The Diagnostic Criteria For Reactive Attachment Disorder (RAD)

My new neighbor called me this afternoon to talk about The Letter, About Our RAD Daughter. We had a short conversation and for as long as it last there is a chance she might be able to understand the situation. It’s so hard to tell people about my daughter’s life in a way they could possibly understand. People don’t want to hear what happens to some children. Some people can’t hear even when they are told about it. Most people can’t imagine.

I have learned to be much less dramatic about “How” my little girl became my daughter when she was five-years-old. I tend to let the details out as facts now, rather then tell a long story about the whole thing. Besides it doesn’t help me or my child if I don’t accept the fact that her behavior is a result of abuse and neglect. The truth is five-year-olds don’t need new parents for any other reason, most of the time.

In the fourth Edition of the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, Copyright 1994 ” The diagnostic criteria for Reactive Attachment Disorder of Infancy or Early Childhood is defined as:

A. Markedly disturbed and developmentally inappropriate social relatedness in most contexts, beginning before age 5 years, as evidenced by either (1) or (2):

  • (1) Persistent failure to initiate or respond in a developmentally appropriate fashion to most social interactions, as manifest by excessively inhibited, hypervigilant, or highly ambivalent and contradictory responses (e.g., the child may respond to caregivers with a mixture of approach, avoidance, and resistance to comforting, or may exhibit frozen watchfulness)
  • (2) Diffuse attachments as manifest by indiscriminate sociability with marked inability to exhibit appropriate selective attachments (e.g., excessive familiarity with relative strangers or lack of selectivity in choice of attachment figures)

B. The disturbance in Criterion A is not accounted for solely by developmental delay (as in Mental Retardation) and does not meet criteria for a Pervasive Developmental Disorder.)

C. Pathogenic care as evidenced by at least one of the following:

  • (1) Persistent disregard of the child’s basic emotional needs for comfort, stimulation, and affection.
  • (2) Persistent disregard of the child’s basic physical needs.
  • (3) Repeated changes of primary caregiver that prevent formation of stable attachments (e.g., frequent changes in foster care).

D. There is a presumption that the care in Criterion C is responsible for the disturbed behavior in Criterion A (e.g., the disturbances in Criterion A began following the pathogenic care in Criterion C).

Specify type:

  • Inhibited Type: if Criterion A1 predominates in the clinical presentation.
  • Disinhibited Type: if Criterion A2 predominates in the clinical presentation.

My daughter is diagnosed with Reactive Attachment Disorder Disinhibited Type. It has been interesting breaking things down and learning to understand what’s going on, and how to deal with it. The one thing most mothers of RAD children learn is that, most people just have no idea what we live through day after day. Our joys come more often in the smallest things the average mother might not even notice.

The only thing most RAD parents really have is hope, that one day our children might heal and be able to trust us and allow our love to touch them enough that they believe it.

Point Special Needs and Adoption-Related Terms:
A | B | C | D | E-F | G-H-I | J-K-L | M | N-O | P | Q-R | S | T-U-V-W-X-Y-Z

For more information about parenting special needs children you might want to visit the Special Needs Blog and the Mental Health Blog. Or visit my personal website.