Reactive Attachment Disorder:
Etiology, Symptoms, Affected Brain Areas and Treatment
Reactive Attachment Disorder (RAD) is characterized by considerably disturbed and inappropriate social interaction, across situations, that is manifested before the age of five (DSM-IV-R). Evidence for the disorder is usually seen in continuous failure to respond appropriately in social situations (being hypervigilant, inhibited, or ambivalent) and/or inability to develop and exhibit selective attachment to primary caregiver(s) (DSM-IV-R). The causes for the disturbed behavior in Reactive Attachment are associated with the developmental stages of Infancy and Early childhood, when pathogenic care can have profound and lasting effects. DSM-IV outlines three aspects of pathogenic care that explain the disturbance in normal development and behavior: persistent disregard for the child’s physical and emotional needs, as well as repeated changes of primary caregiver and/or surroundings. The connection between pathogenic care and disrupted behavior is compelling and reminds us of the critical importance of nurture and effective parenting. Many psychologists have studied child development during the first years of life and have reveal that this is an extremely sensitive period for both physical and emotional development and maturation. It is a critical time for cultivating attachment, social skills, developing empathy and understanding basic values.
Maltreatment, no matter whether it is abuse, neglect, abandonment, or witnessing violence, can lead to enduring negative changes in the still developing brain of a child. Each time there is some sort of traumatic experience, the brain suffers a particular change. Many of the brain abnormalities that have been studied in abused and neglected children are located in the left hemisphere. Very often, in children, victims of abuse, there were fewer dendritic connections between different areas in the left hemisphere (Gunnar & Vazquez, 2001). Children that had showed such abnormal results demonstrate self-destructive or aggressive behavior, as well as certain disturbances in behavior, thinking and physiology (higher blood pressure, heart rates temperature, hyper vigilance) (Gunnar & Vazquez, 2001). Studies of neglected children found that their cortex was about 20 percent smaller than that of a control group of subjects (children) who have not suffered neglect (Gunnar & Vazquez, 2001). The data is compelling and reveals that providing stable environment of nurture is of utmost importance. About 1% of children who have developed insecure-ambivalent attachment develop RAD (Lehman and Jegtvig, 2004) and without intervention, support and help, many of these children might grow up to develop Antisocial Personality Disorder and live a disruptive life. Eventually, many of these individuals end up in correctional facilities. This compels helping professionals to promote and teach effective parenting and explain the implications of early childhood stress. In addition, the issue has to be considered within the context of adoption and foster care where, very often, children would be moved often and are being exposed to very different/inconsistent treatment and living conditions.
The non-pharmaceutical treatment of RAD appears to be more successful and beneficial than the behavioral -medical model (Lehman and Jegtvig, 2004). It utilizes the attachment model as described by Dr. Daniel Hughes in his book “Building the Bonds of Attachment: Awakening Love in Deeply Troubled Children.” The emphasis is on effective parenting - nurturing holding, eye-contact, providing opportunities for enjoyment, encouragement, unconditional love and being a model for self-regulation abilities (Daniel Hughes). Parents and caregivers are to love, nurture, accept and respect the child, so that he/she can grow healthy and happy. Also, professionals in the helping field need to unite their efforts in attempt to educate people and advocate affective parenting and children’s well-being."The Disturbed Child",