From your School Psychologist…



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From your School Psychologist…


Reactive Attachment Disorder (RAD) is a condition found in children that have been severely neglected and/or abused for a long period of time. RAD develops because the child's basic needs for comfort, affection and nurturing aren't met and loving, caring attachments with others are never established. Children with RAD can have markedly disturbed and developmentally inappropriate social relatedness in most contexts that begins before the age of five.
Medical conditions associated with RAD are malnutrition, growth delay, evidence of physical abuse, vitamin deficiencies, or infectious diseases
Two subtypes of RAD are inhibited and disinhibited.

  • Inhibited type refers to children who continually fail to initiate and respond to social interactions in a developmentally appropriate way. As well as, interactions are often met with a variety of approaches, avoidance and resisting to comforting, often hyper vigilant or highly ambivalent. An example of this would be a child or infant that does not seek comfort from a parent or caregiver during times of threat, alarm or distress.




  • Disinhibited type refers to a child who has an inability to display appropriate selective attachments (i.e. will try to attach to everyone) this is more lasting over time than inhibited type. An example of this would be a child who shows extreme familiarity with strangers.


Characteristics of RAD:

  • Lack of self-control / impulsive

  • Speech and language delays

  • Lack of conscience / shows no remorse

  • Indiscriminately affectionate with strangers

  • Avoids physical contact

  • Hyperactive

  • Aggressive

  • Destructive towards self, property and others

  • Food issues: hordes, gorges, refuses to eat, hides food

  • Often on guard, anxious, wary

  • Prefers to play alone

  • Inhibition or hesitancy in social interactions



Potential causes of RAD include frequent changes in primary caregiver, extended separation from the parent/primary caregiver, frequent moves and/or placements in foster care or institutions, traumatic experiences, undiagnosed painful illness such as colic, ear infections, etc., young or inexperienced mother with poor parenting skills, neglect, and abuse.


Family, individual, and play therapy have been seen as effective in treating RAD as well as medication for symptoms (for anxiety, hyperactivity, etc.) There is a unique challenge for children with RAD in a school environment; while the school setting is meant to educate, children with RAD are primarily concerned with internal feelings of safety, security and trust. There is also a heavier burden placed on the teacher due to a greater degree of dependency needed. Children with RAD have a difficult time self-regulating their behaviors and emotions, and have a difficult time forming reciprocal social relationships with others.
Strategies for teachers to use that are very important for RAD students:

  • Be consistent, predictable, and repetitive

  • Set clear, concise expectations

  • Set a classroom routine

  • Model and teach appropriate social behaviors

  • Maintain realistic expectations

  • Ignore behaviors that are not harmful to the child, property, or others.

  • Understand behaviors before punishing

  • Utilize other resources (school counselor/psychologist) to gain needed information to understand the effects of Reactive Attachment disorder on the child’s behavior and emotions

  • Help the child learn how to regulate his or her feelings and actions

Reactive Attachment Disorder is treatable. However, RAD is a disorder that children will most likely require ongoing treatment, there is no quick fix.

References
American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th ed.) Text revision. Washington, DC: Author.

American academy of child and adolescent psychiatry. (2007). http://www.aacap.org/page.ww?name=Reactive+Attachment+Disorder§ion=Facts

Schwartz, E., and Davis, A. (2006). Reactive attachment disorder: Implications for school readiness and school functioning. Psychology in Schools, 43, 471-479.

Stoller, J.L. (2006). Parenting other people’s children: Understanding and repairing reactive attachment disorder. Vintage Press.





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