Just the facts, Ma’am

I don’t like to argue. This “does RAD exist” argument tires me.  And the people shooting off the mouths, err, keyboards, seem to be full of opinions and no facts.  So, just the facts, Ma’am…. But in layman’s terms.

The diagnostic criteria for Reactive Attachment Disorder in the DSM-IV:, 1994, DSMV IV TR, 2000

A. Child has significant difficulties and developmentally inappropriate social interactions in most situations, beginning before age 5, and

B. Child does not have another issue such as mental disability or a pervasive developmental disorder to account for A.  

Type 1: Inhibited.  Consistent failure to respond in an appropriate fashion to social interactions, inhibited, watchfulness, avoidance, resisting comfort

Type 2: Disinhibited.  Indiscriminate sociability, Child does not show appropriate preference to known adults over strangers

C. History of care includes at least 1 of the following:

(1) Child’s basic emotional needs for comfort, stimulation and affection not met

(2) Child’s basic physical needs not met

(3) Repeated change of Child’s primary caregiver

D.  C is presumed to have caused A.

In the DSM-V, the diagnostic criteria focus solely on the former inhibited type.

A. Child shows emotionally withdrawn behavior towards adult caregivers, includes both of the following:

     (1) Child rarely or minimally seeks comfort when distressed

     (2) Child rarely or minimally responds to comfort when distressed

B.  Child shows social or emotional disturbance of at least 2 of the following:

    (1) Minimal social and emotional responsiveness to others

    (2) Limited positive affect

    (3) Episodes of unexplained irritability, sadness, or fearfulness

C. History of care includes at least 1 of the following:

    (1) Child’s basic emotional needs for comfort, stimulation and affection not met

    (2) Repeated change of Child’s primary caregiver

    (3) Raised in unusual setting that limited opportunities for form attachments (i.e. institution)

D.  C is presumed to have caused A.

E. Child does not have autism.

F. Child has signs of disturbance before 5 yrs of age.

G. The child has a developmental age of at least nine months.

And there you have it, instead of inhibited and disinhibited RAD, you now have RAD – formerly known as inhibited.  The RAD formerly known as disinhibited has a new name, it’s called: Disinhibited Social Engagement Disorder.  But the criteria looks oh so familiar:

DSED DIagnostic Criteria – DSM-V, 2013

A. A pattern of behavior where a child actively approaches and interacts with unfamiliar adults and exhibits at least 2 of the following:

     (1) Very little to no hesitation in approaching and interacting with strangers

     (2) Overly familiar behavior outside of age/cultural norms

     (3) Little to no awareness of where caregiver is, even in unfamiliar surroundings

     (4) Little to no hesitation to go off with unfamiliar adults

B. Behaviors are not caused by ADHD and are not limited to impulsivity.

C. History of care includes at least 1 of the following:

    (1) Child’s basic emotional needs for comfort, stimulation and affection not met

    (2) Repeated change of Child’s primary caregiver

    (3) Raised in unusual setting that limited opportunities for form attachments (i.e. institution)

D.  C is presumed to have caused A.

E. The child has a developmental age of at least nine months.

So there you have it.  Although the initial cause might be the same, the direction it takes is different and therefore treatment is different, hence the separation.  Does a name change really change the roots of it?  Obviously not, the criteria are listed identically.  Also, both are now listed under a new type as trauma and stress related disorders – a step in the right direction.  Neither definition, or diagnostic criterion, included the violence, or raging, or passive-aggressiveness that parents associate with our RAD kids, and didn’t before.  Our kids have an alphabet soup of diagnosis and we shorten it to RAD.  Primary, secondary, fifty-sixthary, whatever…. we just shorten it.  Those fall under different diagnosis for the sake of the pencil pushers and the insurance people and the ones who like to enter a bajillion numbers into spreadsheets… ODD, CD, IED, DID, BP, and a lot of other things that can piggy-back with this, genetic or otherwise.

Do you like my Gymnocarpae?  Or maybe you prefer my Hesperrhodos.  Be careful of the thorns as you admire the beautiful buds and breathe in that sweet fragrance.

-realmom

Advertisements

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s