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Reactive Attachment Disorder (RAD) / Disinhibited Social Eng

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Nicole Bright

on 1 March 2016

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Transcript of Reactive Attachment Disorder (RAD) / Disinhibited Social Eng

What Causes RAD in Children?
Disinhibited Social Engagement Disorder (DSED)
What causes DSED in Children?
Children who are diagnosed with DSED tend to be maltreated in the home, or are currently institutionalized. Children who were formally institutionalized tended to be diagnosed with DSED.

· Lacks genuine affection with primary caregivers (especially mother)/ Indiscriminately affectionate with strangers
· Hyperactive, overactive, or attention deficit/Destructive to property, cruelty to pets, aggression towards self, or others
· Significant learning problems or lags
· Controlling, manipulative, defiant, argumentative, demanding, impulsive
· Poor, underdeveloped, or no conscience/ Rages or long temper tantrums, especially in response to adult authority
· Lack of self-control/ Lacks cause and effect thinking

· Family Therapy
· Cognitive Restructuring Cognitive Behavioral Therapy
· Individual psychological counseling
· Play Therapy
· Parenting Skills Classes
· Imagery Social Skills Building
· Body/Mind approaches Theraplay
Reactive Attachment Disorder (RAD)
- Is one of the few disorders listed in the DSM-V(
Diagnostic and Statistical Manual of Mental Disorders, 5th. Edition
) that can be applied to infants. It is a disorder caused by a lack of attachment to any specific caregiver at an early age, and results in an inability for the child to form normal, loving relationships with others.

Reactive Attachment Disorder(RAD)/ Disinhibited Social Engagement Disorder(DSED)

- Children who - have experienced abuse, neglect, or frequent disruptions in primary caregivers often exhibit varying degrees of cognitive, physical, and social-emotional delays.
-Premature Birth or Postpartum Depression in Mothers
- Generally occurs from birth - three years of age
Attachment Disorders
The core behaviors of DSED are inappropriate approach to unfamiliar adults, lack of wariness to strangers, and a willingness to wander off with strangers. Children diagnosed with DSED also demonstrate a lack of appropriate social and physical boundaries.
- Comprehensive psychiatric assessment.
- Individualized Treatment Plan.
- Therapy sessions where the relationship between child and parent is strengthened.
- Development of appropriate social skills.
-Play Therapy.
-Expressive Therapy.

DSED is an attachment disorder defined in the 5th edition of the Diagnostic and Statistical Manual of Mental Disorders by the American Psychiatric Association. Research on DSED is ongoing.
Attachment Theory
Attachment is a strong emotional bond, usually between a child and a caregiver.
Attachment is very important for social and emotional development.
Case Studies
Characteristics of Attachment
Bolby believed that there are four distinguishing characteristics of attachment.

Proximity Maintenance
- The desire to be near the people we are attached to.
Safe Haven
- Returning to the attachment figure for comfort and safety in the face of a fear or threat.
Secure Base
- The attachment figure acts as a base of security from which the child can explore the surrounding environment.
Separation Distress
- Anxiety that occurs in the absence of the attachment figure.

Strange Situation Assessment - Mary Ainsworth
Ainsworth (1970) identified three main attachment styles. These attachment styles were the result of early interactions with the mother.
Secure (type B),
Insecure avoidant (type A)
Insecure ambivalent/resistant (type C)
A forth attachment style known as
was later identified (Main, & Solomon, 1990).
The procedure, known as the ‘Strange Situation’, was conducted by observing the behavior of the infant in a series of eight episodes lasting approximately 3 minutes each:

(1) Mother, baby and experimenter (lasts less than one minute).
(2) Mother and baby alone.
(3) Stranger joins mother and infant.
(4) Mother leaves baby and stranger alone.
(5) Mother returns and stranger leaves.
(6) Mother leaves; infant left completely alone.
(7) Stranger returns.
(8) Mother returns and stranger leaves.
Attachment Styles
Attachment Styles
The cases of Maria and Jimmy.

American Academy of Child and Adolescent Psychiatry (2014) Facts for Families Information Sheets, no. 85.

Margot Moser Richters, PH.D., and Fred R. Volkmar, M.D. (1994). Reactive Attachment Disorder of Infancy or Early Childhood. Journal of the American Academy of Child and Adolescent Psychiatry 33, 3: 328-332.

Simplypsychologyorg. (2016). Simplypsychologyorg. Retrieved 3 February, 2016, from http://www.simplypsychology.org/mary-ainsworth.html

Wordpresscom. (2016). Wordpresscom. Retrieved 3 February, 2016, from https://seedsoflighthealing.wordpress.com/tag/secureattachment/

Zeanah, C. H., & Gleason, M. M. (2015). Annual research review: Attachment disorders in early childhood – clinical presentation, causes, correlates, and treatment. Journal Of Child Psychology And Psychiatry, 56(3), 2
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