PSYC 3F20: January 20, 2013
Reactive Attachment Disorder
Case of David
9 yearold boy currently residing in a foster home.
Father was physically and verbally abusive towards mother, leading to separation.
He has been accused of stalking mother, and a restraining order placed on him.
Mother had full custody but gave David to grandparents because she could not
manage his behaviour.
Kinship arrangement did not work out, so David was placed in foster home and
recently made a Crown Ward of CAS.
Regular visits with father, grandmother and aunt, but only occasional visits with
mother. However, David reports feeling unsafe during visits with father.
Case of David – continued (at school)
At school, there are a number of behavioural/safety concerns about David,
including aggressive behaviour toward staff and peers and physically dangerous
For example, recently did several thousand dollars of damage to school
Just prior to this incident, he had been declared a Crown Ward (which he
found confusing), had been told he could not go on a class trip, and Aunt
wanted to stop his visits due to his behaviour.
RAD: Diagnostic Criteria
A. Consistent pattern of inhibited, emotionally withdrawn behavior toward adult
caregivers including both 1 and 2
1. Child rarely of minimally seeks comfort when distressed
2. Child rarely/ minimally responds to comfort when distressed
B. A persistent social and emotional disturbance characterized by at least two of the
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
C. The child has experienced a pattern of extremes of insufficient care as evidenced
by at least 1 of the following:
1. Social neglect or deprivation in the form of having basic emotional needs
for comfort, stimulation, and affection met
2. Repeated changes of primary caregivers that limit opportunities to form
3. Rearing in unusual settings that severely limit opportunities to form
4. Care in Criterion C presumed responsible for Criterion A
E,F,G: Rule out Autism; emerges before 5; must be at least 9 months of age Attachment Behavioral System
• Works like a thermostat (a control system)
• Attachment behavioral system regulates “felt security”
• When “felt security” is low, attachment behavior is activated (things like crying,
following, smiling, vocalizing), exploratory behavior is deactivated
• Attachment behavior intended to increase proximity to, and gain support from, the
• If caregiver responds sensitively in meeting child’s needs, felt security is restored
and attachment behavior ceases and exploratory behavior can continue (ex.
interacting with other children/adults, manipulating things in environment,
• A dynamic in the parentchild relationship
• Strange situation is used to assess individual differences in attachment security
• Procedure is intended to be mildly stressful to the infant as a result of a) the
unfamiliar setting; b) the presence of a stranger; and c) two separations from the
• These stressors are likely to activate attachment behavior (ex. crying, contact
seeking); may also view balance between exploratory and attachment behavior
o Attachment behavior is only activated when child is stressed
Strange Situation Procedure
1. Parent and infant are alone. Parent does not participate while infant
2. Parent and infant are introduced to the experimental room.
3. Stranger enters, converses with parent, then approaches infant. Parent
4. First separation episode: Stranger's behavior is geared to that of infant.
5. First reunion episode: Parent greets and comforts infant, then leaves again.
6. Second separation episode: Infant is alone.
7. Continuation of second separation episode: Stranger enters and gears
behavior to that of infant.
8. Second reunion episode: Parent enters, greets infant, and picks up infant;
stranger leaves inconspicuously.
Most important thing to observe is the “reunion”
• Pattern B (Secure)
o Seek contact when distressed and easily comforted; use caregiver as
secure base during exploration (ex. playing and turning to show mother
• Pattern A (Avoidant) o Avoidance during reunion; independent exploration (ex. avoids caregiver
and self soothes; ex. no interaction with caregiver during exploration)
• Pattern C (Ambivalent; resistant)
o Mix contact seeking with resistance; difficulty settling upon reunion;
poverty of exploration (ex. allow themselves to be picked up but not easily
soothed, ex. more likely to be clingy and not engage in exploratory
• Disorganized Attachment
o Unpredictable response to stress
o Bizarre, freezing, contradictory, incoherent (ex. child dashes to parent
during reunion then stops and turns to wall, ex. child moves very slowly or
freezes; ex. showing preference to stranger)
Attachment and Psychopathology
• Avoidant and disorganized attachment associated with aggression
• Insecure ambivalent attachment predicts greater likelihood of anxiety disorders
• Avoidant and ambivalent groups more likely to experience depression
• Correlation between disorganized attachment in infancy and number of
psychiatric symptoms at 17 was .40
• Disorganized attachment in infancy associated with dissociation in adolescence
and young adulthood
• Now characterized as one of the trauma and stressor related disorder (was
previously in diagnosis that first appear in childhood and adolescence)
Why does attachment insecurity predict psychopathology?
• Unresponsive, insensitive, frightening caregiving gives rise to internal working
models which lead to increased emotional reactions to stress, avoidance of close
social relationships, and reduced use of support seeking as a coping method
Parenting and Individual Differences in Attachment Security
• Based on home observations prior to attachment classification in Strange
o Observed interactions during play and eating at 3 and 6 months before
classifying attachment security at 12 and 18 months
• Maternal availability, responsiveness and sensitivity regarded as essential to
o Appropriate and prompt responses to infant signals
o Frequent, sustained physical contact between mother and infants
o Environment regulated to allow infant to develop a sense of the
consequences of her own actions • Linked with anxiety (future oriented) ▯when distress signals are not responded to
and they receive no comfort, they become fearful and have difficulty coping with
• Internal working models ▯learning whether getting social support from people is
• Children may interpret that something is wrong with them (self concept)
Caregiving and Disorganized Attachment
• Disorganized attachment stems from frightened or frightening parenting, in which
child experiences fright without solution
o Ex. parent speaks in haunting voice, freezes; parent hisses or growls at
child; parent appears frightened of child
Attachment and Internal Working Models