Reactive attachment disorder (RAD) is the diagnostic term for severe and comparatively uncommon disorders of attachment that can affect children. RAD is characterized by markedly troubled 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 way—known as the “inhibited” form—or can present itself as indiscriminate sociability, such as excessive familiarity with relative strangers—known as the “disinhibited form”. The term is used in both the World Health Organization’s International Statistical Classification of Diseases and Related Health Problems (ICD-10) and in the DSM-IV-TR, the revised fourth edition of the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM). In ICD-10, the inhibited form is called RAD, and the disinhibited form is called “disinhibited attachment disorder” or “DAD”. In DSM, both forms are called RAD; for ease of reference, this article will follow that convention and refer to both forms as reactive attachment disorder.
RAD arises from a failure to form normal attachments to primary caregivers in early childhood. Such a failure could result from first serious experiments of negligence, abuse, abrupt separation of the caregivers between the six months and three years ages, of frequent change of the caregivers, or a lack of response of caregiver to the communicative efforts of a child. Not all or even a majority such experiments have like consequence the disorder. It is differentiated from pervasive developmental disorder or developmental delay and from possibly comorbid conditions such as mental retardation, all of which can affect attachment behavior. The criteria for a diagnosis of a reactive disorder of attachment are very different from the criteria used in the evaluation or categorization of attachment styles such as insecure or disorganized attachment.
Children with RAD are presumed to have grossly disturbed internal working models of relationships which may lead to interpersonal and behavioral difficulties in later life. There are few studies of the long-term effects, and there is a lack of clearness about the presentation of the disorder beyond the five years age. However, the opening of the orphanages in Eastern Europe following the end of the cold war in the early-1990s presented means of research on infants and the infants brought to the top of the very private conditions. Such a research widened the arrangement of the prevalence, the causes, the mechanism and the evaluation of the disorders of the attachment and undertook to the efforts starting from the late-1990s onwards to develop treatment and prevention programs and better methods of assessment. The Mainstream theorists in the field proposed that a broader range of the conditions resulting from the problems with the attachment should be defined beyond current classifications.
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