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ADHD and Attachment


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Title: ADHD and Attachment

  • ADHD and Attachment
  • Victoria Thompson
  • April 6th, 2009

  • Attachment
  • Literature
  • 2 Empirical Studies
  • Developmental Model
  • Reactive Attachment Disorder

  • Close emotional bond between two people that is
    enduring across space and time
  • Proximity-seeking behavior by a dependent
    organism when he or she feels discomfort
  • Internal Working Models
  • Mental representations of the self, attachment
    figures, and relationships in general.
  • Include expectations regarding behaviors and
  • Source Ladnier Massanari, 2000

Attachment Styles
  • Secure
  • Caregiver as a secure base
  • Insecure
  • 3 Types
  • Ambivalent
  • Child contacts caregiver for support while
    simultaneously rejecting her attempts to soothe
  • Avoidant
  • Child rejects or avoids caregiver
  • Disorganized/Disoriented
  • Child lacks a consistent strategy for organizing
    his comfort seeking behaviors
  • Source Ladnier Massanari, 2000

Converging Body of Literature
  • Executive Functioning (EF)
  • Early healthy attachment experiences necessary
    for the development of EF
  • Insecurely attached children show EF deficits
  • Children with ADHD typically show EF deficits
  • Hypothalamic-Pituitary-Adrenal (HPA) Axis
  • Insecure attachments associated with atypical
    reactivity of this system to stressors
  • Secure attachment associated with typical
  • Some children with ADHD show atypical reactivity
  • Source Crittendon Kulbotten, 2007

Literature cont.
  • Orbitofrontal Cortex
  • Crucial to emotional regulation, decision-making
    and processing of rewards
  • Anxious attachment inhibits development of the
    orbitofrontal cortex
  • Anxious attachment may result in chronic
  • Emotion lability
  • Impulsivity
  • Unpredictable and intense behavior
  • Orbitofrontal cortex has been found to be
    functionally disturbed in people with ADHD
  • Source Crittendon Kulbotten, 2007

Literature cont.
  • Dopamine Receptor D4 (DRD4) Gene
  • Link between infant attachment and DRD4 gene
  • Same gene found to be linked to ADHD
  • Disorganized attached children carry 7 repeat
    allele of the DRD4 gene
  • Securely attached children do not carry this
  • Not carrying this allele may act as a resilience
    factor in the optimal development of attachment
  • Children with ADHD who have 7 repeat allele tend
    to be more impulsive then children with ADHD who
    do not have this allele
  • Early attachment might mediate or moderate the
    DRD4-related genetic risk for ADHD
  • Source Crittenden Kulbotten, 2007

Literature cont.
  • Children that are insecurely attached and
    children with ADHD show EF deficits
  • Insecure attachment and ADHD is associated with
    atypical reactivity of the HPA axis to stressors
  • Children that have an anxious attachment style
    and children with ADHD show abnormalities of the
    orbitofrontal cortex
  • Both insecure attachment and ADHD have been
    linked to the DRD4 gene
  • These findings suggest a possible interaction
    between genetic vulnerability and early
    attachment experience, which is expressed in the
    form of symptoms that define ADHD
  • Source Crittenden Kulbotten, 2007

  • Attachment theory the early parent-child
    relationship serves as the foundation for the
    emergence of self-regulation skills
  • Research has consistently shown that insecurely
    attached children are more vulnerable to deficits
    in self-regulation then securely attached
  • Insecure attachment is associated with deficits
    in self-regulation, as is ADHD
  • Source Clark, Ungerer, Chahoud, Johnson,
    Stiefel, 2002

Social Functioning
  • Insecurely attached children have trouble
    developing and maintaining healthy relationships
  • Children with ADHD show difficulties in social
    functioning as well
  • Source Clarke et al., 2002

Secure Infant Attachment Histories
  • Increased attention span
  • High levels of positive affect
  • High levels of persistence in problem-solving
  • Flexibility
  • Impulse control
  • Task orientation
  • Delay of gratification
  • Children with ADHD experience difficulties in the
    above areas
  • Source Clarke et al., 2002

Family Functioning
  • Insecure attachment relationships are associated
    with parental involvement characterized by
  • Minimal involvement
  • Negativity
  • Lack of responsivity to infant signals
  • Intrusiveness
  • In lab settings, mothers of children with ADHD
    show similar behavior (Danforth, Barkley,
    Stokes, 1991 for review).
  • Source Clarke et al., 2002

Family Function cont.
  • Families of children with ADHD experience
    difficulties in a number of areas that are
    considered risk factors for insecure attachment
  • Poor psychological functioning
  • Increased levels of depression and other
    psychiatric diagnoses in parents
  • High rates of marital distress and separation
  • Social isolation
  • Source Clark et al., 2002

Early Parent-Child Relations and ADHD
  • Maternal intrusiveness assessed when infants were
    6 months old more powerfully predicted
    distractibility in early childhood and
    hyperactivity in middle childhood, than did
    biological or temperament factors (Carlson,
    Jacobvitz, Sroufe, 1995)
  • Clinical case reviews suggest that children with
    ADHD have early parent-child relationships that
    are similar to those with insecure attachments

Early Parent-Child Relations and ADHD cont.
  • Haddad and Garralda (1992) described severely
    disrupted early attachment relationships in
    children presenting to clinics with ADHD, which
    were not accompanied by biological indicators
  • Stiefel (1997) linked the emergence of symptoms
    in a clinical cohort of ADHD to a lack of
    sustained parental attention during the first
    years of the childs life

Converging Body of Literature
  • Suggests
  • Attachment not peripheral to an understanding of
  • Appears to be an association between attachment
    and ADHD
  • Attachment theory offers a new perspective on
    ADHD, which might help us to better treat those
    with the disorder
  • Source Clarke et al., 2002

Clarke, Ungerer, Chahoud, Johnson, Stiefel, 2002
  • Participants
  • 19 boys, 5 10 yrs old with ADHD
  • 19 boys, 5 10 yrs old without ADHD
  • Compared on 3 representational measures
  • 2 Internal Working Models
  • 1 Self

Clarke et al., 2002
  • Separation Anxiety Test
  • Pictures of parent-child separation experiences
  • Questions about characters feelings and actions
  • How does the boy feel?
  • What is the boy going to do?
  • How does it all end?
  • Scoring
  • Vulnerability and need in severe separations
  • Self-confidence about handling mild separations
  • Degree of avoidance in discussing the separation
  • Containment of negative emotions
  • Childs general emotional experience of the
    parent-child relationship

Clarke et al., 2002
  • Family Drawings
  • Draw a picture of family, identify all persons in
    the drawing and state relationship to each person
  • Scored based on the presence or absence of 24
    specific drawing signs
  • To assess the context and patterning of the
    drawing signs, 8 global rating scales were used
  • Family Pride/Happiness
  • Vulnerability
  • Emotional Distance/Isolation
  • Tension/Anger
  • Role Reversal
  • Bizarreness/Dissociation
  • Global Pathology

  • 20 Questions assessing self-concept
  • Can you tell me something you like about
  • Can you tell me 5 words that describe you?
  • Scoring
  • Richness of Descriptions
  • Openness/Flexibility
  • Coherency

  • Overall, ADHD group obtained poorer scores on all
    three measures, indicating predominantly insecure
  • Separation Anxiety Test
  • Less likely to express an appropriate level of
    concern, fear, or feelings of sadness about
    difficult separations
  • Expressed extreme feelings and behaviors
  • Less likely to express confidence and feelings of
    well being in the context of easier separations

Results cont.
  • Coping strategies involving retribution,
    hostility, or hatred
  • Situations spiraled into disasters beyond their
    and others control
  • Predominantly negative descriptions of the
    parent-child relationship
  • Family Drawings
  • Differed markedly from control group
  • Suggested lower levels of family pride and higher
    levels of vulnerability, tension, anger, role
    reversal in the mother-child relationship,
    bizarreness, dissociation, and overall pathology

Results cont.
  • Relationship anxiety tended to predominate
  • Themes of anger, confusion, and low self-esteem
  • These themes were expressed in a variety of ways
  • Distorted and/or frightening figures
  • Unusual symbols
  • Little color or detail
  • Overall reckless quality

Results cont.
  • Self-Interview
  • In the ADHD group, their self-descriptions were
    less richly developed and coherent relative to
    controls, conveying a less developed sense of
  • Less open and flexible in their self-concept
  • Often presented a negative self-concept
  • Often appeared emotionally disconnected

  • Results suggest that the nature of attachment
    insecurity in this ADHD group is one of
    heightened emotional expression characterized by
    strong, out of control affects
  • Didnt display the open, flexible emotional
    expression that is considered to reflect a secure
    internal working model
  • Responses suggest insecure attachment style
  • In this context, the impulsivity, negative
    attention-seeking, recklessness, hyperactivity,
    and frequent oppositionality seen in ADHD
    children can be viewed as a strategy to gain
    attention from a less than optimally available

  • Findings contrary to the results of Chahoud
    (2000), in which the same exact participants were
    used as in Clarke et al. (2002)
  • Chahoud rated segments of child-directed play,
    mother-directed play, a teaching task, and
    clean-up activity on variables such as
    gratification, involvement, and sensitivity
  • Results showed no differences between the ADHD
    group and controls
  • 16 of the 19 children in the ADHD group were
    being treated with stimulant medications and 15
    had received some level of psychological

  • Claim that the effects of these medical and
    behavioral interventions may have been to mask
    underlying relational problems, at least in terms
    of their manifestation in a lab-based interaction
  • Traditional treatment approaches may temporarily
    or even permanently improve the behavioral
    manifestations of ADHD, but they do not attempt
    to impact on the childs internal working model
    or the parents view of the child
  • So, parent-child relationship problems will still
    be evident

  • Discrepancy between their findings and those of
    of Chahoud (2000) challenge the claim that
    research showing reversal of problematic
    parent-child interactional patterns following
    treatment with stimulant medications indicates
    that the difficult interactions seen in
    unmedicated kids are mainly due to child factors

Implications for Treatment
  • If we can identify secure and insecure children
    with ADHD, we can tailor their treatment more to
    their needs
  • If there is a secure relationship, parent
    training may be appropriate, as parents may be
    able to focus on the current interaction and
    apply behavior management skills objectively and
  • However, if the relationship is insecure,
    relationship issues may need to be addressed
    first before parents can be expected to focus on
    applying behavior management skills and making
    enduring changes

  • ADHD group all referrals
  • No inclusion of non-ADHD psychiatric control
    group and/or a non-clinic sample with ADHD
  • Small sample size prevented examination of the
    impact of comorbidity on attachment insecurity in
    children with ADHD or a comparison of findings
    for the different subtypes
  • All boys
  • Inclusion of children of hospital employees in
    control group

Unanswered Questions
  • Not clear whether quality of caregiving
    contributes directly to the development of
    ADHD-related problems or if the childs behaviors
    lead to disturbances in interactions
  • Role of child characteristics should not be
  • Likely a transactional model in which attachment
    processes are conceptualized as a function of
    complex and ongoing interactions among parent,
    child, and environmental/experiential factors

Unanswered Questions cont.
  • Longitudinal research is needed to disentangle
    the effects of these different factors on the
    development of attachment security and ADHD
  • Provide info regarding risk and protective
    factors and suggest strategies for early

Pinto, Turton, Hughes, White, Gillberg, 2006
  • Is there an association between
    disorganized/disoriented attachment and later
  • Participants
  • Cohort of 104 children
  • 1 yrs old Attachment style assessed by using the
    Strange Situation
  • 6 8 yrs old ADHD assessed

Pinto et al., 2006
  • Assessment of ADHD
  • ADHD Rating Scale-IV
  • Mothers and teachers independently
  • Observer-rated assessment of ADHD (developed by
    Pinto et al.)
  • 30 min doll-play story completion task
  • Child was required to listen to the story and
    then complete a series of story stems presented

Pinto et al., 2006
  • 3 broad areas, each with different measures
  • Hyperactivity fidgeting, getting up from chair
    and talkativeness
  • Inattention lack of persistent active listening,
    distractibility, and needing prompting to
    continue with the story
  • Impulsivity child interrupting the assessor to
    take over the narrative before story stem
    completion and interrupting with something
    unrelated before the question is finished
  • Measures were rated on a 4-point Likert-type
    scale (0never, 1occasionally, 2 some of the
    time, and 3constantly)

Pinto et al., 2006
  • Put the mother-rated, teacher-rated, and
    observer-rated assessments together to arrive at
    a categorical diagnoses for ADHD
  • Probable case child was given a score of 20 or
    more on the parent-rated and teacher-rated
    assessment plus a score of 2 or more for the
    observed ratings
  • Possible case the above criteria were not met
    but the child was given a score of 18 or more on
    either the parent- or teacher-rated assessment
    and a score of 10 or more on the same scale rated
    by the other (parent or teacher), plus a score of
    2 or more for the observed rating

  • 26 of infants were classified as disorganized
  • 7.8 of children met probable ADHD case
  • 10.7 of children met possible ADHD case
  • 23.1 of mothers vs. 24.3 of teachers rated the
    child above cut-off score of 20
  • Mother and teacher-rated ADHD scores were highly

Results cont.
  • No association between infant disorganized
    attachment and later childhood ADHD caseness
  • Rate of probable ADHD caseness in the children
    was similar to that of the general population
    rate for ADHD
  • Mean disorganized scores were 4.06 (SD1.43) in
    the probable case group, 3.68 (SD1.87) in the
    possible case group, and 3.58 (SD. 1.72) in the
    noncase group
  • Significant correlation between disorganized
    scores and teacher rated ADHD symptoms (more
    strongly associated with inattention than

  • What are the attributes of disorganized infants
    that teachers (but not mothers) observe several
    years later as ADHD symptoms?
  • Likely that both mothers and teachers would find
    hyperactivity hard to manage but that mothers may
    be less sensitive to inattention and perhaps are
    not troubled or become habituated to this aspect
    of ADHD
  • Lent credence by the trend in their results for
    disorganized attachment to be more strongly
    associated with teacher-rated inattention than
    with hyperactivity

  • Small sample size
  • Half of the cohort had experienced a major trauma
    (stillbirth), whereas the other half had not
  • In depth clinical psychiatric examination
    specifically for ADHD and comorbid conditions was
    not included
  • Therefore, the conclusions can only be tentative

Clinical Implications
  • Attachment issues should be addressed in children
    presenting with disruptive behavior disorder, at
    least in those presenting with symptoms of ADHD
    that do not amount to full-blown clinical ADHD

Ladniers Massanaris (2000) Model
  • Based on theory and clinical experience
  • Noticed that many of their ADHD patients shared
    deficits in
  • ability to regulate emotions and behavior
  • ability to form healthy relationships with others
  • Consistent with the classic symptoms of an
    attachment-disordered child

Ladnier Massanari, 2000
  • Also noted that research has shown that a failure
    to form a secure attachment early in life, can
    result in cognitive, emotional, and behavioral
  • Hyperactivity
  • Impulsivity
  • Impaired social functioning

Ladnier Massanari, 2000
  • Sought to answer two questions
  • 1. Is there a causal connection between
    attachment failure and ADHD?
  • 2. Would it be possible to create a developmental
    model, based on attachment theory, that would
    provide a valid and credible explanation for the
    origin of ADHD and suggest a treatment plan that
    could offer a child more than temporary relief
    from symptoms?

Ladnier Massanari, 2000
  • Underlying belief that attachment trauma in early
    childhood results in developmental deficits
    which, in the absence of remedial parenting, are
    likely to be manifested as the symptoms of ADHD
  • The model can be most simply stated as the
  • Bonding breaks gt Attachment deficits gt Symptoms
    of ADHD
  • Bonding break is an event or combination of
    events that causes physiological trauma and
    developmental arrest and interferes with a
    childs opportunity to form a secure attachment
    with a caregiver

Ladnier Massanari, 2000
  • Begins with 3 major assumptions
  • 1. A child diagnosed with ADHD has experienced a
    bonding break(s) before the age of 2
  • 2. The bonding break(s) have interfered with the
    process of healthy attachment between child and
    caregiver and created developmental deficits in
    the child
  • 3. The family system the child grew up in was not
    healthy enough to overcome those deficits

Ladnier Massanari, 2000
  • Basic idea
  • The failure to attach to an adult caregiver as a
    result of a bonding break(s) results in
    psychological and physiological trauma
  • This trauma interferes with an infants
    neurological and hormonal maturation
  • This interference results in developmental delays
    (attachment deficits)
  • These delays are reflected in emotional and
    behavioral problems that are manifested in the
    symptoms of ADHD

Bonding Breaks
  • 4 Types
  • Prenatal Influences
  • Inattentive Caregivers
  • Situational Traumas
  • Faulty Parenting
  • Most experience a combination of bonding breaks,
    sequentially or simultaneously

Prenatal Influences
  • In typical development, a healthy newborn arrives
    in the world programmed to attach to a suitable
  • However, some newborns arrive in a state of
    distress and extreme hyperarousal. For example,
    premature babies babies that were exposed
    prenatally to chronic and acute levels of stress
    hormones or chemical compounds or toxins
  • These newborns are not programmed to seek out a
    caregiver because their state of emotional alarm
    prevents them from responding to attaching cues
    in their caregiver

Inattentive Caregivers
  • Occurs when a healthy infant is born to
    caregivers who fail to provide the minimum amount
    of warmth needed for attachment to occur
  • Do not provide behaviors such as eye contact,
    soothing words and touch, breast-feeding,
    holding, rocking and smiling
  • These behaviors are needed for attachment to
  • Inattentive caregivers neglect their infants
    because they are self-centered and lack empathy
    for others or because they lack sufficient info
    or motivation to provide the nurturance their
    infant needs

Situational Traumas
  • Includes a variety of conditions and events that
    occur outside the control of the primary
  • For example, premature babies, separation for
    caregiver due to death, or illness on the part of
    the parent or child

Faulty Parenting
  • Prevalent in home situations where the child
    experiences trauma that is very difficult, if not
    impossible, for him or her to overcome
  • These situations are typically characterized by
    the following
  • 1. Absence of a healthy relationship between two
    caring adults
  • 2. A pattern of exposure to yelling, criticism,
    sarcasm, and violence
  • 3. Parenting that lacks respect, discipline,
    structure and consistency

Attachment Deficits
  • Bonding breaks result in attachment deficits
  • characteristics that appear to be absent or
    underdeveloped in a child, as evidenced by
    emotions and behaviors that are developmentally
  • These deficits might correspond to specific
    regions of neural circuitry in a childs brain
    that have not developed normally because of early
    bonding breaks
  • Attachment Deficits are divided into two groups
  • Deficits in Self Regulation
  • Deficits in Relating Skills

Deficits in Self Regulation
  • Impulse Control
  • Self-soothing
  • Initiative
  • Perseverance
  • Patience
  • Inhibition

Deficits in Self-Relating Skills
  • Empathy
  • Trust
  • Affection
  • Reciprocity
  • Expression
  • Respect

Cycle of Conflict Between Caregiver and Child
  • Cycle perpetuates and worsens the symptoms of
  • Child experiences strong negative emotion (anger,
    fear, sadness)
  • Since the child lacks the capacity for
    self-soothing, impulse-control and expression, he
    or she attempts to connect with the parent
    through intrusive, demanding, attention-seeking
  • Parent begins to feel irritation and resentment
    and is unable to express empathy, affection or
    respect for the child

Cycle of Conflict Between Caregiver and Child
  • Parent responds by criticizing, threatening or
    hitting child
  • Child reacts by tuning the parent out and
    silently planning revenge or becomes defiant and
    coercive and raises the level of his acting-out
  • Parent feels angry and scared and either gives up
    and withdraws or raises the level of conflict in
    an effort to defeat the child.
  • Both child and parent are left frustrated and
    angry and determined to get even by winning the
    next fight

  • Treatment of choice should be family therapy
  • Children are not likely to make significant
    changes in their thoughts and behaviors without
    simultaneous changes in their family systems
  • Developed a model for family therapy based on
    corrective attachment theory, family systems
    theory, and cognitive and behavioral techniques

Engage the Primary Caregiver as Clients and
  • Parents Problems
  • Medication-Seeking Parent
  • Exhausted, Overwhelmed Parent
  • Guilty Parent
  • Cotherapists
  • Collect biopsychosocial info about the parents
  • Childs history
  • Outline basic goals and objectives of treatment
  • Listen to Parents Concerns

Formulate a Detailed Assessment of the Childs
  • Behavior
  • Feeling
  • Thinking
  • A child who does not form a secure attachment
    with a primary caregiver does not think the same
    thoughts as a healthy child
  • Distorted thoughts and delusional belief are a
    consequence of bonding breaks and attachment

Formulate a Detailed Assessment of the Childs
  • For example, a child that doesnt learn to trust
    will develop core beliefs such as
  • Adults are unreliable, unresponsive and
  • Being close to others is not pleasant
  • I must control others in order to be safe

Formulate a Detailed Assessment of the Childs
  • A child that doesnt receive the modulating
    responses he needs from a primary caregiver fails
    to learn self-regulation and may hold beliefs
    such as
  • I am not able to control myself
  • When I want something, I should not have to wait

Formulate a Detailed Assessment of the Childs
  • A child who lacks sufficient soothing interaction
    with a caregiver does not learn self-soothing and
    may be convinced that
  • Feelings are dangerous and should be avoided
  • Things that are not stimulating or pleasurable
    are a waste of time

Secure Family Environment and Remedial Parenting
  • Eliminate hitting, yelling, criticism, and
    sarcasm from family interactions
  • Create empathy, affection and respect
  • Communication
  • Create consist rules, roles, and routines
  • Establish limits and boundaries
  • Cooperation

Promote Interaction, Attunement, and Attachment
between Caregiver and Child
  • Teach specific ways to use physical contact to
    promote affection and trust between child and
  • Teach parent how to express empathy towards child
  • Teach playful interactions between child and

Access Collateral Therapies to Increase
Self-Regulation and Relating Skills
  • Group Therapy
  • EEG Biofeedback
  • Art and Play Therapy
  • Organized Sports
  • Medication
  • Last resort
  • Will only bring about temporary change, whereas
    other therapy, such as family therapy, will bring
    about more permanent change.

Access Collateral Therapies to Increase
Self-Regulation and Relating Skills
  • Medications cont.
  • Medications that maintain a state of lethargy or
    euphoria can hinder other types of therapy
  • However, there are cases where they must be used
  • Medication can improve symptoms, but cannot help
    in the reparation of the attachment deficits
    caused by bonding breaks between caregiver and

Problems with Model
  • Based on strictly clinical population
  • No research
  • Doesnt explain people with ADHD who came from
    healthy functioning families
  • Doesnt explain people who have experienced
    bonding breaks and come from unhealthy
    functioning families, but have not developed ADHD
  • Doesnt explain why some people can take
    medication only with no other form of
    intervention and lead healthy and fulfilling
  • Applied to any group with psychological problems

Stiefel, 1997
  • Emphasizes the detrimental role of early stress
    on the attachment relationship and that this
    could possibly lead to ADHD
  • Points out that not every child who experiences
    early stressors will develop ADHD
  • Claims that it is sequential patterns of
    interactional stress between the parent and child
    that hinders attachment and possibly leads to
    ADHD, rather then multiple one point in time

Stiefel, 1997 cont.
  • You can have multiple early life stressor, but if
    you have some intervening variable, such as
    psychosocial buffering and support, this can
    alleviate the stress and allow a healthy
    attachment relationship to develop and thus
    possible prevent the development of ADHD
  • If there are no intervening variables, and the
    stress continues, this is going to hinder the
    attachment relationship and possibly lead to ADHD
  • Therefore, if we can identify families who
    experience high levels of stress and then
    intervene, we can possible prevent ADHD from
    developing in some children

Reactive Attachment Disorder (RAD)
  • Attachment disorder characterized by disturbed
    and developmentally inappropriate social
    relatedness that begins before 5 years of age
  • Develops from a failure to form a healthy
    attachment with a primary caregiver as a result
    of severe early experiences of pathological care,
    such as extreme abuse and/or neglect
  • It is uncommon
  • Source American Psychiatric Association, 1994

Reactive Attachment Disorder cont.
  • Two types
  • Inhibited
  • Failure to initiate and respond to most social
    interactions in a developmentally appropriate
    way, as manifest by excessively inhibited,
    hypervigilant, or highly ambivalent and
    contradictory responses
  • Disinhibited
  • Indiscriminate sociability with marked inability
    to exhibit appropriate selective attachment
    (e.g., excessive familiarity with relative
    strangers or a lack of selectivity in choice of
    attachment figures)
  • Source American Psychiatric Association, 1994

Reactive Attachment Disorder
  • DSM-IV points out that the Disinhibited type must
    be distinguished from the impulsive or
    hyperactive behavior seen in ADHD
  • The disinhibited behavior in RAD is associated
    with attempting to form a social attachment after
    a very brief acquaintance
  • RAD is typically comorbid with other disorders,
    such as ODD and ADHD
  • Source American Psychiatric Association, 1994

Reactive Attachment Disorder
  • RAD diagnostic study that also looked at
  • Participants 40 RAD children, 5 - 8 yrs old
  • Assessed RAD symptoms with an18-item
  • Assessed ADHD with ?
  • Results
  • 68 of the RAD cases met criteria for ADHD
  • No children met criteria for ADHD but not RAD
  • Source Reactive Attachment Study, n.d.

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