1
|
Owen C. Obscure Dichotomy of Early Childhood Trauma in PTSD Versus Attachment Disorders. TRAUMA, VIOLENCE & ABUSE 2020; 21:83-96. [PMID: 29334032 DOI: 10.1177/1524838017742386] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
There are two competing schools of thoughts involving children who have experienced early childhood trauma. One posture's nosology focuses on the post-traumatic stress responses; the other focuses on the deviant behaviors that ensue from pathogenic care in early childhood. This author sought to review the literature from a holistic perspective, embracing both diagnostic positions. Seventy-three articles addressing childhood trauma and the ensuing emotional or behavioral disturbances were evaluated, mostly empirical-including 16 that specified posttraumatic stress disorder (PTSD), 21 that specified attachment disorders, and 37 that included potential overlaps between both trauma derivatives. An additional 138 studies were reviewed but not included herein because those focused on broader issues. Statistical data, financial and emotional impacts, and the effects of disrupted attachments were addressed-including both children with secure attachments and those with compromised attachments. The critical effect of both positive and negative parental responses was evaluated, as well as correlations or overlaps in the diagnostic criteria and symptom manifestations of the children and any apparent gaps in the current research. The literature details that the prognosis and course of treatment vary significantly between the two etiologies-apparently at least in part due to possible clinician bias in conceptualizations of the two populations. There are clear overlaps in the diagnostic criteria that strongly suggest comorbidity between the disorders, however, which is especially critical to analyze in the future, since there are solid, empirical, evidence-based treatment protocols for PTSD, but not for attachment disorders resulting from pathogenic caregiver maltreatment.
Collapse
Affiliation(s)
- Christy Owen
- Liberty University, Lynchburg, VA, USA
- Respite Retreat, Blairsville, GA, USA
| |
Collapse
|
2
|
Abstract
The ability to form attachments with other human beings is an essential skill that typically begins early in life. The parent/caregiver-child relationship is the first crucial relationship that an infant forms, and the health of this relationship has a profound effect on the child's social and emotional development. Children who form secure relationships with their parent or other primary caregiver have fewer internalizing and externalizing behaviors, are more socially competent, and have better-quality friendships. Conversely, children with attachment disorders exhibit a varying capacity to form and sustain relationships and demonstrate emotional depth, they and experience a higher level of peer conflict. Children with insecure attachments have a greater likelihood for physical health morbidities and impaired social, psychological, and neurobiological functioning extending into adulthood. It is crucial that pediatric nurse practitioners implement practice behaviors to better identify children at risk for attachment disorders and link them with appropriate interventions. This continuing education article will explore attachment; and attachment theory; and attachment disorders in terms of types, risk factors, consequences, and treatment and will also provide implications for practice.
Collapse
|
3
|
Allen B. Misperceptions of reactive attachment disorder persist: Poor methods and unsupported conclusions. RESEARCH IN DEVELOPMENTAL DISABILITIES 2018; 77:24-29. [PMID: 29626664 DOI: 10.1016/j.ridd.2018.03.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/28/2017] [Revised: 09/02/2017] [Accepted: 03/26/2018] [Indexed: 06/08/2023]
Abstract
Reactive Attachment Disorder (RAD) is an often discussed, but misunderstood, diagnostic presentation. A growing body of well-designed prospective studies is providing a wealth of information about the condition; however, misconceptions of RAD abound in both clinical and research arenas. As such, it can be difficult for reviewers to critically evaluate papers pertaining to RAD that are submitted to academic journals and even more difficult for practicing clinicians operating under the time constraints of community-based practice. Papers continue to appear that promote RAD as a form of conduct disorder (CD) or callous/unemotional (CU) presentation among maltreated children, although this conceptualization is directly at odds with the diagnostic criteria found in the DSM-5 and ICD-10 as well as a significant body of well-conducted research. Studies attempting to promote this understanding of RAD typically suffer from significant and multiple methodological flaws. This paper reviews these concerns and provides 5 questions that must be sufficiently answered when evaluating a paper purportedly examining RAD. A recently published paper promoting the CD/CU-conceptualization of RAD is critiqued as an exemplar of applying these 5 questions.
Collapse
Affiliation(s)
- Brian Allen
- Penn State Children's Hospital, Hershey, PA, USA; Penn State College of Medicine, Hershey, PA, USA.
| |
Collapse
|
4
|
Cyr K, Chamberland C, Clément MÈ, Wemmers JA, Collin-Vézina D, Lessard G, Gagné MH, Damant D. The Impact of Lifetime Victimization and Polyvictimization on Adolescents in Québec: Mental Health Symptoms and Gender Differences. VIOLENCE AND VICTIMS 2017; 32:3-21. [PMID: 28234195 DOI: 10.1891/0886-6708.vv-d-14-00020] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
This study documents lifetime experiences of victimizations, polyvictimization, and trauma symptoms among 1,400 adolescents from the province of Québec. The vast majority (81%) of adolescents were victimized during their lifetime, with most victims (82%) being the target of more than one form of victimization. Polyvictimization accounted for most variability in scores of depression, posttraumatic stress disorder (PTSD), and anger/ aggression compared to individual victimization categories. Sexual victimization and maltreatment still made an independent contribution in predicting all trauma scores once polyvictimization was considered. Gender differences were found in the victimization experiences contributing to the prediction of mental health symptoms. Sexual victimization was a significant predictor of PTSD and anger/aggression symptoms for girls, whereas witnessing violence predicted anger and PTSD symptoms for boys, and assault predicted their anger. This study outlines the importance of assessing various types of victimization among adolescents. Systematic data and observation of trends on child victimization are needed in Canada and elsewhere.
Collapse
|
5
|
La sécurité affective chez l’enfant en milieu résidentiel : des soins du corps au bien-être émotionnel. EVOLUTION PSYCHIATRIQUE 2015. [DOI: 10.1016/j.evopsy.2014.08.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
|
6
|
Woolgar M, Baldock E. Attachment disorders versus more common problems in looked after and adopted children: comparing community and expert assessments. Child Adolesc Ment Health 2015; 20:34-40. [PMID: 32680331 DOI: 10.1111/camh.12052] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/05/2013] [Indexed: 11/27/2022]
Abstract
BACKGROUND Attachment disorders in adopted and fostered children may be overdiagnosed and could obscure more common disorders. METHODS A case note review of 100 referrals to a specialist adoption and fostering service compared community referrals with the specialist assessments of attachment disorders. RESULTS Attachment disorders were identified four times more often in community referrals versus the specialist service, but this only partly explained the significant under-identification of more common disorders in the community, especially for neurodevelopmental factors and conduct disorder by up to 10-fold. CONCLUSIONS The relevant practice parameters are discussed and implications for service models for adopted and fostered children reviewed.
Collapse
Affiliation(s)
- Matt Woolgar
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, King's College London, Box P85, DeCrespigny Park, London, SE5 8AF, UK.,National Adoption and Fostering Service, Michael Rutter Centre, South London & Maudsley NHS Trust, London, UK
| | - Emma Baldock
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, King's College London, Box P85, DeCrespigny Park, London, SE5 8AF, UK
| |
Collapse
|
7
|
Mikic N, Terradas MM. Mentalization and attachment representations: A theoretical contribution to the understanding of reactive attachment disorder. Bull Menninger Clin 2014; 78:34-56. [DOI: 10.1521/bumc.2014.78.1.34] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
|
8
|
Dahmen B, Pütz V, Herpertz-Dahlmann B, Konrad K. Early pathogenic care and the development of ADHD-like symptoms. J Neural Transm (Vienna) 2012; 119:1023-36. [PMID: 22661337 DOI: 10.1007/s00702-012-0809-8] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2012] [Accepted: 04/16/2012] [Indexed: 01/09/2023]
Abstract
Early pathogenic care that is characterised by disregard for the child's basic emotional needs can lead to severe global psychosocial and cognitive dysfunction and deviant developmental trajectories of brain maturation. Reactive attachment disorder (RAD) is a developmental disorder associated with early pathogenic care that is characterised by markedly disturbed ways of relating socially in most contexts. In addition to other severe emotional dysfunctions, children suffering from RAD often display a high number of comorbid attention deficit/hyperactivity disorder (ADHD) symptoms such as inattention, impulsivity and hyperactivity. It is not yet clear whether ADHD-like symptoms in children exposed to pathogenic care represent a true comorbidity of ADHD or similarities in behavioural dysfunction with a different neurodevelopmental pathway in terms of a phenocopy. In this review, we summarise the findings on the neurobiological consequences of early pathogenic care. Pathogenic care is considered a form of care by a primary caretaker involving a lack or a loss of expectable care, e.g., by early separation, frequent change in caregivers, institutionalisation or neglect. The reviewed studies suggest that a primary dysfunction of limbic brain circuits after early pathogenic care might lead to an interference by motivational or emotional cues impinging on prefrontal executive functions resulting in behavioural similarities with ADHD. Thus, the complex phenotype observed after early pathogenic care might be best described by a dimensional approach with behavioural and neurobiological similarities to ADHD coinciding to a certain degree as a function of early experience. Based on this evidence, suggestions for the treatment of ADHD-like symptoms in children after adverse early life experiences are provided.
Collapse
Affiliation(s)
- Brigitte Dahmen
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Medical Faculty, RWTH Aachen University, Neuenhofer Weg 21, 52074 Aachen, Germany.
| | | | | | | |
Collapse
|
9
|
Buckner JD, Lopez C, Dunkel S, Joiner TE. Behavior management training for the treatment of reactive attachment disorder. CHILD MALTREATMENT 2008; 13:289-297. [PMID: 18490700 PMCID: PMC2566997 DOI: 10.1177/1077559508318396] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Reactive Attachment Disorder (RAD) is a childhood disorder characterized by extremely inappropriate social relating across a variety of interactions that must be present by age 5. Although children diagnosed with RAD appear to demonstrate significantly more behavioral problems and psychosocial difficulties than children without RAD, there have been few examinations of empirically informed treatments for this disorder. One avenue that may be particularly promising is the use of treatments that have been successfully used to decrease similar problematic behaviors in children. The present case study outlines the use of behavior management training (BMT) in the treatment of a 7-year-old female child with RAD. Given the marked reduction in problematic behaviors exhibited by this child as a result of a typical course of BMT, it is recommended that randomized clinical trials be conducted to test the efficacy of BMT for RAD.
Collapse
|
10
|
Hardy LT. Attachment Theory and Reactive Attachment Disorder: Theoretical Perspectives and Treatment Implications. JOURNAL OF CHILD AND ADOLESCENT PSYCHIATRIC NURSING 2007; 20:27-39. [PMID: 17284236 DOI: 10.1111/j.1744-6171.2007.00077.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
TOPIC Attachment theory and reactive attachment disorder (RAD). PURPOSE To highlight current perspectives on attachment theory, RAD, and treatment implications using a case study of an 8-year-old patient with RAD. SOURCES Selected multidisciplinary literature related to attachment theory and RAD. CONCLUSIONS The literature provides a body of work that substantiates the importance of early attachment relationships to human development and highlights gaps in our knowledge related to treatment of children with RAD. The quality of early attachment relationships is correlated with future personality and brain development. Attachment disturbances are associated with psychopathology in childhood and adulthood. Although evidence for the effective treatment of children with attachment disorders is minimal and inconclusive, the two major perspectives, developmental psychology and neuropsychoanalysis, offer guidelines for practice.
Collapse
Affiliation(s)
- Lyons T Hardy
- University of Virginia School of Nursing and Virginia Treatment Center for Children, Virginia Commonwealth University Health System, USA.
| |
Collapse
|
11
|
Chaffin M, Hanson R, Saunders BE, Nichols T, Barnett D, Zeanah C, Berliner L, Egeland B, Newman E, Lyon T, LeTourneau E, Miller-Perrin C. Report of the APSAC task force on attachment therapy, reactive attachment disorder, and attachment problems. CHILD MALTREATMENT 2006; 11:76-89. [PMID: 16382093 DOI: 10.1177/1077559505283699] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
Although the term attachment disorder is ambiguous, attachment therapies are increasingly used with children who are maltreated, particularly those in foster care or adoptive homes. Some children described as having attachment disorders show extreme disturbances. The needs of these children and their caretakers are real. How to meet their needs is less clear. A number of attachment-based treatment and parenting approaches purport to help children described as attachment disordered. Attachment therapy is a young and diverse field, and the benefits and risks of many treatments remain scientifically undetermined. Controversies have arisen about potentially harmful attachment therapy techniques used by a subset of attachment therapists. In this report, the Task Force reviews the controversy and makes recommendations for assessment, treatment, and practices. The report reflects American Professional Society on the Abuse of Children's (APSAC) position and also was endorsed by the American Psychological Association's Division 37 and the Division 37 Section on Child Maltreatment.
Collapse
Affiliation(s)
- Mark Chaffin
- University of Oklahoma Health Sciences Center, Center on Child Abuse and Neglect, USA
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|