Reactive attachment disorder in maltreated twins

Abstract

This case report summarizes in detail the clinical course of twins referred for intervention after maltreatment at 19 months of age who were followed to 36 months of age. Data from comprehensive assessment of parent-child relationships in these cases are reviewed and this material is considered in light of numerous family and systems factors that impacted the twins' clinical course. Diagnostic considerations pertaining to Reactive Attachment Disorder and the post-traumatic symptom of dissociation are presented. Links between recent research models of brain development and symptom presentation is discussed.RESUMEN: Este reporte de un caso resume en detalle el curso clínico de gemelos que a los 19 meses de nacidos fueron referidos para intervención debido al maltrato, y a quienes se les dio u seguimiento hasta los 36 meses de edad. Se revisan las informaciones de evaluaciones comprensivas de las relaciones entre padre o madre e hijo en estos casos, y este material es considerado a la luz de numerosos factores de familia y de sistemas, los cuales causaron impacto en el curso clínico de los gemelos. Se presentan consideraciones de diagnóstico concernientes al Trastorno Reactivo de Afectividad y al síntoma postraumtico de disociación. Se discuten las conexiones entre recientes modelos de investigación sobre el desarrollo del cerebro y la aparición de los síntomas.

Attachment Disorder Symptoms and Prosocial Behavior in Middle Childhood: The Role of Secure Base Script Knowledge

“…However, if such a comparison would have revealed a link between ADS and SBS knowledge, it would still have been impossible to claim that insecure attachment is the core and most speci c issue that children with ASD struggle with, because theory suggests that the average child with any mental health problem will have less SBS knowledge than healthy controls [57]. This way, the current ndings resonate with other studies that failed to nd a link between ADS and insecure attachment [34] and with a mounting number of scholars argueing that insecure attachment is not the core and speci c issue characterizing attachment disorder symptoms [27,32,33,35].…”

“…Also, Rutter, Kreppner, and Sonuga-Barke reviewed empirical research on attachment disorders and concluded that ADS are indicative of emotional and behavioral dysregulation in general instead of attachment insecurity speci cally [33]. In a similar vein, other scholars argued that ADS might re ect not so much individual differences in attachment (in)security but re ect hyperarousal linked to post traumatic stress disorder or similar anxiety-related disorders [34,35,36]. Research further suggests that ADS and attachment have a different etiological background.…”

Practice Parameter for the Assessment and Treatment of Children and Adolescents With Reactive Attachment Disorder and Disinhibited Social Engagement Disorder

“…DSED shares the same etiology as RAD, that is, the child with the disorder must have experienced "insufficient caregiving" severe enough to explain the phenotype. Studies of children who have been maltreated 34,38,45,60,62 and those raised in institutions 9,42,51,52,63 have confirmed that indiscriminate behavior, the central feature of the phenotype, is increased compared to that in children who have not experienced such extremes of care.…”

“…In addition, comorbidity with depressive symptoms also has been noted in young children with histories of institutional rearing. 37 Some maltreated children have been documented to show signs of both posttraumatic stress disorder (PTSD) and RAD, 38 but no studies have yet documented the degree of comorbidity between RAD and PTSD. There is, however, longitudinal evidence that disorganized attachment in infancy is associated with the development of PTSD in schoolaged children who were exposed to significant traumatic events, 39 and children diagnosed with RAD are likely to have such trauma exposure.…”

“…42 Although not studied systematically, PTSD also has been reported to co-occur with DSED in young maltreated children. 38 Two independent groups studying children adopted out of severely deprived institutions have reported that some children display features described as "quasi-autism." 55,56 At age 4 years, these children met full clinical criteria for autism, but by age 6 years, they no longer showed all the features of autism.…”