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Reactive attachment disorder
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{{short description|Psychological disorder that can affect children}} {{Update|reason=DSM-5 was published in 2013, DSM-5-TR published in 2022. This article still speaks of DSM-5 as a proposal. Discussion of DSM 3&4 outside of history section should be removed and replaced.|date=September 2023}} {{Use dmy dates|date=October 2019}} {{Infobox medical condition (new) | name = Reactive attachment disorder | image = | caption = Children need sensitive and responsive caregivers to develop secure attachments. RAD arises from a failure to form normal attachments to primary caregivers in early childhood. | field = [[Psychiatry]], [[pediatrics]] | symptoms = | complications = | onset = | duration = | types = | causes = | risks = | diagnosis = | differential = | prevention = | treatment = | medication = | prognosis = | frequency = | deaths = }} [[File:Mother-Child_face_to_face.jpg | thumb | right | Child face to face with mother]] '''Reactive attachment disorder''' ('''RAD''') is described in clinical literature as a severe [[attachment disorder|disorder]] that can affect children, although these issues do occasionally persist into adulthood.<ref name="DSM-IV-TR 2000 p. 129">DSM-IV-TR (2000) [[American Psychiatric Association]] p. 129.</ref><ref>{{cite journal | author = [[Daniel Schechter|Schechter]] DS, Willheim E | title = Disturbances of attachment and parental psychopathology in early childhood | journal = Child and Adolescent Psychiatric Clinics of North America | volume = 18 | issue = 3 | pages = 665β86 |date=July 2009 | pmid = 19486844 | doi = 10.1016/j.chc.2009.03.001 | pmc = 2690512}}</ref><ref>{{cite journal |author1=[[Marinus van IJzendoorn|Marinus]] van IJzendoorn MH |author2=Femmie Juffer | title = Behavior Problems and Mental Health Referrals of International Adoptees | journal = The Journal of the American Medical Association | volume = 293 | issue = 20 | pages = 2501β2515 |date= May 2005 | doi = 10.1001/jama.293.20.2501| pmid = 15914751 |s2cid=25576414 }}</ref> RAD is characterized by markedly disturbed and developmentally inappropriate ways of relating socially in most contexts. It can take the form of a persistent failure to initiate or respond to most social interactions in a developmentally appropriate wayβknown as the "inhibited form". In the [[DSM-5]], the "disinhibited form" is considered a separate diagnosis named "[[disinhibited attachment disorder]]". RAD arises from a failure to form normal attachments to primary caregivers in early childhood. Such a failure could result from severe early experiences of [[neglect]], [[abuse]], abrupt separation from caregivers between the ages of six months and three years, frequent changes of caregivers, or a lack of caregiver responsiveness to a child's communicative efforts. It is differentiated from [[pervasive developmental disorder]] or developmental delay and from possibly [[comorbidity|comorbid]] conditions such as [[intellectual disability]], all of which can affect attachment behavior. The criteria for a diagnosis of a reactive attachment ''disorder'' are very different from the criteria used in assessment or categorization of [[Attachment theory#Attachment patterns|attachment ''styles'']] such as insecure or disorganized attachment. Children with RAD are presumed to have grossly disturbed internal working models of relationships that may lead to interpersonal and behavioral difficulties in later life. There are few studies of long-term effects, and there is a lack of clarity about the presentation of the disorder beyond the age of five years.<ref name=AACAP-2005/><ref name="prior228">Prior & Glaser (2006), p. 228.</ref> However, the opening of orphanages in Eastern Europe following the end of the [[Cold War]] in the early 1990s provided opportunities for research on infants and toddlers brought up in very deprived conditions. Such research broadened the understanding of the prevalence, causes, mechanism and assessment of disorders of attachment and led to efforts from the late 1990s onwards to develop treatment and prevention programs and better methods of assessment. Mainstream theorists in the field have proposed that a broader range of conditions arising from problems with attachment should be defined beyond current classifications.<ref name="oconzean2003">{{cite journal |vauthors=O'Connor TG, Zeanah CH |title=Attachment disorders: assessment strategies and treatment approaches |journal=Attach Hum Dev |volume=5 |issue=3 |pages=223β44 |year=2003 |pmid=12944216 |doi=10.1080/14616730310001593974 |s2cid=21547653 }}</ref> Mainstream treatment and prevention programs that target RAD and other problematic early attachment behaviors are based on [[attachment theory]] and concentrate on increasing the responsiveness and sensitivity of the caregiver, or if that is not possible, placing the child with a different caregiver.<ref>Prior & Glaser (2006), p. 231.</ref> Most such strategies are in the process of being evaluated. Mainstream practitioners and theorists have presented significant criticism of the diagnosis and treatment of alleged reactive attachment disorder or the theoretically baseless "attachment disorder" within the controversial form of psychotherapy commonly known as [[attachment therapy]]. Attachment therapy has a scientifically unsupported theoretical base and uses diagnostic criteria or symptom lists markedly different from criteria under ICD-10 or DSM-IV-TR, or to attachment behaviors. A range of treatment approaches are used in attachment ''therapy'', some of which are physically and psychologically coercive, and considered to be [[wikt: antithetical|antithetical]] to attachment ''theory''.<ref name="O'Connor & Nilsen">O'Connor TG, Nilsen WJ (2005). "Models versus Metaphors in Translating Attachment Theory to the Clinic and Community". In Berlin LJ, Ziv Y, Amaya-Jackson L and Greenberg MT (eds.). ''Enhancing Early Attachments: Theory, Research, Intervention, and Policy''. pp. 313β26. The Guilford Press. Duke series in Child Development and Public Policy. {{ISBN|1-59385-470-6}}.</ref>
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