Reactive Attachment Disorder in maltreated young children in foster care

Abstract

Reactive attachment disorder (RAD) is one of the least researched and most poorly understood psychiatric disorders. Very little is known about the prevalence and stability of RAD symptoms over time. Until recently it has been difficult to investigate RAD due to limited tools for informing a diagnosis. Utilising a newly developed observational tool along with the Disturbances of Attachment Interview. this short-term prospective longitudinal study explored RAD symptoms in maltreated young children in Scotland (n=100, age range =12-62 months) over 12 months. Children were recruited as part of The Best Services Trial (BeST), in which all infants who came in to the care of the local authority in Glasgow due to child protection concerns were invited to participate. Prevalence of RAD was found to be 5.0% (n=5, 95% CI [0.7-9.3]) when children were first placed in to foster care. Following at least 1 year of improved care conditions, prevalence in the 76 children remaining in the study was 2.1% (n=2, 95% CI [below 0-4.7]). RAD was associated with some mental health and cognitive difficulties. While levels of carer-reported RAD symptoms decreased significantly over time, observed symptoms did not. Findings suggest that RAD resolved in a small majority of cases but further exploration in larger samples would be invaluable.

Indiscriminate friendliness in foster children: Associations with attachment security, foster parents’ sensitivity, and child inhibitory control

“…Even though the adverse history of postinstitutionalized foster and adopted children shows similarities with family-reared, never-institutionalized foster children, examinations of the relation between improved caregiving quality after placement in the latter group are scarce. M. Bruce et al (2019) did describe reduced attachment disorder symptoms after children had been placed in a foster family, but these results were limited to inhibited social behavior characterizing RAD and did not include symptoms of DSED.…”

“…Bruce et al (2019) did describe reduced attachment disorder symptoms after children had been placed in a foster family, but these results were limited to inhibited social behavior characterizing RAD and did not include symptoms of DSED. Moreover, of these studies only Van den Dries et al (2012) and Garvin et al (2012) used the Emotional Availability Scales (Biringen et al, 1998) as an instrument to specifically measure parental sensitivity, whereas the other studies presumed that the adoption or foster placement in itself indicated an improvement in caregiving quality (M. Bruce et al, 2019; Rutter et al, 2007; Zeanah et al, 2017).…”

“…It is expected that new caregivers, such as foster parents, generally show higher levels of sensitive behavior than the foster children’s biological parents and that the quality of caregiving after placement is therefore better compared to caregiving quality before placement. Improved caregiving environment is related to reduced attachment disorder symptoms, such as IF, in postinstitutionalized and foster children (M. Bruce et al, 2019; Zeanah et al, 2017). Specifically parental sensitivity seems to be predictive of a decrease in IF (Dobrova-Krol et al, 2010; Love et al, 2015).…”

Attachment disorders diagnosed by community practitioners: a replication and extension

“…This study was based on clinical data collected in the course of providing research‐informed specialist care for maltreated foster and adopted children and their caregivers. Due to differences in diagnostic instruments, procedures, and populations, the relatively low in‐clinic prevalence of DSED and absence of RAD cannot be directly compared to the usually higher clinical prevalence rates of RAD or DSED (e.g., Bruce et al., ; Kay, Green, & Sharma, ; Zeanah et al., ) or rates of inhibited attachment behavior or disinhibited social engagement behavior (e.g., Jonkman et al., ; Scheper et al., ). For one, RAD symptoms were simply recorded as present or absent on the basis of a clinical interview, whereas in the original versions of the DAI and IFI, subclinical levels of these symptoms may also be recorded.…”

“…In fact, to date, none of the studies of children adopted from Romanian orphanages have documented a diagnostic case of RAD after a period of time living in an adoptive home (Zeanah & Gleason, ). However, some cases of persistent observer‐rated and caregiver‐reported RAD behavior in nonpermanent foster care have been reported (Bruce et al., ; Jonkman et al., ). Third, the indiscriminate sociability of DSED may persist even after the child is placed in a stable and responsive caregiving environment (Chisholm, ; Rutter et al., ).…”