Running head: CASE STUDY: REACTIVE ATTACHMENT DISORDER

Case Study: Reactive Attachment Disorder

Kristen D. Kincaid, Mariana E. Hall, Susan C. Kaiser and Emily M. Severance
Touro University Nevada

Case Study: Reactive Attachment Disorder

CASE STUDY: REACTIVE ATTACHMENT DISORDER

Daniel is an 8-year-old boy diagnosed with reactive attachment disorder (RAD), who
lives with his adoptive parents. His mother, Lisa, is 35 years old and his father, David, is 30 years
old. Both parents are active in the Church of Latter Day Saints, incorporating aspects of the
Mormon faith into their home life (L.B. Roth, Personal Communication, November 11, 2013).
Daniels adoptive mother is a stay-at-home mom and his adoptive father works part-time while
attending college. Daniel also resides with his three adopted siblings: Sammy, age 4; Connor,
also age 4; Abby, age 3; and one foster sibling, Troy, age 1. Abby and Troy are biological siblings
and the family is currently in the process of adopting Troy to make him a permanent part of their
family (L.B. Roth, Personal Communication, November 11, 2013). Daniel is Hispanic, his
siblings have multi-ethnic backgrounds (African American, Pacific Islander, and Caucasian), and
his adoptive parents are Caucasian. Daniel loves playing on an organized soccer team, riding his
bicycle, and sleeping over at his friends houses.
Daniel was diagnosed at age five with the inhibited subset of reactive attachment disorder
(RAD) by a private psychologist (L.B. Roth, personal communication, November 11, 2013).
According to the fourth edition, text revised copy of the Diagnostic and Statistical Manual of
Mental Disorders (DSM IV), reactive attachment disorder is extremely uncommon, but it does
not report a specific prevalence rate (4th ed., text rev.; DSMIVTR; American Psychiatric
Association, 2000). However, according to the Encyclopedia of Mental Health, professionals
believe that reactive attachment disorder is experienced by 1% of all children (Sadock, B., 2009).
Daniel also currently shows symptoms of ADHD and an unspecified mood disorder, but has not
yet been formally diagnosed for either condition (L.B. Roth, Personal Communication,
November 11, 2013). Daniels behavior has improved greatly the past few years; however, he
still experiences severe outbursts of anger directed toward his peers and his parents. Daniel also

CASE STUDY: REACTIVE ATTACHMENT DISORDER

experiences panic attacks when he becomes concerned that he will be separated from his
adoptive mother or adoptive family. He is currently repeating the second grade due to difficulties
with reading and reading comprehension (L.B. Roth, Personal Communication, November 11,
2013).
To be diagnosed with RAD, a child must demonstrate developmentally inappropriate
social relatedness in most social interactions before the age of five. There are two subtypes of
RAD, disinhibited and inhibited. The disinhibited subtype is characterized by indiscriminate
sociability coupled with an inability to selectively attach to proper caregivers (an extreme
fondness of strangers is demonstrated). Daniel has been diagnosed with the inhibited subtype of
RAD, which is characterized by the childs participation in inappropriate social interactions. The
child may be excessively inhibited, hypervigilant, or highly ambivalent. In addition, their
responses may seem contradictory at times. Some children with RAD show a mixture of
approach, avoidance, resistance to comforting, and/or frozen watchfulness.
For a RAD diagnosis, the symptoms listed cannot be attributed to a developmental delay.
A history of pathogenic care, characterized by at least one of the following, is required for
diagnosis: persistent disregard of the childs basic emotional needs for comfort, stimulation, and
affection; and/or persistent disregard of the childs basic physical needs; and/or repeated changes
of a primary caregiver that prevents the formation of stable attachments. (4th ed., text rev.;
DSMIVTR; American Psychiatric Association, 2000). In Daniels case, he experienced all
three. In his first year of life, he was locked in a dirty room and unattended with just a television
for company. His daily meal consisted of cereal scattered across the room. His diaper was rarely
changed and he slept on the floor. His eighteen-year-old sister reported the situation to Child
Protective Services, and at age 1, he was removed from his biological mothers care and placed

CASE STUDY: REACTIVE ATTACHMENT DISORDER

with his biological uncle, who also severely abused him. Daniel was denied food and forced to
watch his uncle eat. The uncle often spit in Daniels face and tugged on his ear, eventually
causing disfigurement of the surrounding cartilage. His uncle also forcefully twisted his arm,
causing multiple fractures that were never attended to by a physician, therefore healing
improperly. Daniel entered the foster system at age 2, transitioning through seven foster homes
within six months due to the foster parents inability to control his aggressive and violent
behavior. At age 3, Daniel was placed in his current home and was formally adopted at age five
(L.B. Roth, Personal Communication, November 11, 2013).
Research suggests that extreme pathogenic care can lead to RAD, which will usually
present symptoms by age 5. The caregiver will often notice (by the childs first birthday) that he
or she has difficulty with emotional attachment. Some symptoms an infant or child with RAD
may present are: severe colic and/or feeding difficulties, failure to gain weight, detached and
unresponsive behavior, difficulty being comforted, preoccupied and/or defiant behavior,
inhibition or hesitancy in social interactions, or inappropriate familiarity or closeness with
strangers (Fontenot, J., 2011).
Daniel's adoptive family is currently of a lower socioeconomic status; however, they do
receive assistance from several sources, including their church. Other resources utilized by the
family include Medicaid and counseling services through the State of Nevadas Early Childhood
program. Daniel has an Individualized Educational Plan (IEP) through the Clark County School
District, which allows him to receive additional help that focuses on reading and behavior.
Daniels adoptive mother and father are concerned with his lack of reading
comprehension, but are also very worried about Daniels anger outbursts and his tendency to
defy authority. He sometimes displays an inability or refusal to take direction from authoritative

CASE STUDY: REACTIVE ATTACHMENT DISORDER

figures, kicking walls and doors when asked to partake in an activity or task (especially when
asked to help with chores). His anger outbursts are not only directed toward his parents and
figures of authority, but toward his peers and siblings, as well. His adoptive parents are also
concerned about Daniels low self-esteem and report that he often says things such as, I am
stupid and, nobody likes me. Currently, Daniel attends therapy through the counseling
services provided by the State of Nevadas Early Childhood Program, and was recently
prescribed Risperdal, an antipsychotic medication, to help control his anger. However, his
mother has not yet noticed a difference in Daniels behavior (L.B., Personal Communication,
November 11, 2013). Lisa and Davids main priorities are more focused on the betterment of his
sudden outbursts (emotional regulation) and his self-esteem.
Daniels adoptive mother keeps him on a strict daily schedule to eliminate a great
variability in their routine, which decreases the frequency of his anger outbursts and behavioral
problems. Daniel usually wakes up at 7:00 a.m., gets dressed, and makes his bed. Breakfast is
served at 7:30 a.m., and at 8:15 a.m., the family reads scriptures and prays together. Daniel goes
to school from 8:30 a.m. until 3:00 p.m., when he comes home and has a snack. He does home
chores at 4:00 p.m. and homework at 5:00 p.m. Dinner is served at 6:00 p.m. and then he has
playtime. At 7:00 p.m., the children have showers and baths, and at 7:30 p.m., they are allowed
to watch cartoons. The family has prayer at 8:00 p.m. and the children go to sleep at 8:15 p.m.
(L.B., Personal Communication, November 11, 2013). Every Tuesday Daniel goes to Boy
Scouts, on Saturday mornings he plays soccer, and on Sundays, he goes to church. He also
spends time playing with two boys from his neighborhood that are similar in age.
There are many cultural considerations when working with Daniel and his adoptive
family. It is important to be sensitive to the multi-ethnic composition of the family, as the family

CASE STUDY: REACTIVE ATTACHMENT DISORDER

strives to maintain the individual traditions of each of their childrens ethnic background.
Therefore, the occupational therapist needs to be aware of traditions in the Hispanic culture, as
well as the other cultures that his parents and siblings identify with. The faith of Daniels
adoptive family also plays an important role in any potential occupational therapy that Daniel
receives because they integrate aspects of their faith into their daily routine.
An assessment for RAD takes place over a minimum of two to three visits with a child
that is under five years of age. The assessment includes evidence obtained directly from repeated
observations of the child interacting with his primary caregivers and unfamiliar adults.
Observations take place through episodes of play, teaching, and separation/reunion. Focus is
generally placed on the quality of the caregiver-child interactions, as well as how the child
interacts with the discriminated attachment figure compared to a stranger. Next, whenever
available, the assessment needs to include a history of the childs attachment behavior with the
caregivers. Furthermore, a comprehensive history of the childs early caregiving environment is
documented with input from pediatricians, teachers, or caseworkers who are familiar with the
child. An example of an assessment (Using J.Am, 2005) is outlined in Table 1.

CASE STUDY: REACTIVE ATTACHMENT DISORDER

Clinical Observation of Attachment (Table 1)
Episode

The clinician observes parentchild free play. Note especially familiarity, comfort, and

minutes

warmth in the child as he/she interacts with attachment gure.

Episode

The clinician talks with, then approaches, then attempts to engage the child in play. Most

minutes

young children exhibit some reticence, especially initially, about engaging with an
unfamiliar adult

Episode

The clinician picks up child and shows him/her a picture on the wall or looks out window

minutes

with the child. This increases the stress for the child. Again, note the childs comfort and
familiarity with this stranger.

Episode

The caregiver picks up the child and shows him/her a picture on the wall or looks out

minutes

window with the child. In contrast to stranger pick up, the child should feel obviously more
comfortable during this activity

Episode

The child is placed between the caregiver and a stranger, and a novel (e.g., scary/exciting)

4a

minute

remote control toy is introduced. The child should seek comfort preferentially from parent.
If interested rather than frightened, the child should share positive affect with parent.

Episode

The clinician leaves the room. This separation should not elicit much of a reaction in the

minutes

child because the clinician is a stranger

Episode

The clinician returns. Similarly, the child should not be much affected by the strangers

minute

return

Episode

The caregiver leaves the room. The child should denitely take notice of caregivers

minutes

departure, although not necessarily exhibit obvious distress. If the child is distressed, then
the clinician should be little comfort to the child.

Episode

The caregiver returns. The childs reunion behavior with the caregiver should be congruent

minute

with separation behavior. That is, distressed children should seek comfort and nondistressed
children should re-engage positively with the caregiver by introducing them to a toy or
activity or talking with them about what occurred during the separation.

Beyond observation and the history of the child, the assessment should also include
formal psychological testing to assess both primary and comorbid disorders. Recommended for
this task are the Child Behavior Checklist and the Behavioral Assessment Scale for Children
(Walker, T., 2009). In addition, a trauma screen and PTSD assessment may be useful. For

CASE STUDY: REACTIVE ATTACHMENT DISORDER

children ages 3 to 12, the Trauma System Checklist for Young Children can be used, while older
children ages 8 to 17 should be assessed with the Trauma Symptom Checklist for Children
(Using J.Am, 2005). Furthermore, formal assessments of the parents should also be completed.
One in particular, the Parenting Stress Index, helps to assess the parents level of stress in the
relationship with the child (Walker, T., 2009).
The majority of Daniels waking hours are spent at home and at school. Therefore, these
should be the focus environments of the intervention. RAD is affecting Daniels occupational
performance across several areas including: academic performance, social interactions with
family and peers, and emotional regulation. As previously discussed, his academic performance
has been compromised due to his lack of reading comprehension. Daniel does experience an
outburst of anger when playing with his friends if they arent getting along. Emotional regulation
is the biggest aspect of Daniels life that is disrupted by his disorder. Getting him to participate in
chores has proven to be a very hard task for his adoptive parents. After learning what is affecting
Daniels occupational performance, and assessing the priorities and concerns Daniels parents
have for him, the focus for intervention should center on completion of his daily chores,
outbursts of anger, panic attacks, and underlying low self-esteem.
The Model of Human Occupations (MOHO) focuses on an individuals occupations, and
will guide interventions with Daniel and his caregivers. MOHO can also assist in developing a
sense of competence and identity. MOHO can help an occupational therapist support client
engagement in occupations in order to shape the clients choices, their routine ways of doing
things, and their skills (Forsyth, K., 2014).
MOHO understands an individual through three interacting elements. The first element is
volition, which refers to the process of how people are motivated in choosing activities they

CASE STUDY: REACTIVE ATTACHMENT DISORDER

engage in. It consists of three subgroups including personal causation. This refers to an
individuals thoughts and beliefs about how effective they are in performing everyday activities,
as well as their values and interests (Forsyth, K., 2014). Daniel has low efficacy in regards to his
intelligence and his social interactions, frequently stating that he is stupid and that no one likes
him. His beliefs about himself are shaped by his past experiences and are likely a direct effect of
his abusive infancy. Daniel experiences frustrations with his performances, which contribute to
his low self-esteem and lead to outbursts of anger.
Another element of MOHO is habituation, the process of how an individual organizes
their actions into patterns and routines. Two subgroups of this element are habits and roles.
(Forsyth, K., 2014). Daniel has many negative habits related to his RAD that affect his
occupational performance (as seen through his violent anger outbursts). He also has a habit of
following a negative internal script when he doesnt succeed at something, telling himself that he
isnt good enough. Daniels roles are that of a student, Boy Scout, soccer player, son, and brother.
His mother believes that Daniel has difficulty accepting his role as a son. This is likely due to the
abuse and instability Daniel experienced early in life. The constant switching of homes and
inadequate care have affected Daniels ability to bond easily and/or trust (L.B. Roth, Personal
Communication, November 11, 2013). The final element of MOHO is performance capacity,
which refers to a persons underlying mental and physical abilities and how they are used and
experienced.
MOHO also acknowledges that when engaged in an occupation, a persons characteristics
and their environment are linked together. Environment is a very important consideration when
understanding Daniel as a client. The environment that Daniel experienced when he was younger
was one of neglect, abuse, and instability. His early environment played a pivotal role in his

CASE STUDY: REACTIVE ATTACHMENT DISORDER

10

diagnosis of RAD and his current deficits in his occupational performance. MOHO also views
occupation as the dynamic process of input, throughput, output, and feedback. In the case of his
early neglect, Daniel may have taken in the input of his neglect and abuse, determined that he
wasnt worth love and care (throughput), and stopped trying to seek or bond with a caregiver
(output), thus leading him to feel that he wont get hurt again if he doesnt let people get close to
him (feedback) (Forsyth, K. 2014). Through interventions, an occupational therapist will try to
create opportunities to present Daniel with positive feedback.
The interventions used with Daniel will focus on creating positive interactions between
him and his adoptive mother, Lisa. The goals include building a secure attachment between
them, addressing behavioral problems, and building a healthier self-esteem within Daniel. Three
psychotherapeutic modalities are available to help children with RAD and their caregivers
interact positively: working through the caregiver, working on the caregiver-child relationship,
and working alone with the child (Using J.Am, 2005).
In the first modality, the occupational therapist works directly with Lisa. Caring for a
child with behavioral and emotional difficulties can be taxing on the caregiver; therefore, the
occupational therapist could administer the Parenting Stress Index to assess Lisa. The therapist
could then use a cognitive behavioral frame of reference to address the caregivers own feelings
of anxiety, frustration, and anger (if needed), and offer new contexts in which to understand
Daniels behavior. If Lisa can separate Daniels outward behaviors (output) from his internal
thoughts (throughput), she would be better equipped to handle his behaviors while providing a
secure, consistent, and trustworthy environment. Working with a caregiver may be difficult until
the caregivers personal stress, anger, or negative perceptions are addressed (Using J.Am,
2005). The OT could also educate Lisa on ways to manage Daniels behavioral problems. An

CASE STUDY: REACTIVE ATTACHMENT DISORDER

11

important advantage to using this modality is that it sends the message that the caregiver is
capable of managing the child herself, without having to seek outside help.
The second modality focuses on the caregiver-child relationship and consists of two
models: infant-parent psychotherapy and interaction guidance. Neither model has been formally
researched with RAD, but they have been used (and evaluated) in children who experience
disturbed attachment relationships. The subsequent interventions will use interaction guidance
along with the behavioral frame of reference. When Lisa and Daniel interact, the focus of the
interventions will be to reward positive behaviors of both the caregiver and the child; ignoring
the negative behaviors. The occupational therapist will observe and videotape (if possible)
interactions between Daniel and Lisa. The occupational therapist will then use suggestions and
positive reinforcements to alter Lisas responses to Daniel. Lisa will also offer positive
reinforcement to Daniel. The goal will be to increase caregiver-child engagement. Furthermore,
once trust has been established between Lisa and the therapist, the therapist can point out
moments where the caregiver may be frustrated or disengaged. After progress is made in this
area, the intervention modality can be widened to include all family members and Daniels
teacher at school (Using J.Am, 2005).
The third modality works with the child alone. This is generally not the preferred
treatment with RAD because the goals are usually directed at improving a childs social
processing and interactive behaviors. However, individual therapy may be useful when focusing
on behaviors that interfere with the dyadic therapy (Using J.Am, 2005). According to research,
two types of therapy are particularly well-supported and efficacious when working with children
with RAD. The first, Parent-Child Interaction Therapy, is shown to increase parenting skills, the
parent-child relationship, and decrease externalizing behaviors. It is appropriate for ages 4 to 12.

CASE STUDY: REACTIVE ATTACHMENT DISORDER

12

The second, Trauma-Focused Cognitive Behavior Therapy, is shown to decrease symptoms of

PTSD, depression, anxiety, externalizing behaviors, feelings of shame and mistrust, and to
increase parenting skills (Walker, T., 2009).
To promote a higher level of functioning within the priorities specified by Daniels
parents, various activities will be used. First, an activity calendar will be implemented to foster
positive interactions between Daniel and Lisa during chore time. It will also aim to promote
Daniels role as a brother and son, and will increase Daniels understanding that when he
monitors his emotions, he will be rewarded. Every day that Daniel does his chores when asked
and without a meltdown, he will be awarded one sticker. He can then choose the sticker he wants
and place it on the correct day on the calendar. If Daniel experiences an uncontrolled anger
outburst, he will not gain a sticker for that day. When Daniel has been awarded six stickers, he
earns a sleepover with his two best friends (an activity that he thoroughly enjoys). The goal is to
keep the environment safe and loving for Daniel, while also helping him identify the connection
between choices and consequences.
The next part of intervention will focus on teaching Daniel calming and coping activities,
practicing the techniques, and then putting them into action whenever he feels his anger building.
The goal is to interrupt the negative behavior before it creates an outburst. In doing so, it will
help dissolve the disrupting habit that Daniel has of acting out his anger physically and will
replace it with a more positive/functional habit that can improve his emotion regulation.
Activities that will be used to work through his anger are removing himself from the situation
and going outside to ride his bicycle, or play with his soccer ball. The goal is to replace Daniels
anger with a physical activity that brings him joy. The occupational therapist will also educate
Lisa to remind Daniel to use his anger coping activities, and will let him have his space when she

CASE STUDY: REACTIVE ATTACHMENT DISORDER

13

senses his emotions are getting the best of him. This will help foster good interactions between
Lisa and Daniel and will reduce the negative feelings that both Lisa and Daniel experience.
Whenever Daniel removes himself and copes with his anger, Lisa will verbally reward his
behavior and tell him how proud his actions make her.
The interventions used must also address Daniels panic attacks. One step is to establish a
healthy bond between Daniel and his family. The occupational therapist will set up an activity
that both parties enjoy, such as a puzzle, that is intentionally slightly beyond Daniels cognitive
abilities. Then Daniel and Lisa will work together on the puzzle. The goal is to encourage
Daniels trust of Lisa and to provide input to Daniel that she will be there for help whenever
needed. When Daniel looks to Lisa for help, he will be rewarded with a smile and assistance.
Another step that the family has already taken to reduce Daniels anxiety is to stop fostering new
children. When the family would foster additional children, it was always temporary, and
eventually the children would leave. This caused Daniel a great deal of stress and anxiety, as he
was always worried that he too would be taken away.
Finally, Daniels self-esteem needs to be improved. One of Daniels strengths is that he
has massive amounts of energy and enjoys physical activities. Daniel will therefore continue to
play on an organized soccer team. The engagement in one of his favorite activities will provide
positive feedback. In addition, it will give him opportunities to use his anger coping strategies
while engaged in peer play. Furthermore, his parents will provide positive reinforcement for his
efforts in sports and his positive peer interactions. A habit that will be significant to Daniel is a
weekly outing with one of his adopted parents. With four younger children in the house, Daniel
needs one-on-one interaction to help him create a healthy attachment to his caregivers. The
interactions should be based on activities that Daniel enjoys and that highlight his strengths as an

CASE STUDY: REACTIVE ATTACHMENT DISORDER

14

active young boy. Possible activities include swimming, playing soccer, or riding bikes at the
park. As Daniel receives positive input from his success at sports and private time with
caregivers, the intervention aims to change his throughput so he can produce more acceptable
behavior (output) and believe that it is safe to form lasting attachments (feedback).
In conclusion, there are many opportunities for an occupational therapist to work with
Daniel to enhance his occupational performance (and overall experience) in school and at home.
By eventually eliminating his sudden outbursts of rage, increasing his self-esteem, and
promoting a healthy attachment between him and his adoptive mother, Daniel will be able to
trust those around him. He will also be able to successfully complete his daily chores without
negative interruptions (previously caused by his outbursts). Working with Lisa and focusing on
her personal stress and specific interactions with Daniel will further develop a positive motherson attachment. As time goes on, Daniels anger outbursts will become less frequent and will no
longer hinder him in completing vital occupations that enhance his quality of life and selfconcept.

Appendix Fact Sheet

Reactive Attachment Disorder (RAD) is defined as having a developmentally
inappropriate social relatedness for ones age (4th ed., text rev.; DSMIVTR; American
Psychiatric Association, 2000). The onset of this disorder occurs in infancy and/or early

CASE STUDY: REACTIVE ATTACHMENT DISORDER

15

childhood, and is thought to be caused by extreme pathogenic care. Pathogenic care is defined as
the disregard for the childs basic emotional needs, often depriving the child of physical touch,
affection, and comfort. There are two subtypes of RAD: the Inhibited Type (in which the child
cannot initiate nor engage in most social interactions appropriately) and the Disinhibited Type
(which is displayed through the childs lack of selectivity in regards to attachment figures) In
terms of prevalence, RAD is very uncommon (4th ed., text rev.; DSMIVTR; American
Psychiatric Association, 2000). According to the Encyclopedia of Mental Disorders, it is
estimated that 1% of all children under five years of age experience RAD (Sadock, B., 2009).
The areas of major occupational deficits are seen in the childs interactions with others in
both the school environment and the home setting. Young children who experience RAD
sometimes have the inability to learn from their mistakes and they may display cruel behavior
and impulsiveness (Sadock, B., 2009). Not interacting with others successfully can mean a
decrease in daily occupational performance. Furthermore, many children with RAD are plagued
with the disruption of their own anger outbursts. Such outbursts not only disrupt the activity the
child was working on, but also impact the attachment of relationships that involve the child.
There are three occupational therapy treatment options available to help children with
RAD and their caregivers interact positively: working through the caregiver, working on the
caregiver-child relationship, and working alone with the child (Using J.Am, 2005).
Incorporating the caregiver into the intervention plan will help develop and strengthen the
attachment between the child with RAD and his/her primary caregiver; however, working with
the caregiver alone (on stress management and coping strategies) and the child alone (helping to
positively reinforce behavior) are also beneficial. All intervention plans for a child that
experiences RAD focus on developing and strengthening the attachment between the child and
caregiver, and increasing the childs overall self-esteem and self-concept.
Parents, teachers and caregivers can find additional information at the following website:
www.helpguide.org/mental/parenting_bonding_reactive_attachment_disorder.htm.

References
American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders
(4th ed., text rev.). doi:10.1176/appi.books.9780890423349

CASE STUDY: REACTIVE ATTACHMENT DISORDER

16

Fontenot, J., (2011, March 18). Reactive attachment disorder. Retrieved from
http://www.aacap.org/AACAP/Families_and_Youth/Facts_for_Families/Facts_for_Famili
es_Pages/Reactive_Attachment_Disorder_85.aspx
Forsyth, K., Taylor, R.R., Kramer, J.M., Prior, S., Ritchie, L., Whitehead, J., Owen, C., Melton,
J. (2014) In B. A. B Schell, G. Gillen, & M.E. Scaffa (Eds). Willard and Spackmans
occupational therapy (12th ed. pp. 505-508). Philadelphia: Lippincott: Williams &
Wilkins.
Practice parameter for the assessment and treatment of children and adolescents with reactive
attachment disorder of infancy and early childhood. Journal of American Academy of
Child Adolescent Psychiatry, 2005; 44(11), 12061219.
Sadock, B. (2009, April 11). Reactive attachment disorder of infancy or early
childhood. Retrieved from http://www.minddisorders.com/Py-Z/Reactive-attachmentdisorder -of-infancy-or-early-childhood.html
Walker, T. (2009, November 4). Reactive attachment disorder guidelines. Retrieved from
http://www.pbhcare.org/pubdocs/upload/documents/radguidelines2009.pdf

Appropriate Website for Parents:

http://www.helpguide.org/mental/parenting_bonding_reactive_attachment_disorder.htm

Research Article:

CASE STUDY: REACTIVE ATTACHMENT DISORDER

Practice parameter for the Assessment and Treatment of children and adolescents with reactive
attachment disorder of infancy and early childhood. J. Am. Acd. Child Adolesc.
Psychiatry, 2005;44(11):12061219.

Multiple Choice Questions:

1. Reactive attachment disorder is
a. Diagnosed using the RAD assessment
b. Assumed to be present in all children in the foster system
c. Prevalent in roughly 10 % of children
d. Prevalent in under 1 % of the population
2. Reactive attachment disorder is not characterized by
a. Ambivalence
b. Inappropriate social interactions
c. Excessive inhibition
d. Pathological lying
e. Excessive familiarity with strangers
3. A diagnosis of reactive attachment disorder requires
a. A history of pathogenic care
b. A developmental delay
c. Co-morbid diagnosis of ADHD
d. All of the above
e. A and C

17