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Abstract

The past 20 years have been turbulent regarding Reactive Attachment Disorder (RAD), with conflicting research about its causes, effects, treatment, and prognosis. The current diagnostic criteria in the DSM-5 fails to adequately address this disorder. A number of deviant and maladaptive behaviors common amongst children with RAD are not even mentioned in the diagnostic criteria. As such, the diagnostic definition is almost unidentifiable or incompatible with real-life conduct manifestations of the disorder. Rather, this author contends that RAD is foundationally a unique and extreme form of Posttraumatic Stress Disorder (PTSD) from Early Childhood Trauma. The child endured unspeakable neglect and/or abuse in his early years by someone who was supposed to protect him, and he, understandably, is terrified of trusting anyone lest that person harm him, too. These children dissociate and experience PTSD flashbacks to prior abusers when a new caregiver yells at them or has angry, disapproving eyes. The underlying issues are that child does not feel safe and does not trust his parents to protect him, due to past trauma. This author contends that this is the core causation of RAD and the myriad of behaviors that RAD children employ to maintain control of their environment. This etiological stance naturally leads to treatment implications. Treatment becomes systemic as well as individual. An explicit and detailed case study ties together all of the elements of this new etiology by addressing the presenting issues, case conceptualization, and treatment plan for a family with an adopted child.

Bio

Christy and her husband minister to families who have adopted or are providing kinship care for children with severe emotional and behavioral disturbances. They wrap around these families and try to help them salvage the adoptions, by helping them heal from the inside-out. Christy has completed her master's degree in professional counseling and is currently pursuing her doctoral degree in counselor education and supervision.