Reactive Attachment Disorder (RAD) and Disinhibited Social Engagement Disorder (DSED)
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The document discusses Reactive Attachment Disorder (RAD) and Disinhibited Social Engagement Disorder (DSED), highlighting their roots in complex trauma and insufficient care, which affect emotional and social behaviors in children. Key features of RAD include withdrawal from caregivers and emotional disturbances, while DSED is characterized by overly familiar behavior with unfamiliar adults. Supportive parenting and environments play a crucial role in helping affected children manage their symptoms and develop healthier attachments.
Reactive Attachment Disorder (RAD) and Disinhibited Social Engagement Disorder (DSED)
- 1. Reactive Attachment Disorder & Disinhibited Social Engagement Disorder Jane F. Gilgun, Ph.D., LICSW School of Social Work University of Minnesota, Twin Cities, USA
- 2. Topics Reactive Attachment Disorder (RAD) Disinhibited Social Engagement Disorder (DSED)
- 3. “disturbances in the regulation of affect/emotion are the core deficits underlying symptomatology related to traumatic responses or attachment disturbances” (Hinshaw-Fuselier et al., 1999, p. 56).
- 4. Disorganized Attachment, RAD & DSED Result from complex trauma Two or more traumatic events that go unattended These children have issues with Attachment Executive function Self-regulation Neurological changes in brain—synapses encode schemas/inner working models
- 5. Children with These Issues Can do well when parents Are emotionally available Give love and set clear rules Affirm behaviors they want children to repeat Give minimal attention to children’s difficult behaviors Ensure safety
- 6. Children with These Issues Can do well when They do not also have fetal alcohol effects, autism, and other co-occurring conditions Parents deal well with their own issues Have good executive function and self-regulation Can manage own traumas well Have emotional and instrumental support Parent support groups Spend time with others who have common interests
- 7. Children with These Issues Can do well when Other people are fair, consistent, loving, and clear in their expectations Extended family members Neighbors Other children Teachers Youth workers Anyone else who has contact with the children
- 8. Reactive Attachment Disorder A. A consistent pattern of inhibited, emotionally withdrawn behavior toward adult caregivers, manifested by both of the following: The child rarely or minimally seeks comfort when distressed. The child rarely or minimally responds to comfort when distressed.
- 9. Reactive Attachment Disorder B. A persistent social or emotional disturbance characterized by at least two of the following: Minimal social and emotional responsiveness to others Limited positive affect
- 10. Reactive Attachment Disorder B. A persistent social or emotional disturbance characterized by at least two of the following: Minimal social and emotional responsiveness to others Limited positive affect Episodes of unexplained irritability, sadness, or fearfulness that are evident even during nonthreatening interactions with adult caregivers.
- 11. Reactive Attachment Disorder C. The child has experienced a pattern of extremes of insufficient care as evidenced by at least one of the following: Social neglect or deprivation in the form of persistent lack of having basic emotional needs for comfort, stimulation, and affection met by caring adults
- 12. Reactive Attachment Disorder Repeated changes of primary caregivers that limit opportunities to form stable attachments (e.g., frequent changes in foster care) Rearing in unusual settings that severely limit opportunities to form selective attachments (e.g., institutions with high child to caregiver ratios)
- 13. Reactive Attachment Disorder D. The care in Criterion C is presumed to be responsible for the disturbed behavior in Criterion A (e.g., the disturbances in Criterion A began following the lack of adequate care in Criterion C). E. The criteria are not met for autism spectrum disorder. F. The disturbance is evident before age 5 years.
- 14. Reactive Attachment Disorder G. The child has a developmental age of at least nine months. Specify if persistent: The disorder has been present for more than 12 months. Specify current severity: Reactive Attachment Disorder is specified as severe when a child exhibits all symptoms of the disorder, with each symptom manifesting at relatively high levels.
- 15. Disinhibited Social Engagement Disorder (DSED0 A. A pattern of behavior in which a child actively approaches and interacts with unfamiliar adults and exhibits at least two of the following: Reduced or absent reticence in approaching and interacting with unfamiliar adults. Overly familiar verbal or physical behavior (that is not consistent with culturally .
- 16. Disinhibited Social Engagement Disorder (DSED) A. A pattern of behavior in which a child actively approaches and interacts with unfamiliar adults and exhibits at least two of the following: Reduced or absent reticence in approaching and interacting with unfamiliar adults. Overly familiar verbal or physical behavior (that is not consistent with culturally sanctioned and with age-appropriate social boundaries).
- 17. Disinhibited Social Engagement Disorder (DSED) 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. B. The behaviors in Criterion A are not limited to impulsivity (as in ADHD) but include socially disinhibited behavior.
- 18. C. The child has experienced a pattern of extremes of insufficient care as evidenced by at least one of the following: Social neglect or deprivation in the form of persistent lack of having basic emotional needs for comfort, stimulation, and affection met by caregiving adults. Repeated changes of primary caregivers that limit opportunities to form stable attachments. Disinhibited Social Engagement Disorder (DSED)
- 19. Disinhibited Social Engagement Disorder (DSED) Rearing in unusual settings that severely limit opportunities to form selective attachments . The care in Criterion C presumed to be responsible for disturbed behavior in Criterion A. The child has a developmental age of at least 9 months.
- 20. RAD & DSED Defining feature: “pathogenic care” Not all children who receive “pathogenic care” have RAD RAD is not Mental retardation Autism Fetal alcohol effects ADHD Conduct Disorder Oppositional Defiant Disorder
- 21. “disturbances in the regulation of affect/emotion are the core deficits underlying symptomatology related to traumatic responses or attachment disturbances” (Hinshaw-Fuselier et al., 1999, p. 56).
- 22. Emotion Regulation Emotion Regulation: Capacities to modulate emotional responses in a range of situations Teach parents and children methods of self-regulation
- 23. References American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author. Gilgun, Jane F. (2011). The NEATS: A Child and Family Assessment. Amazon. Heller, Sherryl Scott, Neil W. Boris, Sarah Hinshaw Fuselier, Timoty Page, Nina Koren-Karie, & Devi Miron (2006). Reactive attachment disorder in maltreated twins follow-up: From 18 months to 8 years. Attachment & Human Development, 8(1), 63-86. Hinshaw-Fuselier, S., Boris, N. W., & Zeanah, C. Z. (1999). Reactive attachment disorder in maltreated twins. Infant Mental Health Journal, 20, 42 – 59.