How Reactive Attachment Disorder (rad) Can Affect Children

A child must feel comforted, cared for, and loved consistently to learn how to love and trust others as they grow and develop. Reactive attachment disorder (RAD) is an uncommon but serious disorder that can affect children. It is when a child does not establish healthy relationships with their parents or caregiver, resulting in a negative self-image and the inability to develop and flourish stable attachments, socially. RAD can impact a child’s life and development through every aspected due to the deficiency of care and love from neglect or abuse; starting before the age of five. In this study, “Reactive Attachment Disorder following Early Maltreatment: Systematic Evidence beyond the Institution” conducted by Catherine Kay and Jonathan Green they plan to examine RAD behaviors in non-institutional adolescent from a high-income country from high-risk children in out-of-home foster and group care placements.

The purpose of this study was to scrutinize RAD from a different perspective that has not been studied before. They wanted to conduct the first systematic study on children from an industrialized country because previous research is not generalizable to this population. There are two types of RAD: inhibited and disinhibited. Symptoms of inhibited RAD include but are not limited to being: detached, rarely seeks comfort when distressed, limited positive emotions, and socially and emotionally withdrawn to others. While the symptoms of disinhibited RAD may include: willing to go with an unfamiliar adult without hesitation, not checking back with their parents, and indiscriminate sociability. Kay and Green used different methods to discover how RAD behaviors impact non-institutionalized risk behaviors from those who have experienced physical, sexual, and emotional abuse and neglect.

Throughout the study, they had many questions they tried to answer. They wanted to know the prevalence of reactive attachment disorder symptoms in children environments in non-institutionalized children from a developed country. They were trying to discover how it was supported by the DSM-5 and how it could be improved to be generalizable across settings. RAD is seen to have an impact on developmental impairment and has clinical implications however, they believe it should be investigated further to non-institutionalized risk populations. Furthermore, they used tenets of developmental psychopathology such as age, gender, and ethnicity into account to know what behaviors are acceptable and expected.

This study used two sample population one being high-risked looked after care (LAC) and a low risk (LR) sample resulting in 195 participants total. There were 153 LAC individuals of young people in out-of-home foster care and group homes that were thought to have poor outcomes in their future. They were high-risk looked after young people that were referrals from social workers or authorities because there unstable and at risk to becoming a part of custody and had trouble with behavior and emotions.They received consent from their caregivers or social workers to collect data for the study. The LR sample included a recruitment of 42 individuals from youth clubs and secondary schools. These adolescents had no history of being in out-of-home care and no coherent differences between the LAC and LR groups. They received written consent by the parents and students before they could participate. They gathered their measurements through four aspects: maltreatment and care history, reactive attachment disorder, psychopathology caregivers, and adaptive functioning. The data for maltreatment and care history was for the LAC sample which was from social services records and social workers questionnaires. Evidence used to see the prevalence of maltreatment was forms of abuse: emotional, sexual, physical, and if they neglected rating it 1 to 0; 1 being its is current and present, 2 being it does not exist, absent. Furthermore, The Development and Wellbeing Assessment-Reactive Attachment Disorder (DAWBA-RAD) questionnaire was used for the LAC sample to assess inhibited and disinhibited subtypes of RAD to determine their behaviors such as friendliness, how they respond to familiar adults--do they cling to them or is their relationship strong?, and the questions asked to strangers. The Child Behavior Checklist (CBCL) was completed by the LAC sample andparents from LR sample to investigate psychological problems. To measure adaptive functioning in LAC sample, they utilized the Health of the Nation Outcome Scales for Children and Adolescent to see the scores with higher scores meaning poor functioning and Child Global Assessment Scale to see lower scores representing increasing functional impairment and assess what goes on at their homes. These factors are how they measured their areas of interest.

In the study, they found almost the whole LAC sample, 97% had experienced at least one category of maltreatment with means of 121 participants experiencing emotional maltreatment and 114 being neglected. An average of 2.6 had multiple maltreatment. In the LAC group, 63% met the diagnostic criteria for RAD symptoms of disinhibited indiscriminate, unpredictability, attention seeking, and superficial relationships. The DAWBA-RAD found age was not affiliated with Attention Seeking scores for females or the LR group; however it did show higher scores for males in LAC sample.

I found this study to be interesting. Some of the strengths I found was the representative population of high and low risk children. They had several base measures such as CBCL, DAWBA-RAD, Child Global Assessment Scale, and others to determine if they met the criteria.They did the right thing by adjusting analyses for some of the tenets of developmental psychopathology such as age, gender, and ethnicity and balanced both sample group as well. However, I believe they should have taken into account biological factors concerning their family even though they were in foster care or group homes. It could have been some important information that could have been useful for this study andan explanation for their patterns of behaviors. A self-report from the participants would have been beneficial as well because they could have displayed internal emotions and behaviors that the caregiver or parent were unaware of; internal factors are just as important as external ones. Additionally, they did not observe the participants with these behaviors or emotions, they went off what the caregiver told them from their observation. If they would have observed it themselves in different settings, it would have been better and it would be able to generalize from different settings and another perspective.