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for a neuropsychological evaluation for longstanding inattention, learning difficulties, being socially and emotionally withdrawn, and suspected Autism Spectrum Disorder (ASD).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.

Revisiting the case for ‘feral’ humans under the light of the human self-domestication hypothesis

Historically, some cases of ‘feral’ children have been reported. Contemporary descriptions generally preclude any insightful inference about the nature and the extent of the language deficits exhibited by these children, as well as the ultimate causes of their problems with language. However, they have been regularly used to support the view that language acquisition requires a proper social environment in order to occur. In this paper, we revisit the case for ‘feral’ children with the viewpoint that human evolution entailed a process of self-domestication that parallels what we find in domesticated animals. Because feralization commonly occurs in nature and because it entails a partial reversion of features of domestication, this self-domestication approach to the evolution of language reassesses the case for ‘feral’ children, particularly when compared with present-day conditions involving abnormal patterns of socialization, whether they are genetically-triggered as in autism spectrum disorder, or environmentally-triggered, as in reactive attachment disorder. Overall, the structural and functional language deficits observed in these human groups emerge as useful proxies for previous stages in the evolution of language(s) under the influence of human self-domestication.

A boy who could not be comforted

Reactive attachment disorder (RAD) is a rare disorder occurring in young children who have experienced extremely insufficient care and have been deprived of the opportunity to form a secure attachment with a reliable caregiver. Children with RAD exhibit inhibited, emotionally withdrawn behavior toward caregivers, rarely seeking and responding to comfort when distressed. They may also have minimal social and emotional responsiveness to others, limited positive affect, and episodes of unexplained irritability, sadness, or fearfulness. Symptoms must begin prior to the age of five years. There are no medication treatments for RAD; however, psychiatric comorbidities may benefit from psychopharmacology. The single effective treatment for RAD is placing the child in an environment where they have the opportunity to form a selective attachment to a caregiver. Symptoms of RAD may completely resolve if this occurs.

REACTIVE ATTACHMENT DISORDER AS A DERMINANT OF VICTIM BEHAVIOR OF MINORS

The article is devoted to the consideration of the correlation between reactive attachment disorder and victim behavior of a minor. The author considers the main types of such a disorder and, depending on them, differentiates the type of victim of a criminal offense. It is noted that the lack of close emotional connection with the mother leads to a simplification of the worldview and destructive changes in the set of moral values. A child who is brought up in harsh conditions and placed in a certain framework gradually begins to feel discomfort, due to the inability to understand their place and role in family life, a value for their own parents. Such a situation can have two probable scenarios of further development: the first – the child will shut himself in and consider himself unworthy of the environment, friendship, love and recognition; second, the child will seek a spiritual replacement for parental love, and therefore will become vulnerable to people who will show affection and interest. It is pointed out that the formation in the mind of a juvenile victim of a criminal offense of the correct reaction to the wrongful influence and the generation of an adequate conditioned reflex to its negative consequences can be achieved by visualizing and gradually consolidating certain guidelines that form the algorithm necessary to avoid victimization. It turns out that the main reason for the victimization of such children is the emphasized protective compensation, which is aimed at overcoming the psychological trauma caused by dissatisfaction with the relationship with the mother. Adolescents who suffer from this type of disorder subconsciously seek to become victims, their behavior encouraging illegal influence. It is concluded that reactive attachment disorder can be considered an independent and full-fledged determinant of victim behavior of a minor. Disorders of reactive attachment can negatively affect several areas of adolescent life: emotional and volitional; intellectual; psychological. To date, the victim behavior of adolescents suffering from RAD is infantile (regressive), stimulating (fictitious-provoking) or situational. The reasons for victimization of such adolescents are their conformity, as well as transformational processes in the mind, caused by the wrong approach of parents to interact with their own children.

Mental health and use of health care services in opioid-exposed school-aged children compared to foster children

Given the concerns raised regarding the effects of prenatal exposure to methadone and buprenorphine on the developmental outcomes of the children, this study assessed mental health and use of services in a national sample of school-aged children (N = 78) born to women enrolled in opioid maintenance treatment during pregnancy, compared with a group of foster children (N = 140). The majority of the opioid-exposed children lived with their birth parent(s) at the time of assessment (N = 62), while 16 lived in foster homes. Caregivers completed the Strengths and Difficulties Questionnaire (SDQ) and the Reactive Attachment Disorder scale. Teachers completed the SDQ. Three kinds of services were included in measuring service use: school-based education services, child mental health services, and hospital-based habilitation services. The main finding of the study is that children prenatally exposed to methadone or buprenorphine living with their family of origin had significantly better mental health status than their foster-placed counterparts and that of the comparison group of foster children. In addition, the exposed children living at home had less child welfare involvement, and only half of them were using any of the three services measured. The odds for using services increased significantly in accordance with increasing mental health problems, independent of group affiliation, indicating a need-based access to services. In line with other studies, we found that the odds for using one or more services was 2.3 times greater for boys than for girls. Our results contribute to a more-nuanced understanding of the developmental outcomes of prenatal exposure to methadone and buprenorphine, and factors associated with increased service use in groups of at-risk children.