Reactive attachment disorder (RAD), a disorder marked by a severe disruption in developmental attachment, is most often diagnosed in youth who have received substandard or negligent care from their primary caregiver. Such youth have increased risk of behavioral and emotional issues as well as future relationship problems; they generally do not respond to traditional evidence-based practices of therapy. The present study examined the use of the biofield energy practice of Healing Touch (HT) as a viable therapeutic option for improved quality of life for youth diagnosed with RAD. A quantitative, quasi-experimental research study using secondary data was conducted. Eligible participants were 40 children between the ages of 6and 21 residing at a residential facility and having the diagnosis of RAD. Half of the participants received HT therapy while the other half did not. Dependent variables of frequencies of seclusion, aggression, self-injury/self-harm, property damage in excess of $50, and running away from the facility were assessed at set intervals before and after implementation of HT therapy. Findings from a 2 x 2 mixed factorial design using mixed ANOVAs lacked statistical significance; therefore, the alternative hypotheses were not supported. However, the potential remains for positive social change. Clinical importance was evidenced in several variables demonstrating improvement in behaviors for many participants. In addition, while statistical significance was not obtained, the study contributes to the knowledge base regarding the use of HT therapy for future studies.

Common diagnoses have greater emphasis in the Master of Social Work (MSW) Program, yet there is an oversight on other disorders that are just as important to address, such as Reactive Attachment Disorders (RAD). Although researchers have determined a need for additional training and education on RAD, none have measured MSW students’ level of knowledge on RAD and whether or not it influences their perceived preparedness. The purpose of this study was to analyze the perceived preparedness of MSW students to serve children with RAD before and after participating in an educational training. The study consisted of an explanatory quantitative design using pre/post self-administered surveys and an educational training on RAD. Findings determined that participating in the RAD Training significantly increased MSW students’ knowledge and perceived preparedness to serve children with RAD. The study’s findings may influence MSW administration to recognize the significance of implementing additional training on rare disorders.

Reactive attachment disorder (RAD) is characterised by severely underdeveloped or absent attachment between a child and a caregiver. Adopted children who have experienced adverse early experiences prior to adoption may have lacked opportunities to form selective attachment relationships and, in rare cases, may have a diagnosis of reactive attachment disorder. The needs of adoptive families rearing children with special needs, such as children with a RAD diagnosis, are unique and it is crucial to understand the experiences of the families in order to increase the understanding of how to provide support and adequate services and interventions that respond to the needs of the families. Previous research focusing on adoptive parents’ experiences rearing children with a RAD diagnosis is scarce. Therefore, this systematic literature review aimed to explore their experiences. After a comprehensive literature search, seven articles that addressed the study aim and met the predefined inclusion criteria were included. A thematic synthesis was carried out to combine the results of the included articles. The findings suggest that adoptive families rearing children with a RAD diagnosis experience a wide range of challenges in their everyday lives, such as a lack of social network support and adequate support, services and interventions from professionals and service providers. Some facilitative factors, such as adoptive parents’ willingness to stay committed to their children, were found. Further research is needed to find out effective interventions to address the complex challenges adoptive families and their children with a RAD diagnosis experience. Study limitations and methodological considerations are discussed.

Abstract : The diagnostic criteria for Reactive Attachment Disorder (RAD) have remained fairly constant over the last few decades. However, the most recent change in the fifth version of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5; American Psychiatry Association; APA, 2013) is fairly significant, as the inhibited and disinhibited types of RAD that were found in the previous versions of the manual have been removed. RAD has been replaced with a definition that resembles in some ways the previous inhibited type. Diagnosed in early childhood, this disorder interferes with the child’s ability to form secure relationships with their attachment figures and others. One of the criteria that remain constant is that deprivation in the quality of early care is a risk factor for developing RAD. Although physical abuse and extreme neglect may be easier to identify, emotional neglect is more challenging as a variable to understand. There has been less research on RAD regarding the subtle interactions between mother and child. The theory of mentalization explores some of the complications that arise in attachment and relationships to others that are aggravated by neglect, abuse, and trauma (Bateman & Fonagy 2004). The infant relies on the sensitive attunement and capacity to mentalize of the primary caregiver to help him understand what he is experiencing. The first article uses mentalization and object relations theory applied to children with RAD, in order to facilitate an understanding of these children psychologically as well as certain aspects of the relationship with their mothers. The second article presents two case studies of mother-child dyads of children who have been diagnosed with RAD. The mother and child were evaluated with instruments that provided information regarding the mother’s capacity to mentalize and the child’s attachment representations. The objective of the case studies were meant to reveal how these instruments could be utilized for the specific scores, but also to illustrate what is transpiring psychologically in the relationship between mother and child. The capacity to mentalize of the mothers was measured with the Addendum to Reflective Functioning Scoring Manual (Fonagy, Steele, Steele, & Target, 1998) applied to the Parent Development Interview-Revised (PDI-R; Slade, Aber, Berger, Bresgi, & Kaplan, 2005). The results of the mother’s scores for mentalization were in the low and questionable range. The attachment representations of the children were evaluated through the use of the Attachment Focused Coding System (AFCS; Reiner & Splaun, 2008) applied to the Attachment Story Completion Task (ASCT; Bretherton, Ridgeway, & Cassidy, 1990). The results of the instrument revealed that the two children with RAD (inhibited and disinhibited type) had lowered scores for Supportive Mother and a tendency for Avoidant Attachment Behaviour and Communication. The notions of mentalization and attachment representations were shown to provide a more profound understanding of the mother and child dyad. These evaluation methods support considering a larger study to explore the link between the mother’s capacity to mentalize and the child’s attachment representations in children diagnosed with RAD. / Résumé : Les critères diagnostiques du trouble réactionnel de l'attachement (TRA) sont demeurés relativement stables au cours des dernières décennies. Toutefois, la cinquième version du Manuel diagnostique et statistique des troubles mentaux (DSM-5; American Psychiatric Association; APA, 2013) propose un seul type de TRA, qui correspond au type inhibé de la quatrième version révisée (DSM-IV-TR; APA, 2000), au lieu de distinguer entre deux types, soit inhibé et désinhibé. Diagnostiqué dans la petite enfance, le TRA interfère avec la capacité de l'enfant à former des relations sécurisantes avec ses principales figures d'attachement qui demeure un des critères diagnostiques et un facteur de risque pour le développement du TRA. Bien que l’abus physique et la négligence extrême soient plus faciles à identifier, la négligence au plan affectif est plus subtile et difficile à comprendre. Peu de recherches portent sur les interactions subtiles entre les mères et les enfants ayant reçu un diagnostic de TRA. La notion de mentalisation explore les complications qui peuvent survenir dans la relation aux principales figures d’attachement et dans les interactions sociales dans un contexte d’abus et de négligence (Bateman & Fonagy 2004). Pour être en mesure de comprendre ce qu’il vit, l'enfant nécessite des figures d’attachement sensibles et capables de mentaliser. Dans le premier article, les théories relatives aux notions de mentalisation et des relations d’objet sont utilisées pour comprendre le fonctionnement psychologique des enfants et la relation qu’ils entretiennent avec leurs mères chez des jeunes présentant un diagnostic de TRA. Dans le second article, deux études de cas de dyades mère-enfant ou l’enfant a reçu un diagnostique de RAD sont présentés. Les études de cas avaient pour objectif d’illustrer que les notions de mentalisation et de représentation d’attachement ainsi que les instruments permettant de les mesurer pourraient être utilisé pour approfondir ce qui passe entre la mère et l’enfant aux plans psychologique et relationnel. La capacité de mentalisation des mères participant à l’étude a été mesurée à l’aide de l'Échelle du fonctionnement réflexif (Addendum to Reflective Functioning Scoring Manual; Fonagy et al., 1998) appliquée à l’Entrevue sur le développement du parent (Parent Development Interview-Revised; PDI-R; Slade et al., 2005). Les résultats de la capacité de mentalisation des mères se situent dans les catégories faible ou questionnable. Les représentations d'attachement des enfants ont été évaluées en utilisant le Système de cotation centré sur l’attachement (Attachment Focused Coding System. (AFCS; Reiner & Splaun, 2008) appliqué aux Histoires d’attachement à compléter (Attachment Story Completion Task, ASCT; Bretherton, Ridgeway, & Cassidy, 1990). Les enfants participant à l’étude, ayant respectivement un TRA de type inhibé et désinhibé, ont obtenus des scores faibles dans les échelles Mère soutenante et Évitement des comportements et des communications relatifs à l’attachement. La théorie et la recherche concernant la notion de mentalisation permettent de mieux comprendre les difficultés rencontrées chez les dyades mère-enfant dont les jeunes présentent un diagnostic de TRA. Les notions de mentalisation et de représentations d’attachement ont permis d’approfondir la compréhension des dyades mère-enfant. Les méthodes d’évaluation utilisées dans la présente étude pourraient être utilisés pour explorer le lien entre la capacité de mentalisation de la mère et les représentations d'attachement de l'enfant au sein d’un échantillon plus large d’enfants présentant un diagnostic de TRA.

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