Last updated January 18, 2022

Assessment and Treatment of Children and Adolescents With Reactive Attachment Disorder and Disinhibited Social Engagement Disorder

Recommendations

For young children with a history of foster care, adoption, or institutional rearing, clinicians should inquire routinely about a) whether the child demonstrates attachment behaviors and b) whether the child is reticent with strangers. (CS)
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The clinician conducting a diagnostic assessment of RAD and DSED should obtain direct evidence from both a history of the child’s patterns of attachment behavior with his or her primary caregivers and observations of the child interacting with these caregivers. (CS)
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The clinician may be aided in making the diagnosis of RAD and DSED by a structured observational paradigm that compares the child’s behavior with familiar and unfamiliar adults. (OP)
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Clinicians should perform a comprehensive psychiatric assessment of children with RAD or DSED to determine the presence of comorbid disorders. (CS)
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The clinician should assess the safety of the current placement for previously maltreated children with negative behaviors who are at high risk for being re-traumatized. (CS)
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The most important intervention for young children diagnosed with RAD or DSED is ensuring that they are provided with an emotionally available attachment figure. (CS)
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For young children diagnosed with DSED, limiting contacts with noncaregiving adults may reduce signs of the disorder. (OP)
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Clinicians should recommend adjunctive interventions for children who display aggressive and/or oppositional behavior that is comorbid with DSED. (CS)
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Psychopharmacological interventions are not indicated for the core features of RAD or DSED. (NE)
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Clinicians should not administer interventions designed to enhance attachment that involve noncontingent physical restraint or coercion (e.g., “therapeutic holding” or “compression holding”), “reworking” of trauma (e.g., “rebirthing therapy”), or promotion of regression for “reattachment” because they have no empirical support and have been associated with serious harm, including death. (NE)
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Recommendation Grading

Overview

Title

Assessment and Treatment of Children and Adolescents With Reactive Attachment Disorder and Disinhibited Social Engagement Disorder

Authoring Organization

Publication Month/Year

August 24, 2016

Document Type

Guideline

External Publication Status

Published

Country of Publication

US

Inclusion Criteria

Female, Male, Adolescent, Child

Health Care Settings

Ambulatory, Childcare center, School

Intended Users

Psychologist

Scope

Assessment and screening, Management, Treatment

Diseases/Conditions (MeSH)

D019962 - Reactive Attachment Disorder, D012920 - Social Behavior Disorders

Keywords

reactive attachment disorder, disinhibited social engagement disorder, indiscriminate social behavior, indiscriminate friendliness