Presentation is loading. Please wait.

Presentation is loading. Please wait.

An Overview 921: Reactive Attachment Disorder (RAD):

Similar presentations


Presentation on theme: "An Overview 921: Reactive Attachment Disorder (RAD):"— Presentation transcript:

1 An Overview 921: Reactive Attachment Disorder (RAD):

2 921: Reactive Attachment Disorder: An Overview The Pennsylvania Child Welfare Resource Center Learning Objectives Describe how healthy attachment occurs Describe the effects of maltreatment and disordered attachment on brain development, self concept and behavior Define risk factors for and symptoms of Reactive Attachment Disorder (RAD) and related disorders List the recommended approaches for diagnosis and treatment of RAD and related disorders Utilize attachment parenting principles when caring for a child with RAD The Pennsylvania Child Welfare Resource Center 2

3 921: Reactive Attachment Disorder: An Overview The Pennsylvania Child Welfare Resource Center Agenda I.Introduction II.Development of healthy attachment III.Effects of unhealthy attachment IV.Symptoms, diagnosis and treatment of RAD and related disorders V.Parenting principles that promote attachment VI.Closing 3

4 921: Reactive Attachment Disorder: An Overview The Pennsylvania Child Welfare Resource Center Healthy Attachment 4

5 921: Reactive Attachment Disorder: An Overview The Pennsylvania Child Welfare Resource Center Poll Think about your response to separating from the person(s) you are MOST attached to for 6 months. What would you want? A.To feel secure, I would not need any contact. B.To feel secure, I would want monthly contact. C.To feel secure, I would want weekly contact. D.To feel secure, I would want daily contact. E.To feel secure, I would tell them don’t go! 5

6 921: Reactive Attachment Disorder: An Overview The Pennsylvania Child Welfare Resource Center How Does Healthy Attachment Occur? Watch the First Years Last Forever clip Can you identify the five main things parents are doing in the clip that facilitate parent/child attachment? 6

7 921: Reactive Attachment Disorder: An Overview The Pennsylvania Child Welfare Resource Center Normal Cycle of Attachment Infant feels need (hunger, pain, attention) Infant is aroused and expresses need (cry) Response/gratification (need is promptly met in nurturing way) Relief/relaxation (infant feels relief and relaxes, develops TRUST) 7

8 921: Reactive Attachment Disorder: An Overview The Pennsylvania Child Welfare Resource Center Normal Cycle of Attachment Need Relief Arousal Relaxation Expression Response Gratification 8

9 921: Reactive Attachment Disorder: An Overview The Pennsylvania Child Welfare Resource Center Disordered Cycle of Attachment Infant feels need (hunger, pain, attention) Infant is aroused and expresses need (cry) There is no response, or response is angry/punitive There is not relief/relaxation (infant develops anger/rage and learns not to depend on caregivers for need satisfaction) 9

10 921: Reactive Attachment Disorder: An Overview The Pennsylvania Child Welfare Resource Center Disordered Cycle of Attachment Need Discomfort/Fear/ Arousal Anxiety Expression Lack of Trust in Apathy Others & Lack of Empathy No Response -> Anger 10

11 921: Reactive Attachment Disorder: An Overview The Pennsylvania Child Welfare Resource Center Continuum of Attachment SECUREANXIOUSDISORGANIZEDNONATTACHED Comfortable with closeness and trust Felt security Vulnerability acceptable Positive working model Individuality, togetherness balanced Resists or ambivalent about closeness or trust Moderately controlling and insecure Negative working model Rejecting or clingy Unable to trust or be close Lacks remorse Aggressive and punitive control Negative working model (severe) Pseudo- independent Unable to form emotional connections Lacks conscience Predatory behaviors Negative working model (severe) Extreme narcissism (From: Attachment, Trauma, and Healing, p. 94) 11

12 921: Reactive Attachment Disorder: An Overview The Pennsylvania Child Welfare Resource Center Effects of Unhealthy Attachment 12

13 921: Reactive Attachment Disorder: An Overview The Pennsylvania Child Welfare Resource Center Effect on the Brain Frontal Lobes –Manages impulse control, social reasoning, organization and planning Amygdala –Assesses threats and danger in the environment and results in fight, flight or freeze responses (Source: Dr. Bruce D. Perry, 2006, The Boy Who was Raised as a Dog) 13

14 921: Reactive Attachment Disorder: An Overview The Pennsylvania Child Welfare Resource Center Effect on the Brain: Hand Model Let’s watch Dr. Siegel’s hand model of the brain –http://www.youtube.com/watch?v=DD-lfP1FBFkhttp://www.youtube.com/watch?v=DD-lfP1FBFk 1)What does this mean for children who did not develop smooth regulation and impulse control as a result of disrupted attachment early in life? 2)What does this mean for us as parents when we respond to some of the extreme behaviors exhibited by children with disordered attachment? 3)How can you use this hand model with children who struggle with regulating their emotions, impulses and sensory responses? 14

15 921: Reactive Attachment Disorder: An Overview The Pennsylvania Child Welfare Resource Center Beliefs: About Self and the World People are untrustworthy and inconsistent The world is chaotic, unpredictable and unsafe Nothing I say or do has an impact, not on others, myself or situations My needs will only be met through my own efforts: I have to do it all myself (Source: Cross, 2003, Dyadic Developmental Psychotherapy) 15

16 921: Reactive Attachment Disorder: An Overview The Pennsylvania Child Welfare Resource Center Beliefs: About Self and the World (cont.) I am worthless, unlovable and bad I am unsafe and weak Caretakers are unresponsive, unreliable and dangerous The world is hostile and dangerous. (Source: Cross, 2003, Dyadic Developmental Psychotherapy) 16

17 921: Reactive Attachment Disorder: An Overview The Pennsylvania Child Welfare Resource Center Behavior: Attachment Disruption Signs INFANCYTODDLERSCHOOL AGEADOLESCENCE Lack of eye contact Inability to soothe Does not express needs Slow development and weight gain Excessive tantrums Self-Injury Overly friendly/ attention- seeking with strangers Affectionate on their own terms Tantrums continue Cruel to animals Encopresis/ Enuresis Lying, hoarding, stealing, destruction of property Drug/Alcohol abuse Excessive sexual behaviors (multiple partners) Immediate bonding and need to attach with strangers 17

18 921: Reactive Attachment Disorder: An Overview The Pennsylvania Child Welfare Resource Center Symptoms, Diagnosis and Treatment of Reactive Attachment Disorder (RAD) and Related Disorders  Symptoms of RAD  Risk factors  Diagnostic process  Related disorders  Recommended treatments 18

19 921: Reactive Attachment Disorder: An Overview The Pennsylvania Child Welfare Resource Center Symptoms of RAD A consistent pattern of inhibited, emotionally withdrawn behavior toward adult caregivers, evident before age 5, and manifested by both of the following: –Rarely or minimally seeks comfort when distressed –Rarely or minimally responds to comfort offered when distressed A persistent social and emotional disturbance characterized by at least 2 of the following: –Minimal social and emotional responsiveness to others –Limited positive affect –Episodes of unexplained irritability, sadness, or fearfulness which are evident during nonthreatening interactions with adult caregivers (Source: DSM-5) 19

20 921: Reactive Attachment Disorder: An Overview The Pennsylvania Child Welfare Resource Center Symptoms of RAD Child has experienced a pattern of extremes of insufficient care (pathogenic care) as evidenced by at least one of the following: –Persistent disregard of the child’s basic emotional needs for comfort, stimulation, and affection (i.e., neglect) –Persistent disregard of the child’s basic physical needs. –Repeated changes of primary caregiver that prevent formation of stable attachments (e.g., frequent changes in foster care) –Rearing in unusual settings such as institutions with high child/caregiver ratios that limit opportunities to form selective attachments Not due to Autism Spectrum Disorder (Source: DSM-5) 20

21 921: Reactive Attachment Disorder: An Overview The Pennsylvania Child Welfare Resource Center Risk Factor for RAD: Social Neglect and Deprivation Due to One or More of the Following Neglect Abuse Maternal postpartum depression Parental mental illness Substance abuse of parent Inexperienced parent Inconsistent care giving Many different caregivers (Source: Mayo Clinic, 2013) 21

22 921: Reactive Attachment Disorder: An Overview The Pennsylvania Child Welfare Resource Center Case Vignette Using HO#6 (RAD: Symptoms, Risk Factors and Treatment), please identify the possible indicators of RAD Using HO#5 (Effects: Brain, Self-Concept and Behavior), please identify the possible beliefs this child might have based on the behavior Trisha exhibits 22

23 921: Reactive Attachment Disorder: An Overview The Pennsylvania Child Welfare Resource Center How Are Children Diagnosed? Major focus of assessment is obtaining the most complete history of caregiving for the child and evaluating the attachment between parent and child A full picture of the child’s behaviors is obtained Psychiatric evaluation and/or psychological evaluation –Presenting problem –Child’s history (psychosocial, medical, school) –Family history –Interview with child –Interview with parents 23

24 921: Reactive Attachment Disorder: An Overview The Pennsylvania Child Welfare Resource Center Diagnosing Challenges and Debates Is it RAD or another disorder? Disinhibited Social Engagement Disorder (due to pathogenic care) –Attachment may or may not be present –A pattern of behavior in which the child actively approaches and interacts with unfamiliar adults by exhibiting at least 2 of the following: Reduced or absent reticence to approach and interact with unfamiliar adults Overly familiar behavior (verbal or physical violation of culturally sanctioned social boundaries) Diminished or absent checking back with adult caregiver after venturing away, even in unfamiliar settings Willingness to go off with an unfamiliar adult with minimal or no hesitation (Source: DSM-5) 24

25 921: Reactive Attachment Disorder: An Overview The Pennsylvania Child Welfare Resource Center Diagnosing Challenges and Debates Is it RAD or another disorder? Posttraumatic Stress Disorder (PTSD) –Symptoms of avoidance and emotional numbing –Symptoms of intrusive memories (flashbacks/nightmares) –Symptoms of alterations in cognitions and mood Sensory Processing Disorder (SPD) –Difficulty processing sensory input –Hyper (over) or hypo (under) in one or more senses Mood Dysregulation Disorder (MDD) –Severe recurrent temper outbursts that are grossly out of proportion in intensity or duration to the situation –Three or more times per week in more than one setting (Source: DSM-5) 25

26 921: Reactive Attachment Disorder: An Overview The Pennsylvania Child Welfare Resource Center Diagnosing Challenges and Debates Is it RAD and another disorder? Posttraumatic Stress Disorder (PTSD) Sensory Processing Disorder (SPD) ADHD –Inattention and/or hyperactivity-impulsive behavior (Source: DSM-5) 26

27 921: Reactive Attachment Disorder: An Overview The Pennsylvania Child Welfare Resource Center Types of Treatment RAD treatment must focus on supporting attachment Many children diagnosed with RAD also experienced trauma due to neglect and/or abuse History of controversy exists regarding treatments Research continues to determine the most effective modes Types of treatment available: –Attachment-based therapies –Trauma-informed therapies –Neurologically-based therapies –Ancillary therapies (OT, Speech/Language) –Medication to treat conditions such as sleep disturbances, anxiety, etc. No one medication for RAD 27

28 921: Reactive Attachment Disorder: An Overview The Pennsylvania Child Welfare Resource Center Types of Treatment Attachment-Based Facilitates attachment through nurturing, structure, attunement, empathy, support, positive affect, reciprocity, and sometimes holding to reduce “alarm” reaction Example: Theraplay –Ann Jernberg in ‘60s –http://www.theraplay.or g/http://www.theraplay.or g/ Trauma-Informed Psychotherapy Play therapy Art therapy Equine therapy 28

29 921: Reactive Attachment Disorder: An Overview The Pennsylvania Child Welfare Resource Center Types of Treatment Neurologically-Based EMDR Watch Colleen West and EMDR with children –http://www.emdrinacti on.com/short-videos- introduction-emdrhttp://www.emdrinacti on.com/short-videos- introduction-emdr OT and Meds Occupational therapy to address sensory integration issues No known “family” of medications for RAD Medications only used to treat specific issues such as sleep disturbances, anxiety, etc. 29

30 921: Reactive Attachment Disorder: An Overview The Pennsylvania Child Welfare Resource Center Parenting Principles that Promote Attachment 30

31 921: Reactive Attachment Disorder: An Overview The Pennsylvania Child Welfare Resource Center Resource/Adoptive Parents Play a Critical Role in the Healing Process Parenting with warmth and support Disciplining to facilitate trust and safety Collaborating with professionals and engaging in treatment approaches 31

32 921: Reactive Attachment Disorder: An Overview The Pennsylvania Child Welfare Resource Center Parenting Principles: Warmth and Support Acknowledge mixed feelings of child Allow expression of feelings Let child know how much you care Provide clear explanations for visitations and any moves Dispel magical thinking common in young children 32

33 921: Reactive Attachment Disorder: An Overview The Pennsylvania Child Welfare Resource Center Parenting Principles: Warmth and Support “Read” child’s cues to build trust Reframe behaviors as grief/loss Accept regression (feel safe to do so) Allow mingling of scents between households and caregivers, especially for younger children 33

34 921: Reactive Attachment Disorder: An Overview The Pennsylvania Child Welfare Resource Center Parenting Principles: Discipline Supervise, supervise, supervise for prevention Create a low stress environment Routines are KEY; use pictures or words to list sequence of routines 34

35 921: Reactive Attachment Disorder: An Overview The Pennsylvania Child Welfare Resource Center Parenting Principles: Discipline Teach the child calming techniques (slow breathing, movement) and help the child calm down periodically throughout the day to minimize meltdowns Use time IN not time out –Young child on your lap, facing outward –Older children in same room as you –Offer specific praise when child is calm Give the child one concise direction at a time, monitor that it is followed, provide specific praise 35

36 921: Reactive Attachment Disorder: An Overview The Pennsylvania Child Welfare Resource Center Parenting Principles: Collaboration Attend all team meetings to create a network of support Follow guidelines recommended by caseworkers and therapists Strive for consistency in all settings of the child’s life Ensure that any school accommodations are followed Birth parents are key members of the team 36

37 921: Reactive Attachment Disorder: An Overview The Pennsylvania Child Welfare Resource Center What Advice Would You Give These Resource/Adoptive Parents? Divide into small groups and read the case vignette on HO# 8 (Parenting Principles that Promote Attachment) Respond to the following questions : 1)How can these parents collaborate as a team with the child’s caseworker to move treatment toward a focus on attachment and addressing the trauma the child experienced? 2)What principles of parenting would you emphasize in this situation? 3)What discipline approaches would you emphasize? 37

38 921: Reactive Attachment Disorder: An Overview The Pennsylvania Child Welfare Resource Center What’s the #1 Take Away Message for You? Healthy attachment Effects of unhealthy attachment Symptoms, diagnosis and treatment Parenting principles 38

39 921: Reactive Attachment Disorder: An Overview The Pennsylvania Child Welfare Resource Center Useful Websites Adverse Child Experiences Study – The Institute for Attachment and Child Development –www.instituteforattachment.orgwww.instituteforattachment.org National Child Traumatic Stress Network –http://www.nctsn.org/http://www.nctsn.org/ Trauma Center –www.traumacenter.orgwww.traumacenter.org 39

40 921: Reactive Attachment Disorder: An Overview The Pennsylvania Child Welfare Resource Center Additional Readings Cline, F., & Fay, J. (2006). Parenting with Love and Logic. Colorado Springs, CO: NavPress. Perry, B. D., & Szalavitz, M. (2006). The Boy Who Was Raised as a Dog: And Other Stories from a Child Psychiatrist's Notebook: What Traumatized Children Can Teach Us About Loss, Love and Healing. New York: Basic Books. Siegel, D., & Hartzel, M. (2004). Parenting from the Inside Out: How a Deeper Self-Understanding Can Help You Raise Children Who Thrive. NY: Penguin Books. Thomas, N. (1997). When Love Is Not Enough: A Guide to Parenting Children with RAD. Glenwood Springs, CO: Families by Design. 40


Download ppt "An Overview 921: Reactive Attachment Disorder (RAD):"

Similar presentations


Ads by Google