The Unfamiliar Childhood Disorder – Reactive Attachment Disorder

The purpose of this paper is that a study was conducted for the diagnosis of Reactive attachment dsorder (RAD). This study was assessed with using the Relationships Problem Questionnaire (RPQ) and Reactive Attachment Disorder – Checklist (RAD-C). Chronbach’s alpha of was used to test inter-rater, reliability and test-retest reliability (Thrall, Hall, Golden, & Sheaffer, 2009). There were fifty-three parents and caregivers who participated in the study. The first group were composed of children and adolescents who had former diagnoses of RAD, which was of the disinhibited subtype. There were thirteen participants, six boys and seven girls in the study with ages with a range of five to nineteen years (Thrall et al, 2009). The second group was composed of children and adolescents who had been in foster care or had been adopted. None of the children had been diagnosed with RAD. There were a total of twelve participants, six boys and six girls. The children’s age with a range of five to nineteen years (Thrall et al, 2009). The third group was the control group composed of children and adolescents who had no history of RAD or other attachment disorders. The children lived with one or both biological parents since birth and never were in foster care. There were 28 participants, 12 boys and 16 girls. Their ages with a range of six to fifteen years (Thrall et al, 2009). Reactive attachment disorder (RAD) is an emotional disorder that can affect young children by age five. There are two subtypes of RAD, inhibited and disinhibited (Thrall et al, 2009).

Summary of the Article According to the study, there is limited research on children with RAD compared to other disorders. The reason for the lack of research is because of not having the clear and concise definitions. This is because of unacceptable and standardized methods for assessing and diagnosing RAD (Thrall et al, 2009). RAD is one of the least researched and most understood disorders according to the DSM. There are very limited assessments tools available for diagnosing RAD and have just recently developed the guidelines for the assessment process (Thrall et al, 2009). There are checklists and questionnaires but this still lacks the reliability and validity for the assessment process. The RAD diagnosis can be made with assessments that would be with child observations and if this meets the RAD criteria. There are interviews with the parents or caregivers to determine the history of the child (Thrall et al, 2009). Literature Review Reactive attachment disorder (RAD) is an emotional disorder that can affect young children by age 5, but this may be noticed before age 5. The early signs of RAD are: severe colic, failure to thrive, and detached (Fritz, 2013). RAD can be caused by abuse or neglect, going into foster care and having new caregivers or having several caregivers, not having emotional bond with caregivers, and caregiver who does not have parenting skills.

The symptoms are: not wanting to be comforted, wanting to be alone, not wanting physical contact, etc. (Fritz, 2013). Children who have signs and symptoms need to have an assessment completed to be properly diagnosed for RAD. If a child is diagnosed with RAD, this would require therapy for child and parent/caregiver. Parents or caregiver neglect or abuse children, and lacks the skills for emotional needs of children. This is more seen in children adopted from countries outside of the US (Fritz, 2013). Reactive attachment disorder (RAD) is children who lack attachment to their caregivers or mothers. This is due to a type of trauma that has happened to them, for example going into foster care and having negligence done to them (Thrall et al, 2009). The attachment period is where the child learns to love, trust, and have feelings and their needs met. If a child does not have this form of attachment, then they can develop negative feelings and can develop an attachment disorder. It is important for a child to have a healthy relationship with their parents or caregivers. (Thrall et al, 2009). Reactive attachment disorder (RAD) was first introduced Diagnostic and Statistical Manual: DSM – III. RAD is when children develop extensive trauma and developmentally inappropriate social interactions in settings before the age of five. There are two subtypes of RAD, inhibited and disinhibited (Thrall et al, 2009). A child with RAD can have symptoms of being withdrawn or detached and lacks the ability to form a bond or attachment. A child with Disinhibited RAD lacks the ability to discriminate among people in his/her attachments. The child with disinhibited RAD often shows attachment and affection equally towards strangers and his/her primary caregivers. Children who have trauma or negligence by parents and caregivers are often diagnosed as having RAD (Thrall et al, 2009).

Methods Section

The study was conducted to assess two rating scales in order to diagnosis RAD. They used a RAD Checklist (RAD-C) and the Relationships Problem Questionnaire (RPQ). The Reactive Attachment Disorder Checklist (RAD-C) is a checklist with seventeen questions that asks questions about the child’s or adolescent’s behavior. Also, the parents and caregivers answered nine questions about the child or adolescent’s behavior when they were younger. The RPQ was developed by to aid in the diagnosis of RAD. The Chronbach’s alpha of (.70), inter-rater reliability (.81) and test-retest reliability (.78) (Thrall et al, 2009). There were originally seventy-one participants which consisted of parents, caregivers, and social workers who agreed to participate in the study. The study then consisted of fifty-three, as the other seventeen had incomplete data. There were three groups in the study, which asked social services, mental health agencies, and community agencies to contact families of the children and adolescents for the participants (Thrall et al, 2009). The first group were composed of children and adolescents who had former diagnoses of RAD. They had a diagnosis of RAD and the disinhibited subtype which was diagnosed by a doctor, and they received counseling for RAD. There were thirteen participants, six boys and seven girls in the study with ages with a range of 5 to 19 years (Thrall et al, 2009). The second group was composed of children and adolescents who had been in foster care or had been adopted. There were records and histories from the children. None of the children had been diagnosed with RAD. There were a total of twelve participants, six boys and six girls. The children’s age with a range of 5 to 19 years (Thrall et al, 2009). The third group was the control group composed of children and adolescents who had no history of RAD or other attachment disorders. The children lived with one or both biological parents since birth and never were in foster care. There were twenty-eight participants, twelve boys and sixteen girls. Their ages with a range of six to fifteen years. There races/ethnicity consisted of twenty-three were African-American, twenty-three Caucasian, one Native American, four Hispanic/Latino, and two had indicated bi-racial as race and ethnicity (Thrall et al, 2009).

Results Section

Chronbach’s alpha was used for internal reliability and computed for scores on each measure. Chronbach’s alpha provides an assessment how each item was measured. This provides a coefficient of reliability and demonstrates that items are measuring on the same level (Thrall et al, 2009). The first test – Analysis of variance (ANOVA) was conducted with RAD, non-RAD and control groups. This indicated that the RAD group had considerably higher scores on the RPQ and RAD-C than the non-RAD or control groups. The non-RAD and control groups had about the same results on the RAD-C and the non-RAD was somewhat higher than the control group on the RPQ (Thrall et al, 2009). The second test was conducted with RAD, non-RAD and control groups. The test scores served as the independent variable and RAD-C scores as the dependent variable. The RAD group had considerably higher scores than the non-RAD or control groups on the RAD-C. The scores for the non-RAD and control groups were not very different from each other (Thrall et al, 2009). The third test was conducted with RAD, non-RAD and control groups. The test scores served as the independent variable and RPQ scores as the dependent variable. The RAD group again had considerably higher scores from the non-RAD and control groups. While the non-RAD and control groups were similar in scores (Thrall et al, 2009). According to figure 1, The RAD group had a higher score overall. The non-RAD had two participants and control group had one participant with scores above 20.

Two of the children and adolescents in the RAD group had scores below 20. This is due to the RAD group participants being in therapy. The scores between 15 and 20 are reasonable scores noted from clinical views. Those who scored 33 would be recommended for therapy, as they may have attachment problems that are associated with RAD (Thrall et al, 2009). According to figure 2, there were three scores in the non-RAD group and three in the control group with a score above 40, who did not present with RAD symptoms. The children and adolescents who identified as having a RAD diagnoses had scores below 40. It is noted to study the results further on the scores between 40 and 50 (Thrall et al, 2009).

Discussion Section

The purpose of the study was to analyze the RPQ and RAD-C scores to show the internal reliability and validity. Chronbach’s alpha showed solid measurements with the use of RPQ and RAD-C as the testing mechanisms for determining the diagnosis of RAD (Thrall et al, 2009). The RPQ and RAD-C checklists used the DSM IV TR for the scores. It is important to have a thorough analysis, testing, and evaluation from a doctor for the diagnosis of RAD (Thrall et al, 2009). It is noted that when a child reaches the adolescence period, that it is very unlikely to determine the diagnosis of RAD. This would require further recommendations and a diagnosis from a doctor. The recommendations would include evaluating behavior patterns over a period of time, problem areas with parents or caregivers and if any cultural issues (Thrall et al, 2009). There needs to be checklists that have the data with expectable measurements. There also needs to be assessors who are have experience and education with the RAD disorders for completely making a diagnosis. The diagnoses should be fully on the completion of the test scores and not on the child’s younger life of trauma, etc. (Thrall et al, 2009). Conclusion Section In conclusion, there is much more research that needs to be done on RAD. This would truly help identify those who actually have the diagnoses. There needs to be a better understanding on signs and symptoms and treatment for RAD (Thrall et al, 2009). The group of the parents and caregivers could have been larger. The RAD group only had participants who were diagnosed with the disinhibited subtype of RAD. There were some individuals who started the study but did not complete the forms and some decided not to participate at all. There was a small number of children and adolescents who was diagnosed with RAD. This makes the sample hard to determine with only a few diagnoses with RAD. The ages need to be simplified (Thrall et al, 2009). In the future, it would be helpful to have information on both children’s groups and adolescent groups. It would also be better to have those diagnosed with RAD, to not be in therapy for better results (Thrall et al, 2009). Analysis of the Article There needs to be further research on the RPQ and RAD-C checklists. The children and adolescents need to be similar in age, race, and sex who are diagnosed with RAD as well as having disinhibited and inhibited subtypes (Thrall et al, 2009).

Strengths

The strengths of this article is that the study indicated showed that a person regardless of sex, race, and age can have a diagnosis of RAD (Thrall et al, 2009).

Weaknesses

The weaknesses of the article is that there is still not enough needed information and research on RAD. This is a childhood disorder that needs to have more research conducted (Thrall et al, 2009).

Reflections

This research shows how limited it has on RAD, as it is hard to diagnosis an individual. The checklists are known to be helpful as in this study (Thrall et al, 2009).

Supported Opinions

In my opinion, I thought the article was interesting and how the study was conducted. I hope that I will have a chance to work with individuals who may present symptoms or that are diagnosed with RAD. This subject is important to me, as my husband and I are in the process of adopting a child.

Standards Check

Further research is needed for Reactive Attachment Disorder (RAD), in order to effectively be able to diagnosis an individual accurately. This is a serious disorder that needs proper treatment and therapy.

Conclusion

In conclusion, I found the article and the study to be very interesting. The article was insightful and helpful to me. There needs to be more research conducted for RAD. This is terrible of what children go through with going into foster care, and other forms of trauma. The RAD disorder is a very unfamiliar with little research done.

References

Reactive Attachment Disorder: What Parents and Caregivers Should Know. (2013).

Brown University Child & Adolescent Behavior Letter, 29, 1–2. Retrieved from http://search.ebscohost.com.libauth.purdueglobal.edu/login.aspx?direct=true&db=tfh&AN=85740622&site=eds-live

Thrall, E. E., Hall, C. W., Golden, J. A., & Sheaffer, B. L. (2009).

Screening measures for children and adolescents with reactive attachment disorder. Behavioral Development Bulletin, 15(1), 4–10. https://doi.org/10.1037/h0100508

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