Assessment and Treatment of Children and Adolescents With Reactive Attachment Disorder and Disinhibited Social Engagement Disorder
Publication Date: August 24, 2016
Last Updated: March 14, 2022
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
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Overview
Title
Assessment and Treatment of Children and Adolescents With Reactive Attachment Disorder and Disinhibited Social Engagement Disorder
Authoring Organization
American Academy of Child and Adolescent Psychiatry
Publication Month/Year
August 24, 2016
Last Updated Month/Year
August 1, 2023
Document Type
Guideline
External Publication Status
Published
Country of Publication
US
Inclusion Criteria
Male, Female, Adolescent, Child
Health Care Settings
Ambulatory, Childcare center, School
Intended Users
Nurse, nurse practitioner, physician, physician assistant, psychologist
Scope
Assessment and screening, Treatment, Management
Diseases/Conditions (MeSH)
D019962 - Reactive Attachment Disorder, D012920 - Social Behavior Disorders
Keywords
reactive attachment disorder, disinhibited social engagement disorder, indiscriminate social behavior, indiscriminate friendliness
Methodology
Number of Source Documents
116
Literature Search Start Date
January 1, 1998
Literature Search End Date
June 15, 2016