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TOPIC: Attachment theory and reactive attachment disorder (RAD).
PURPOSE: To highlight current perspectives on attachment theory, RAD, and treatment implications using a case study of an 8-year-old patient with RAD.
SOURCES: Selected multidisciplinary literature related to attachment theory and RAD.
CONCLUSIONS: The literature provides a body of work that substantiates the importance of early attachment relationships to human development and highlights gaps in our knowledge related to treatment of children with RAD. The quality of early attachment relationships is correlated with future personality and brain development. Attachment disturbances are associated with psychopathology in childhood and adulthood. Although evidence for the effective treatment of children with attachment disorders is minimal and inconclusive, the two major perspectives, developmental psychology and neuropsychoanalysis, offer guidelines for practice.
Search terms: Attachment theory, attachment, attachment disorders, reactive attachment disorder, RAD, child psychiatry, psychiatric treatment
History and Evolution of Attachment Theory
Attachment theory was developed by John Bowlby in the 1960s. Bowlby was a psychoanalyst who began to focus on a child's early relationship with the primary caregiver as the most important predictor of the child's future personality development. This position contrasted with the classic Freudian psychoanalytic view, which generally looked backward from adult neurosis to determine the instinctual conflicts that had originated in childhood. Bowlby was the first to suggest that information about a person's future interpersonal relationships could be predicted by looking forward from the early ones. Ainsworth, Blehar, Waters and Wall (1978) state that Bowlby's ideas constituted a paradigm shift in developmental psychology, and indeed, attachment theory has been extremely influential on current thought in psychiatry, psychology, and related fields.
Attachment theory suggests that infants are evolutionarily primed to form a close, enduring, dependent bond on a primary caregiver beginning in the first moments of life. The vulnerability of the infant requires that care be provided by an adult, and the infant's behaviors and inherent faculties ensure that a bond will be created. Infants attend to human voices, recognize human faces, and gaze into parents' eyes when being fed. They look to the attachment object for cues when faced with novel stimuli. The fulfillment of their physiological needs requires close and frequent physical contact throughout infancy (Carlson, Sampson, & Sroufe, 2003). As they develop the capacity for locomotion...