Practice Parameter for the Assessment and Treatment of Children and Adolescents With Reactive Attachment Disorder and Disinhibited Social Engagement Disorder

Zeanah, Charles H.; Chesher, Tessa; Boris, Neil W.; Walter, Henrik; Bukstein, Oscar G.; Bellonci, Christopher; Benson, R. Scott; Bussing, Regina; Chrisman, Allan K.; Hamilton, John D.; Hayek, Munya; Keable, Hélène; Rockhill, Carol; Siegel, Matthew; Stock, Saundra

doi:10.1016/j.jaac.2016.08.004

Cited by 103 publications

(138 citation statements)

References 95 publications

(182 reference statements)

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“…In the DSM, there are two attachment-related diagnoses, and both are strongly associated with experiences of extreme social neglect, capturing “distinctive patterns of aberrant attachment and social behaviors in young children who are socially neglected or are being raised in environments that limit opportunities to form selective attachments” (Zeanah et al, 2016, p. 990). The first is reactive attachment disorder (RAD), which is assigned to children who are very inhibited or withdrawn from their caregivers and who do not show proximity seeking or contact maintenance to the caregivers, even when the children display high distress.…”

Section: Introductionmentioning

confidence: 99%

“…For instance, Smyke, Zeanah, Fox, Nelson, and Guthrie (2010) found that rates of disorganized attachment substantially declined for infants randomly assigned to high-quality foster care – but, by contrast, rates of DSED did not differ between infants who remained institutionalized and those in foster care. Zeanah et al (2016, p. 992) have recently questioned whether DSED should be considered an “attachment” disorder at all, as it “may occur in the absence of attachment, in an aberrant attachment or in a healthy attachment to a subsequent foster or adoptive parent” (though see also Lyons-Ruth & Jacobvitz, 2016). …”

Section: Introductionmentioning

confidence: 99%

“…Although formal attachment assessments may be too costly for regular use by practitioners, the principles derived from attachment theory can inform clinical practice (see Slade, 2004; Steele & Steele, 2008; Woolgar & Baldock, 2015; Zeanah et al, 2016). For example, it may be useful to consider whether the child can use the caregiver as a safe haven when distressed and as a secure base for exploration (e.g.…”

Section: Introductionmentioning

confidence: 99%

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Disorganized attachment in infancy: a review of the phenomenon and its implications for clinicians and policy-makers

Granqvist

Sroufe

Dozier

et al. 2017

Attachment & Human Development

211

156

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Disorganized/Disoriented (D) attachment has seen widespread interest from policy makers, practitioners, and clinicians in recent years. However, some of this interest seems to have been based on some false assumptions that (1) attachment measures can be used as definitive assessments of the individual in forensic/child protection settings and that disorganized attachment (2) reliably indicates child maltreatment, (3) is a strong predictor of pathology, and (4) represents a fixed or static “trait” of the child, impervious to development or help. This paper summarizes the evidence showing that these four assumptions are false and misleading. The paper reviews what is known about disorganized infant attachment and clarifies the implications of the classification for clinical and welfare practice with children. In particular, the difference between disorganized attachment and attachment disorder is examined, and a strong case is made for the value of attachment theory for supportive work with families and for the development and evaluation of evidence-based caregiving interventions.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Disorganized attachment in infancy: a review of the phenomenon and its implications for clinicians and policy-makers

Granqvist

Sroufe

Dozier

et al. 2017

Attachment & Human Development

211

156

View full text Add to dashboard Cite

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“…Aberrant social behavior in the form of lack of reticence with unfamiliar adults was first reported in children who were raised in institutions under conditions of serious insufficient care and neglect (Tizard & Rees, ). Since then, this type of behavior has been designated by terms as indiscriminate social behavior, indiscriminate friendliness, disinhibited attachment, and disinhibited social engagement behavior (DSEB) (Zeanah, Chesher, & Boris, ). The criteria for Disinhibited Social Engagement Disorder (DSED) in the fifth edition of the Diagnostic and Statistical Manual of mental disorders (DSM‐5) include a pattern of behavior with at least two of the following: reduced reticence in interacting with unfamiliar adults, overly familiar verbal or physical behavior, a failure to maintain proximity to the primary caregiver in unfamiliar settings, and willingness to go off with strangers (American Psychiatric Association, ).…”

Section: Introductionmentioning

confidence: 99%

Course of disinhibited social engagement behavior in clinically referred home‐reared preschool children

Scheper

Groot

Vries

et al. 2018

Child Psychology Psychiatry

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Background Evidence supporting clinical relevance and persistence of disinhibited social engagement behavior (DSEB) pertains mostly to children reared in institutions and foster care. This study examined the course of DSEB in clinically referred home‐reared children from early into middle childhood, and associations with neglect/emotional maltreatment, effortful control, Attention Deficit/Hyperactivity Disorder, Oppositional Defiant Disorder, and Autism Spectrum Disorder. Methods Disinhibited social engagement behavior was examined in 124 children (82% boys, M = 4.06 years, SD = 0.89), referred for treatment of emotional and behavioral problems, by use of the Disturbances of Attachment Interview (DAI) with biological parents. Neglect and emotional maltreatment were assessed from case records and effortful control by use of the Child Behavior Questionnaire. At follow‐up, on average 4 years later, DSEB was examined by use of DAI as well as two observational ratings: the Stranger at the Door procedure (SatD) and a structured home observation of stranger approach. Psychiatric disorders were assessed by means of the Kiddie‐Schedule for Affective Disorders and Schizophrenia. Results Persistence of parent‐reported DSEB was found in 57% (n = 27) of the children with DSEB at baseline (n = 47). Parent‐reported DSEB at follow‐up was significantly related to DSEB observed in the SatD (rpb = .31, p = .001) and to observed stranger approach (rs = .41, p < .001), but only stranger approach was associated with baseline DSEB. The course of DSEB was not related to neglect/emotional maltreatment, nor to the level of effortful control. There was no association between DSEB and Autism Spectrum Disorder, but course of DSEB was associated with Attention Deficit/Hyperactivity Disorder/Oppositional Defiant Disorder at follow‐up (χ2 = 13.08, p = .004). Conclusions Although explanations for the onset and course of DSEB in home‐reared children remain elusive, findings suggest that DSEB is part of a complex of clinically significant problem behaviors in referred home‐reared preschool children.

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“…A social bond refers to a relationship with shared dyadic interactions whereas attachment involves a system of activities to reduce the risk of an individual coming to harm, and consequently increases a sense of security (Bowlby, 1969). Attachment is a central component of social and emotional development in early childhood (Zeanah et al, 2016). It has been considered the heart of human development, as the early attachment relationship between child and caregiver is seen as the most important organiser of the self (Sroufe & Waters, 1977).…”

mentioning

confidence: 99%

Avoidance of the real and anxiety about the unreal: Attachment style and video-gaming

Coulson

Oskis

Gould

2017

Contemporary Issues in Early Childhood

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In this article we discuss the light and dark side of attachments and attachment style in physical and digital worlds. We argue that many games offer opportunities for the generation of new and meaningful attachments to both physical and digital others. We discuss two 'Fundamental Attachment Errors', and show how these can lead to both 'light' outcomes, in terms of opportunities to learn more secure attachment patterns, and 'dark' outcomes where existing dysfunctional behaviours become more pronounced. We argue that the avatars which children adopt online have important consequences for their psychosocial development, and that these are mediated through the degree to which the real self is differentiated from the avatar. We propose that attachment is a key force in understanding play, and that studying its manifestations and effects in digital playscapes may contribute to our understanding of the effects of life online, and how insecure attachments may become secure.

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Practice Parameter for the Assessment and Treatment of Children and Adolescents With Reactive Attachment Disorder and Disinhibited Social Engagement Disorder

Cited by 103 publications

References 95 publications

Disorganized attachment in infancy: a review of the phenomenon and its implications for clinicians and policy-makers

Disorganized attachment in infancy: a review of the phenomenon and its implications for clinicians and policy-makers

Course of disinhibited social engagement behavior in clinically referred home‐reared preschool children

Avoidance of the real and anxiety about the unreal: Attachment style and video-gaming

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