Reactive Attachment Disorder - Coursework Example

Reactive Attachment Disorder The Reactive Attachment Disorder (RAD) is one of the most unnoticed disorder around the world and is not given much attention till date. The disorder is form of a mental and social disorder which effects the overall health of the person affected. Normally, it is observed in children at the age of five. However, it is only found to be present in less than 1% of the children. RAD, in clinical literature, is described as intense or relatively uncommon attachment disorder which can have extremely negative consequences for a child in his developmental stages. Despite the unpopularity of any considerable research being done on it psychologists have come up with several interventions to treat it in the most effective manner. One of these interventions is Dyadic Developmental Psychotherapy, a mental treatment done in an environment which has adequate control over the patients’ dysregulation. The paper further elaborates the clinical issues, types of interventions used, and their modification in reference to this particular disorder. Clinical Issues: Dyadic Developmental Psychotherapy is used to treat children who are experiencing reactive attachment disorder (DSM-IV) and complex trauma. The mental health diagnosis which will be discussed is the 313.89 Reactive Attachment Disorder of Infancy or Early Childhood. Parental pathology, life-threatening illness during the pregnancy, multiple caretakers of the infant can harm the attachment process of the baby to develop with its parents. (Reid et al, 1997) There are several cases in which such disorder may emerge. A child undergone through parental neglect, continuous change of caregivers, or physical abuse may develop this illness. (Hall & Geher, 2003). However there are other causes cannot be much controlled by human beings, like the pre-mature birth of the baby. Generally, prematurity requires isolating the baby by keeping it in incubator where the baby is provided with necessary and life-sustaining care. Normally, this is the time when the baby requires most care from its parents but due to these circumstances it becomes difficult for the parents of the baby to spend their time with the infant. According to the book on The Treatment of Psychiatric Disorders: Premature infants without consistent caring adult may be irritable, fail to thrive, or have increasing organic problems. In response to that many hospitals now are increasingly practicing prevention procedures to stop this illness at the foremost stage. These prevention techniques include avoiding loud noises in the room where the baby is kept and ensuring that the light is not too bright. According to Goodfriend “the attachment needs of the premature infants are not well known, but there is an evidence of an interactive system even in premature infants. (Goodfriend, 1993) The symptoms of this diagnosis may include weak crying response from the infant, tactile defensiveness, or a failure to thrive, all these behaviors indicate an alarming situation for the mental health of the infant. (Kenny et al, 2013) The most effective intervention used for this type of illness is the inpatient intervention (treatment while being hospitalized). According to Journal of psychiatric Research, the in-patient mother and baby units (MBUs) provide the opportunity to the mothers in developing their relationship with their infants in order to minimize this issue. (Kenny et al, 2013) Description of Intervention: O’Connor and Zeanah (2003) compiled all the existing treatments into four groups: holding therapies, attachment based interventions, family support and training, and socio- cognitive interventions. Inpatient intervention is normally used in severe cases for example the separation between mother and infant as a consequence to premature birth. Since, inpatient intervention requires a combined effort of the entire hospital staff and nurses, to sustain normality in the infant, this type of intervention is most expensive and generally approached by a middle to high class population. Secondly, there is no age limit specified for this intervention except the condition that it is only undertaken in severe cases. However, it is recommended that inpatient intervention should be consulted when all the other community based options have failed or in the event of danger of harm to self or others. Many families resist this type of intervention they do not feel comfortable with the idea of keeping their infants and children hospitalized for a longer period. There are no gender differences in this intervention. Apparently, the result of this type of intervention are difficult to measure but the video feedback intervention solves this problem as well. In this particular type of intervention the mother interacts with her child and a video tapes all these interaction along with the infant passiveness, and cooperativeness. According to the book on The Treatment of Psychiatric Disorders, “Inpatient interventions for the baby include nutritional habilitation, stimulation, and emotional care.” This type of intervention is beneficial for both the mother and the baby, as the baby who is responding to the treatment increases the somatic growth and affective responses. On the other hand, the mother feels less lonely and more hopeful. It is also recommended for mothers to give massage to the infants as that helps in developing an organized behavior in the infants in later age. Many hospitals provide the inpatient intervention which includes the educating parents how to interact and understand the verbal as well as non-verbal signs of their child. This type of intervention is usually undertaken for children who are under 5 years or infants with cases like pre-mature birth. A technique to build supportive therapy to the mothers has proved to be somewhat effective. Robinson (2003) discussed that through this technique the attachment of the infant increased however there was no considerable change in the maternal sensitivity. Yet, follow-up observations at age three discovered enduring effects of this technique. Evaluation of the Intervention: Considering the extremely sensitive condition of an infant who is born prematurely the inpatient intervention can be the most effective treatment for infants with reactive attachment disorder. Since the child is in incubator so it becomes difficult for frequent parental interaction as compared to the interaction a normal healthy baby has with his/her parents. The techniques used in the intervention not only increase the attachment of the kid with his/her mother but also the mother’s attachment increases. Moreover, since the illness is treated in the early stage so chances of emergence of negative behaviors in later age are decreased to much extent. Moreover, with the presence of mother the child starts to develop a bond and the symptoms begin to decrease like frozen gestures and less crying of the baby. However, inpatient intervention is taken place at the hospital so it may be inconvenient for the parent to visit regularly. Plus, the time given to the infant is still not compensated compared to the time a normal infant gets by staying with the parents 24 hours so this might inhibit the developmental activity to some extent. The intervention encourages the mother and child interaction by physical as well as visual and audible interactions. Physical interaction is very important in the early stage as it gives the child a feeling of security, love, and care which is crucial for the development of mother and child attachment. Modification to Intervention: The intervention can be made more culturally competent by giving the hospital staff and nurses a proper training on how to interact with people from diverse cultures so that culturally restricted people do not feel comfortable, rather feel secure to trust the hospital staff with their infant. (Beach et al, 2005) The intervention can be improved by treating the illness at home with careful and frequent follow ups by the nurses or clinic staff to ensure that everything is being done rightly. Also, in this way the child will be in the company of his parents 24 hours and so it will reduce any inconvenience for the mother to come to the hospital regularly. Secondly, some cultures do not allow women to go out of homes so frequently, also there are some places, especially in the rural regions, where hospitals are faraway in the urban regions so it becomes difficult to carry out this intervention. Therefore, a residential intervention should also be adopted for children with premature birth. It is important to maintain a bond-sensitivity for hospital staff. Since, the child also interacts with the hospital staff and nurses during the intervention therefore the hospital should adopt policies for the staff to build positive relationship with the child by ensuring child’s security during the process. Work Cited American Psychiatric Association (2010). Reactive attachment disorder: A review for DSM-V. http://www.dsm5.org/Proposed%20Revision%20Attachments/APA%20DSM- 5%20Reactive%20Attachment%20Disorder%20Review.pdf Beach, M. C., Price, E. G., Gary, T. L., Robinson, K. A., Gozu, A., Palacio, A., ... & Cooper, L. A. (2005). Cultural competency: a systematic review of health care provider educational interventions. Medical care, 43(4), 356. Kenny, M., Conroy, S., Pariante, C. M., Seneviratne, G., & Pawlby, S. (2013). Mother–infant interaction in mother and baby unit patients: Before and after treatment. Journal of Psychiatric Research, 47(9), 1192-1198. King, M. C. (n.d.). Reactive Attachment Disorder: A Review . Reactive Disorder . Retrieved June 6, 2014, from http://www.lynchburg.edu/sites/default/files/documents/GraduateStudies/Lynchburg%20College%20Journal%20of%20Special%20Education/Volume%201-4%20PDF%20Articles/KingM%20-%20Reactive%20Attachment%20Disorder%20-%20A%20Review.pdf Parent Child Interactional Training: Online Manual for clinicians http://pcit.phhp.ufl.edu/Presentations/PCIT%20Integrity%20Checklists%20and%20Materials%204-13-06.pdf Reid, W. H., Balis, G. U., & Sutton, B. J. (1997). The treatment of psychiatric disorders (3rd ed.). Bristol, PA: Brunner/Mazel. Read More