RAD is one of the least researched and most poorly understood disorders in the DSM. There is little systematic epidemiologic information on RAD, its course is not well established and it appears difficult to diagnose accurately. There is a lack of clearness about the presentation of the attachment disorders above the five years age and difficulty by distinguishing the aspects from the attachment disorders, the disorganized attachment or the consequences of the maltreatment. According to the American Academy of Child and Adolescent Psychiatry (AACAP), children who show signs of reactive attachment disorder need a complete psychiatric assessment and individualized treatment plan. The signs or the symptoms of RAD can also be found in other psychiatric disorders and AACAP advises against to give to a child this label or diagnosis without complete evaluation. Their practice parameter declares that the evaluation of the reactive attachment disorder requires the obviousness directly obtained starting from the periodic observations of the child acting one on the other with its caregivers and history primary educations of the modes of the child of the behavior of attachment with these caregivers. Moreover it requires observations of the child’s behavior with unfamiliar adults and a comprehensive history of the child’s early care giving environment including, for example podiatrists, the teachers, or the welfare officers. In the USA, initial evaluations can be carried out by psychologists, psychiatrists, specialist Licensed Clinical Social Workers or psychiatric nurses.
In the UK, the British Association for Adoption and Fostering (BAAF), advise that only a psychiatrist can diagnose an attachment disorder and that any assessment must include a comprehensive evaluation of the child’s individual and family history. To agree to the parameter of practice as regards AACAP (2005) the question of if attachment disorders can be surely diagnosed in older children and adults was not solved. Attachment behaviors used for the diagnosis of RAD change markedly with development and defining analogous behaviors in older children is difficult. There is no appreciably validated measurement of the attachment in middle childhood or early adolescence. The evaluations of RAD past school age may not be probable at all as by this time children have developed along individual lines to such an extent that early attachment experiences are only one factor among many that decide emotion and behavior.
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