Recognizing and Treating Uncommon Behavioral and Emotional Disorders in Children and Adolescents Who Have Been Severely Maltreated: Reactive Attachment Disorder

• NCJ Number: 205429
• Journal: Child Maltreatment Volume: 9 Issue: 2 Dated: May 2004 Pages: 154-160
• Author(s): Jeffrey J. Haugaard; Cindy Hazan
• Date Published: May 2004
• Length: 7 pages
• Sponsoring Agency: New York State
• Publication Format: Article
• Publication Type: Guideline
• Language: English
• Country: United States of America
• Note: For the other articles in this series, see NCJ-205425-28 and NCJ-205430-31.

Annotation

After an overview of reactive attachment disorder in children and adolescents, a disorder linked to severe and chronic maltreatment, this article suggests treatment strategies.

Abstract

The core feature of reactive attachment disorder (RAD) is inappropriate styles of relating to others. RAD typically manifests itself in children in one of two extremes of relating to others: either indiscriminate and excessive attempts to receive comfort and affection from any available adult, even relative strangers, or an extreme reluctance to initiate or accept comfort and affection, even from familiar adults and especially when distressed. The rarity of RAD and its recent emergence as a clinical issue means there is little systematic information on its nature, diagnosis, and treatment. In addition to being difficult to diagnose accurately, interventions with children who have RAD can be difficult because the children are often unable to form a connection with clinicians; also, many continue to experience caregiving problems in their home environments. This article provides an overview of ethological attachment theory, including sections on patterns of attachment and maltreatment and attachment; an overview of the characteristics of RAD; and discussions of differential diagnosis, obstacles to recognizing RAD in children, behaviors associated with RAD, and therapeutic interventions. Individual therapeutic interventions for children with RAD involve giving the child a source of emotional security, opportunities for corrective social experiences, and better social skills. The controversial therapies of holding and "rebirthing," along with other coercive techniques have been classified as contraindicated by the American Psychiatric Association. The development of a secure bond with the therapist and the use of play therapies designed to teach the child more effective strategies for coping with stress have shown promise. This article also discusses interventions with parents, families, and other caregivers. A case study is provided. 2 notes and 35 references