The DSM-V estimates that RAD is very uncommon, occurring in less than 10% of severely neglected children. A more positive attitude by caregivers, in turn, may enhance attachment security and promote healthy development for the child (Potter, 2014). Caregivers who see their child as having a Fetal Alcohol Spectrum Disorder (FASD) may be much more understanding of the child's behavior, since this is a neurological problem, not psychiatric. It should also be noted note that fetal alcohol exposure is quite common among children in foster care (Ospina & Dennett, 2013). Diagnosis is further complicated by the fact that compared to other children, children with RAD experience higher rates of general behavior problems, social problems, somatic complaints, anxiety/depression, thought and attention problems, delinquent or aggressive behavior, and/or a lack of empathy (Buckner, et al., 2008). The American Academy of Child and Adolescent Psychiatry (Boris, et al., 2005) does not recommend diagnosing RAD in children over age 5.ĭiagnosing RAD can also be difficult because it shares traits with disorders such as autism spectrum disorder, intellectual disability, oppositional defiance disorder, conduct disorder, social phobia, and PTSD. Assessments of RAD past school age can be quite difficult by this age early attachment experiences are just one of many factors that determine emotion and behavior (Mercer, 2006). RAD is generally diagnosed in children between the ages of 9 months and 5 years. Symptoms of DSED take much longer to resolve (Zeanah, et al., 2004). After children have been placed in a stable environment, research shows that signs of RAD disappear over time and become quite rare. One of the reasons the DSM-V separates RAD and DSED are their different progressions. RAD's new narrower, more targeted definition is now characterized by a child who is inhibited and withdrawn from adult caregivers, rarely seeks or responds to comfort when they are upset, and has persistent social and emotional disturbances, such as minimal responsiveness to others, minimal positive emotions, and irritability, sadness, or fear during non-threatening social interactions. Now the DSM-V, which appeared in 2013, classifies these disorders as separate diagnoses: RAD, which involves emotionally withdrawn and inhibited behaviors, and disinhibited social engagement disorder (DSED) which involves indiscriminately social and disinhibited behaviors. Until recently there were two types of RAD: emotionally withdrawn/inhibited and indiscriminately social/disinhibited. Researchers and practitioners have been wrestling to clearly identify and treat it ever since. RAD was first added to the Diagnostic and Statistical Manual of Mental Disorders (DSM) in the 1980s. Reactive attachment disorder (RAD) is a disruptive disorder believed to be caused by chronic and severe neglect in early childhood.
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