants and Gage whether or not their behaviors are abnormal. Unlike older people, infants cannot report to the psychologist (or whomever) if they believe that they are experiencing symptoms of RAD. Moreover, maladaptive care taking can be very difficult to detect or control.

Both the DSM-IV and ICD-10's criteria for the disorder are vague and do not draw a definite line or even moderately clear distinctions for when infants' behavior crosses from normal to abnormal. Not only are the criteria for RAD vague, but they are also subjective. The infant clearly cannot state whether he or she experiences symptoms such as a "lack of comfort seeking for distress," "emotion regulation difficulties," or " a willingness to go off with relative strangers," to name a few. Some readings from the book and research papers also address the issue of the temperament of the child and its relation to RAD. What may seem like RAD may have nothing to do with possible abuse, but may be just part of the child's natural temperament. Some children who naturally possess more difficult temperaments may show signs of RAD. The vague criteria can lead to false diagnoses, such as in cases of hypersensitive caretakers or children who originally possess more problematic temperaments. Moreover, given that the diagnosis for RAD includes the presence of a maladaptive caregiver, if a child develops symptoms that are consistent with RAD but has not suffered any form of abuse, what diagnosis would the child receive?

Some of the readings stated that RAD is based on the inability of children to form normal attachments but does not specify whether the children have difficulty forming attachment exclusively with their primary caretaker or if the difficulty extends to the other family members and peers as well. The paper also did not specify if the child is unable to form normal attachments only in relation to the maladaptive caregiver, all other caregivers and family members, or with whomever else they come in contact on a regular basis.

The limitations of this disorder, Because RAD is a new disorder, perhaps the literature on RAD just does not cover aspects such as treatment, heredity, prevalence, gender, or age of onset. I think that RAD, as a disorder, needs to undergo much more research to be understood as a valid disorder. Though the nature of this disorder makes it difficult to study, perhaps future classification modifications and research will give more concrete insight into this new disorder.




http://articles.latimes.com/keyword/reactive-attachment-disorder.


Zeanah, C. H., Scheeringa, M., Boris, N. W., Heller, S. S., Smyke, A. T., & Trapani, J. (2004). Reactive attachment disorder in maltreated toddlers.