At this time many reactive attachment disorder cases are registered in US. Even increasing the number of childhood mental health problems are being attributed to genetic defects, reactive attachment disorder is by definition based on a problematic history of care and social relationships. Abuse can take place alongside the required factors, but on its own does not explain attachment disorder. It has been recommended that types of temperament, or legitimate response to the environment, may make some individuals susceptible to the stress of volatile or hostile relationships with caregivers in the early years. In the absence of available and responsive caregivers it appears that some children are particularly vulnerable to developing attachment disorders. There is as yet no explanation for why comparable abnormal parenting may produce the two distinct forms of the disorder, reserved and disinhibited.
The issue of temperament and its influence on the development of attachment disorders has yet to be resolved. RAD has not at all been reported in the absence of serious environmental adversity yet outcomes for children increasing in the same environment vary extensively. In discussing the neurobiological basis for attachment and trauma symptoms in a seven-year twin study, it has been recommended that the roots of various forms of psychopathology, including RAD and post-traumatic stress disorder (PTSD), can be found in conflict in affect regulation. The subsequent development of higher-order self-regulation is jeopardized and the formation of internal models is affected. Consequently the “templates” in the mind that drive organized behavior in relationships may be impacted. The potential for “re-regulation” in the presence of “corrective” experiences (normative care giving) seems possible. Like many other papers in this poorly-researched area many new avenues of enquiry are raised.
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