A-86 Reactive Attachment Disorder in Adulthood: A Neuropsychological Perspective

Objective The sequelae of poor attachment and trauma on psychological and social functioning is well documented, however, this complex relationship applied to a neuropsychological profile is less understood. The current case uses a neuropsychological assessment to further understand the brain-behavior relationship in a case of poor maternal attachment, multiple traumas, psychiatric comorbidities, and poor social adaptation. Method Patient is a 22-year-old, right-handed, Eastern European woman with fetal alcohol and infant toxic mold exposure, failure to thrive, maternal neglect, adoption and relocation to the United States (age four), posttraumatic stress disorder (PTSD; multiple reported sexual traumas and bullying victimization), and depression. Referred for a neuropsychological evaluation for longstanding inattention, learning difficulties, being socially and emotionally withdrawn, and suspected Autism Spectrum Disorder (ASD). Results Data revealed average intellectual ability, dyscalculia, Attention Deficit Hyperactivity Disorder (ADHD), PTSD, and depression. A self-report measure of ASD revealed a strong perception of ASD, characterized by inability to read verbal cues or other’s emotions, and poor communication and self-expression, however, this diagnosis was not supported by formal assessment and behavioral observations; instead, it was determined a diagnosis of Reactive Attachment Disorder (RAD). Conclusions This case provides an example of the complex interplay of poor maternal–infant bonding coupled by adolescent trauma on adult attachment style and compromised social interactions. More specifically, the case addresses the poly-etiologic and neuropsychological impact of an insecure attachment style and trauma on self-perceptions of social and emotional withdrawal commonly seen in ASD. The case further stresses the overlapping presentations RAD, ADHD, learning disabilities, and psychiatric comorbidities.