Reactive Attachment Disorder
Connection, according to Curt Thompson (2010), is the most crucial determinant of our long-term welfare. The degree to which we are attached to significant others in our lives, affects not only our interpersonal dynamics throughout life, but impacts our neural networks as well as those of our children (Thompson, 2010). This attachment begins during the first moment of life, and is nurtured and shaped by a child’s relationship with his or her parents, or lack thereof.
Bowlby’s (1969) foundational work on attachment explored the formation of a “secure base” in children through healthy attachment with their parents. This attachment allows those children to explore their world with confidence and security. Ainsworth (1978) built on Bowlby’s foundation, exploring behaviors and attitudes associated with different attachment patterns (Thompson, 2010). Recently, a team of Harvard researchers reinforced the importance of secure attachment with their work on how attachment shapes the architecture of the developing brain (Center on the Developing Child at Harvard University, 2011). They describe the architecture of the brain as being composed of highly integrated sets of connections among brain cells. These neural circuits are “wired” under the influences of both genetics and the environment of experiences, relationships, and physical conditions in which children live. Experiences “authorize” genetic instructions to be carried out and shape the formation of the circuits as they are being constructed. The progression of developmental depends on appropriate sensory input and stable, responsive relationships to build healthy brain architecture. Extensive biological and developmental research over the past 30 years has shown that young children who experience severe neglect suffer long-term effects. These effects include cognitive delays, impairments in executive functioning, and disruptions of the body’s stress response (Bruce, Fisher, Pears, & Levine, 2009; Pollak, Cicchetti, Hornung, & Reed, 2000). When chronic deprivation leads to persistent activation of stress response systems in a young child, it can actually disrupt and weaken developing brain architecture. Over time, the wear and tear of this excessive stress response and the chemicals it releases can lead to academic struggles, difficulties in social adjustment, mental health problems, and even chronic physical disease (Egeland, Sroufe, & Erickson, 1983).
Reactive Attachment Disorder (RAD) in the DSM-V
Reactive Attachment Disorder (RAD), as described in the DSM-V (American Psychiatric Association, 2013), is typified by a consistent pattern of inhibited, emotionally withdrawn behavior toward adult caregivers, in which the child 1) rarely seeks or responds to comfort when distressed, 2) shows minimal social responsiveness or positive affect, and 3) has unexplained episodes of irritability, sadness or fearfulness. According to DSM-V (APA, 2013), the contributing factors to...