Reactive attachment disorder—a theoretical model beyond attachment

Abstract

Despite its importance in public health, reactive attachment disorder (RAD) is an under-researched and little used clinical category. Abnormalities of social relatedness have long been documented in children who have been abused, neglected or institutionalised, but there have been more recent efforts to define these behaviours within the psychiatric nosology. There has been an implicit assumption that the central deficit in RAD is in the attachment system, but this has caused controversy and may have blocked research. We propose that RAD is better construed within the framework of intersubjectivity, which has a central role in the development of core brain and social functions and may also have had an important role in the evolution of a key human characteristic-complex social functioning. This broader framework may potentially explain apparently diverse symptoms such as indiscriminate friendliness and negative or unpredictable reunion responses. Finally, we suggest that a change of name may be useful in progressing the field, but accept that this may be difficult until there is better agreement in the clinical and scientific communities about the core features and aetiology of this disorder.

Annual Research Review: Attachment disorders in early childhood – clinical presentation, causes, correlates, and treatment

“…In fact, in keeping with the suggestions of social cognitive and behavioral abnormalities of the disorder (Green, 2003; Minnis et al, 2006; Rutter et al, 2009; Tarullo & Gunnar, 2005), there is now evidence that DSED is predictive of functional impairment, difficulties with close relationships, and more need for special education services (Gleason et al, 2011; Rutter et al, 2007). …”

Health visitors’ assessments of parent–child relationships: A focus group study

“…We found it somewhat surprising that clinic contacts and, in particular, immunisation sessions, were not seen as being particularly useful. By definition, the attachment system is activated in stressful situations and can only be assessed by careful observation of the child's reaction to stress and the parents' capacity to help the child to moderate discomfort (Minnis et al 2006). It is likely that time pressures during clinic and immunisation sessions make it difficult to use this potentially informative situation most effectively, but this may be an area worthy of observational research.…”

Disinhibited reactive attachment disorder symptoms impair social judgements from faces

“…Thus, it seems that, in contrast with children with ASD, the difficulties experienced by children with RAD are not linked to sampling of facial features but to a problem with specific processing of the very same visual information that is available to typically developed children. Various authors have described Reactive Attachment Disorder as a social impairment, rather than as a disorder of attachment (Green and Goldwyn, 2002;Minnis et al, 2006) and these results support this view: despite its environmental aetiology, it appears that neurological processes may have been set in train by the early environmental insult that are perpetuated through development.…”

“…These will soon lead to a preference for caregiver over strangers. In a maltreating relationship characterised by discordant clashes and failed attempts at interaction, relationships with strangers may seem at least as satisfying -or even preferable (Minnis et al, 2006). A qualitative study of maltreated, indiscriminately friendly children supported this view: despite being grossly over-inclusive in those they regarded as "friends", these children were also preoccupied with issues of trust .…”