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Reactive Attachment Disorder
& Disinhibited Social
Engagement Disorder
Jane F. Gilgun, Ph.D., LICSW
School of Social Work
...
Topics
Reactive Attachment Disorder (RAD)
Disinhibited Social
Engagement Disorder (DSED)
“disturbances in the regulation of
affect/emotion are the core deficits
underlying symptomatology related to
traumatic re...
Disorganized Attachment,
RAD & DSED
Result from complex trauma
Two or more traumatic events that go
unattended
These ch...
Children with These
Issues
Can do well when parents
Are emotionally available
Give love and set clear rules
Affirm beh...
Children with These
Issues
Can do well when
They do not also have fetal alcohol effects,
autism, and other co-occurring ...
Children with These
Issues
Can do well when
Other people are fair, consistent, loving, and clear
in their expectations
...
Reactive Attachment Disorder
A. A consistent pattern of inhibited,
emotionally withdrawn behavior toward
adult caregivers...
Reactive Attachment
Disorder
B. A persistent social or emotional
disturbance characterized by at least
two of the followi...
Reactive Attachment
Disorder
B. A persistent social or emotional
disturbance characterized by at least two
of the followi...
Reactive Attachment
Disorder
C. The child has experienced a pattern of
extremes of insufficient care as evidenced
by at l...
Reactive Attachment
Disorder
Repeated changes of primary caregivers
that limit opportunities to form stable
attachments (...
Reactive Attachment
Disorder
D. The care in Criterion C is presumed to be
responsible for the disturbed behavior in
Crite...
Reactive Attachment
Disorder
G. The child has a developmental age of at
least nine months.
Specify if persistent: The di...
Disinhibited Social
Engagement Disorder
(DSED0
A. A pattern of behavior in which a child
actively approaches and interact...
Disinhibited Social
Engagement Disorder (DSED)
A. A pattern of behavior in which a child
actively approaches and interact...
Disinhibited Social
Engagement Disorder (DSED)
Diminished or absent checking back with adult caregiver
after venturing aw...
 
C. The child has experienced a pattern of
extremes of insufficient care as evidenced by at least
one of the following...
 
Disinhibited Social
Engagement Disorder (DSED)
Rearing in unusual settings that severely limit
opportunities to form se...
RAD & DSED
Defining feature: “pathogenic care”
Not all children who receive “pathogenic care” have
RAD
RAD is not
Ment...
“disturbances in the regulation of
affect/emotion are the core deficits
underlying symptomatology related to
traumatic re...
Emotion Regulation
Emotion Regulation: Capacities to
modulate emotional responses in a
range of situations
Teach parents...
References
 American Psychiatric Association. (2013). Diagnostic and
statistical manual of mental disorders (5th ed.). Wa...
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Reactive Attachment Disorder (RAD) and Disinhibited Social Engagement Disorder (DSED)

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This presentation discusses two types of serious attachment problems that are often found in children who have experienced complex trauma and disorganized attachments with care providers. Children who spent early years in orphanages and children who experienced multiple care providers and complex trauma are at risk for these disorders. The topics covered are reactive attachment disorder (RAD) and the new diagnostic classification which is disinhibited social engagement disorder, which used to be part of RAD. Some children who appear to have RAD and DSED should be evaluated for other issues, such as autism and fetal alcohol effects.

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Reactive Attachment Disorder (RAD) and Disinhibited Social Engagement Disorder (DSED)

  1. 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. 2. Topics Reactive Attachment Disorder (RAD) Disinhibited Social Engagement Disorder (DSED)
  3. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 22. Emotion Regulation Emotion Regulation: Capacities to modulate emotional responses in a range of situations Teach parents and children methods of self-regulation
  23. 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.
  • JimLaceyBaker1

    Dec. 14, 2020
  • JimLaceyBaker

    Dec. 12, 2020
  • ozanfiliz

    Dec. 1, 2020

This presentation discusses two types of serious attachment problems that are often found in children who have experienced complex trauma and disorganized attachments with care providers. Children who spent early years in orphanages and children who experienced multiple care providers and complex trauma are at risk for these disorders. The topics covered are reactive attachment disorder (RAD) and the new diagnostic classification which is disinhibited social engagement disorder, which used to be part of RAD. Some children who appear to have RAD and DSED should be evaluated for other issues, such as autism and fetal alcohol effects.

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