I need someone to take my weekly short online quiz
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ATTACHMENT
Recap: What is attachment? ◦ Attachment: An emotional bond with a specific person that is
enduring across space and time (Bowlby, 1969) ◦ Classified as : secure, insecure-avoidant, insecure-resistant, disorganized
◦ Insecure attachment poses a risk for developing a variety of disorders
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Studies of Institutionalized Children Dr. Robert McCall (University of Pittsburgh) spent almost two decades studying institutionalized children, including those in St. Petersburg, Russia
Based on work by Bowlby which showed that children from institutions were showing deficits in social emotional and cognitive domains
These institutions were providing youth with food, shelter, and meeting their basic needs
What was missing?
Many of these institutions had inconsistent caretakers (e.g., shiftwork), and whose interactions were limited to meeting basic needs (e.g., feeding)
DSM-5 Criteria: Reactive Attachment Disorder
A. A consistent pattern of inhibited, emotionally withdrawn behavior toward adult caregivers, manifested by both of the following:
1. The child rarely or minimally seeks comfort wen distressed. 2. The child rarely or minimally responds to comfort when distressed.
B. A persistent social and emotional disturbance characterized by at least two of the following:
1. Minimal social and emotional responsiveness to others. 2. Limited positive affect. 3. Episodes of unexplained irritability, sadness, or fearfulness that are evident even
during nonthreatening interactions with adult caregivers.
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DSM-5 Criteria: Reactive Attachment Disorder (cont’d)
C. The child has experienced a pattern of extremes of insufficient care as evidenced by at least one of the following:
1. Social neglect or deprivation in the form of persistent lack of having basic emotional needs for comfort, stimulation, and affection met by caregiving adults. 2. Repeated changes of primary caregivers that limit opportunities to form stable attachments (e.g., frequent changes in foster care). 3. Rearing in unusual settings that severely limit opportunities to form selective attachments (e.g., institutions with high child-to-caregiver ratios)
D. The care in Criterion C is presumed to be responsible for the disturbed behavior in Criterion A.
DSM-5 Criteria: Reactive Attachment Disorder (cont’d)
E. The criteria are not met for autism spectrum disorder.
F. The disturbance is evident before age 5 years.
G. The child has a developmental age of at least 9 months.
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What does RAD look like? Information on presentation and etiology: http://abcnews.go.com/2020/video/experts-parents-discuss-rad-reactive- attachment-diorder-34667787
Example of living with RAD: https://www.youtube.com/watch?v=TI6I-C3-H6s
DSM-5 Criteria: Disinhibited Social Engagement Disorder (DSED)
Similar to DSM-IV RAD disinhibited type A. A pattern of behavior in which a child actively approaches and interacts
with unfamiliar adults and exhibits at least two of the following: 1. Reduced or absent reticence in approaching and interacting with unfamiliar
adults. 2. Overly familiar verbal or physical behavior. 3. Diminished or absent checking back with adult caregiver after venturing away,
even in unfamiliar settings. 4. 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).
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DSM-5 Criteria: DSED(cont’d) C. The child has experienced a pattern of extremes of insufficient care as evidenced by at least one of the following:
1. Social neglect or deprivation in the form of persistent lack of having basic emotional needs for comfort, stimulation, and affection met by caregiving adults. 2. Repeated changes of primary caregivers that limit opportunities to form stable attachments (e.g., frequent changes in foster care). 3. Rearing in unusual settings that severely limit opportunities to form selective attachments (e.g., institutions with high child-to-caregiver-ratios).
D. The care in Criterion C is presumed to be responsible for the disturbed behavior in Criterion A.
E. The child has a developmental age of at least 9 months.
RAD vs. DSED ◦ DSED has similarities with other externalizing disorders (e.g., ADHD) while RAD
has similarities with other internalizing disorders (e.g., anxiety)
◦ Seems like DSED is more persistent throughout child’s life
◦ RAD appears to be responsive to enhanced caregiving unlike DSED (based on research thus far)
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INTERVENTIONS
Steps Toward Effective and Enjoyable Parenting (STEEP) program
Target Population: First-time low-income mothers of children 0-23 months old For parents/caregivers of children ages: 0 – 1
Goals: ◦ Improve parental knowledge and understanding of child’s behavior and development ◦ Improve parental sensitivity and responsiveness to infant cues ◦ Improve parental coping skills and decision-making related to life-planning for
themselves and their child ◦ Strengthen the family’s support network, including both formal and informal resources ◦ Improve parents’ reflective capacity as it relates to how their relationship history
influences their responses to their child
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STEEP Program Components ◦ Bi-weekly home visiting beginning during the 2nd trimester of pregnancy and continuing
through the duration of the program (usually when child turns 2 years old)
◦ Bi-weekly mother-infant groups that include both mother-child interaction time and mom-talk time
◦ Video-recording of ordinary parent-child interaction and guided viewing of the video with the parent to promote parental sensitivity and perspective-taking and to identify factors that support or hinder the parent from sustaining sensitive responsiveness
◦ Regularly scheduled reflective supervision for all staff, both individually and as a team during case consultation (that includes review of recent videos of the families being discussed)