The Need for Early Recognition of Children with Reactive Attachment Disorder

Introduction
The purpose of this community project is to educate social welfare workers, parents and clients, to better understand and utilize attachment theory and specifically reactive attachment disorder theory, in their decision making process with abused and neglected children.

Statement of Need
Infant need for protection and nurturance is the most prolonged of any mammal and parental responsibility is considerable during this time (MacLean, cited in Levy & Orlans, 1998). This relationship between infant and caregiver is crucial to later development of personality, and the chronic disruption of these early patterns of attachment may result in Reactive Attachment Disorder (RAD) (Lieberman & Zeanah, 1995). “Chronic inconsistency in meeting infant and toddler needs as well as the introduction of early childhood trauma (i.e. abuse), is linked to the formation of RAD and may result in psychiatric syndromes, criminal behavior and drug use,” (Sheperis, Renfro-Michel & Doggitt, 2003, p.76).

Crittenden (1995) reports that more and more children are failing to develop secure attachments to caring, protective caregivers, and therefore are hindered developmentally without this important foundation. The estimated occurrence rates projected from maltreatment research reveals that approximately 1% of all children may have RAD (Richters & Volkmar, 1994). With 80% of abused or neglected children showing signs of RAD, the effects are far reaching when considering the disturbing consequences that RAD children may have on family and society (Reber, 1996).

Typically, traditional parenting does not work with attachment-disordered children. Such tools like sticker charts and behavioral programs do not work. Why? Because all these approaches, including play therapy and traditional talk therapies, require a relationship. Many children diagnosed with Reactive Attachment Disorder, impact the child welfare and court system with an array of emotional, physical, behavioral and developmental social problems. These children often grow up to perpetuate this cycle with their own children and without intervention, the chance for normal emotional development and the ability to build trusting relationships is poor.

Description of the Intervention
As my research confirmed, there appears to be a lack of knowledge about attachment disorders in general, and RAD specifically. Although I only interviewed a small number of supervisors, social service providers and clients, it seems reasonable to apply my findings to the general population. One common theme among the majority of those I interviewed is the interest in the informational pamphlet. The first administrator suggested that not only her staff, but also her clients might benefit from such a pamphlet (personal communication, January 30, 2006). The second administrator said that she thought that such a pamphlet could benefit the collateral organizations her agency works with (personal communication, February 6, 2006)

I decided that my community project would be to design a brochure that will have an explanation of Reactive Attachment Disorder, along with a list of symptoms that a child with Reactive Attachment Disorder might present. Additionally, I will add a list of suggestions to help parents/caregivers bond with their child, as well as resources for concerned caregivers to access.

Evaluation of the Intervention
After the recognition of symptoms, parents need to be provided direct instruction in caretaking responsibilities and understanding their child’s needs (Smyke, et al., 2002). Instruction might include therapy to explore the underlying cause of the parent’s lack of nurturing. Children in foster care are possibly the most at risk and foster parents need to be trained in how to create a bond with children who are at risk for developing attachment disturbances. Specialized classes as well as reading material could be a mandated aspect to the certification process.

It is the author’s opinion that infants and older children who exhibit signs of reactive attachment disorder need a comprehensive psychiatric assessment and an individualized treatment plan. Additionally, close and ongoing collaboration between the child's family and the treatment team will increase the likelihood of a successful outcome. Though the nature of this disorder makes it difficult to study, perhaps future revision to classification, as well as more in depth research, will offer more insight into RAD. With this understanding, more effective intervention and treatment will be available to those impacted by reactive attachment disorder.

Social service agencies who serve children, need to be aware of the symptoms of RAD and pursue all available resources to aid in early intervention for there clients. Because reactive attachment disorder is such a severe disorder, researchers are pressuring social workers and health professionals to recognize the early onset of RAD and to provide treatment resources as soon as possible (Sheperis, Doggett, et al., 2003).

My goal in designing the brochure was to make it attractive, and easy to read and understand. Additionally, I wanted to list several resources that professionals and parents could utilize if they were concerned about a client.

Reflections on the Project
I am pleased with the brochure that I have designed and feel it was an important project. In my enthusiasm for designing them, I forgot to add my name as the author of the brochure, as well as the date they were designed. The purpose of adding this information would be so that those who read the brochure, would know how current the research is. Additionally, by adding my name, I would then be able to include this as a “publication” for my resume. My hope is that my brochures will be useful for agencies who work with children as well as biological parents and foster families who may be struggling with a Reactive Attachment Disorder child.

References

• Crittenden, P. M. (1995). Attachment and risk for psychopathology: The early years. Pediatrics, 16 (3).
• Levy, T. & Orlans, M. (1998). Attachment, trauma, and healing: Understanding and treating attachment disorders in children and families. Washington, DC: CWLA Press.
• Lieberman, A. F. & Zeanah, C. H. (1995). Disorders of attachment in infancy. Child and Adolescent Psychiatric Clinics in North America, 4 (3), 571-587.
• Reber, K.(1996) Children at risk for reactive attachment disorder: assessment, diagnosis and treatment. Progress: Family Systems Research and Therapy, 5, 83-98
• Richters, M. M. & Volkmar, F. R. (1994). Reactive attachment disorder of infancy or early childhood. Journal of the American Academy of Child and Adolescent Psychiatry, 33, 328-332.
• Sheperis, C. J., Renfro-Michel, E. L. & Doggitt, R. A. (2003). In-home treatment of reactive attachment disorder in a therapeutic foster care system: A Case Example. Journal of American Health Counseling, 25, 76-88.
• Sheperis, C. J., Doggett, R. A. & Hoda, N. E. (2003). The development of an assessment protocol for reactive attachment disorder. Journal of Mental Health Counseling, 25, (4) 291-310.
• Smyke, A. T., Dumitrescu, A. & Zeanah, C. H. (2002). Attachment disturbances in young children. I: The continuum of caretaking causality. Journal of the American Academy of Child and Adolescent Psychiatry, 41, 972-982.