What Is Reactive Attachment Disorder?

What Is Reactive Attachment Disorder?

Reactive attachment disorder, also known as RAD, is a mood or behavioral disorder that affects babies and children. It involves difficulties with bonding and forming relationships, as well as having social patterns that are not appropriate, but without an intellectual disability or pervasive developmental disorder (such as autism ) to explain these characteristics.1

Additionally, reactive attachment disorder is caused by some type of issue with care, such as caregivers being unable to fully provide for the needs of the child, not fulfilling physical and emotional needs, inconsistency, or too many primary caregiver changes.

The term “reactive attachment disorder” is sometimes shortened to “attachment disorder,” but reactive attachment disorder is actually a type of attachment disorder, aquaARTS studio / Getty Images Reactive Attachment Disorder vs. Disinhibited Social Engagement Disorder

Attachment disorders are sometimes described as being inhibited or disinhibited. These terms are used to describe the behaviors of babies and young children.

Children who fall into the category of inhibited struggle to regulate their emotions, do not prefer any specific adult or caregiver, do not seek caregiver comfort, or do not show much affection, or they display a combination of these behaviors.2 On the other hand, children who fall into the category of disinhibited may engage or overly engage with all adults evenly, including strangers, and they do not prefer primary caregivers.

Reactive attachment disorder is the inhibited type of attachment disorder. There used to be only one diagnosis for both inhibited and disinhibited attachment, but that has changed with more recent research. The disinhibited type of attachment disorder is called disinhibited social engagement disorder, or DSED.1 Characteristics

The characteristics of reactive attachment disorder are the inhibited type, meaning that the child behaves in ways that show little or no attachment to parents or other caregivers. This is seen in babies and young children. They are not able to bond with their parents or primary caregivers in a way that is healthy and secure.3 Reactive Attachment Disorder Symptoms

Symptoms of RAD include:

  • Avoidance of comfort when distressed
  • Avoidance of physical touch
  • Difficulty managing emotions
  • Not being affected when left alone
  • Not making eye contact, smiling, or engaging
  • Emotional detachment
  • Excessive rocking or self-comforting Inability to show guilt, remorse, or regret
  • Inconsolable crying Little or no interest in interaction with others
  • Need to be in control
  • Tantrums, anger, sadness

Diagnosis Reactive attachment disorder can be diagnosed by a mental health professional such as a psychiatrist or psychologist specializing in children. They do this by assessing the child based on the fifth edition of the “Diagnostic and Statistical Manual of Mental Disorders” ( DSM-5 ) diagnostic criteria. Then they assess the child in terms of how the symptoms affect their ability to function.4 […]

Preventive interventions can improve mental health outcomes in children, teens and young adults

Preventive interventions can improve mental health outcomes in children, teens and young adults

May 18, 2021 – Offering interventions to young people in the general community can prevent the emergence of certain mental health disorders , according to the first comprehensive systematic review to address this question. The results appear in the May/June issue of Harvard Review of Psychiatry , which is published in the Lippincott portfolio by Wolters Kluwer .

“Preventive interventions for poor mental health outcomes in young people are feasible and appear to be effective,” according to the review by Gonzalo Salazar de Pablo, MD, and Andrea De Micheli, MD, of King’s College London, and colleagues. Evidence suggests that young people respond well to early interventions.

Universal and selective interventions reduce risk of most mental disorders The researchers systematically reviewed decades of medical literature and found 295 studies in which individuals under 35 years old were randomly assigned to a mental health preventive intervention or a control group. Most studies examined psychoeducation (37 percent) or psychotherapy (28 percent), whereas 18 percent explored both and 17 percent involved other types of interventions.

Forty percent of the studies investigated universal interventions, which target a general population – for example, a high school assembly about alcohol use is a universal intervention. Other studies focused on selective interventions, which target symptom-free individuals who are considered at high risk of developing a mental disorder. Seventy percent of the studies were conducted in North America or Europe.

All told, 447,206 young individuals participated: 234,330 in intervention groups and 212,876 in control groups. The average age of the participants was 15 years, but they ranged from infants under 1 year to adults 34 years old.

The researchers combined the results of all studies using a statistical process called meta-analysis. Compared with control conditions, the 17 mental health disorders studied fell into three groups: Risk reduced by both universal and selective prevention measures: affective (mood) symptoms, alcohol use and its consequences, anxiety features, conduct problems, interpersonal violence, general psychological distress, posttraumatic stress disorder, tobacco use, and “other” emotional and behavioral problems

Risk marginally reduced by both universal and selective prevention measures: attention-deficit/hyperactivity (ADHD) features, cannabis use, and externalizing behaviors (e.g., aggressive or antisocial)

Risk not reduced by either universal or selective prevention measures: eating-related problems, impaired functioning, internalizing behaviors (e.g., fearful, anxious, or inhibited), and sleep-related problems

Psychoeducation interventions were particularly promising for ADHD features, affective symptoms, or interpersonal violence. Psychotherapy was most effective for anxiety features.

Even for interventions that showed some ability to prevent mental health problems, the effect sizes (the magnitude of the improvements) were small. However, Dr. Salazar de Pablo, Dr. De Micheli, and colleagues note: “Since these samples are typically young and not yet affected by psychiatric conditions, small effect sizes…can potentially translate into relevant benefits […]

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