Running head: A Review of “Attachment Theory and Reactive Attachment Disorder”
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A Review of “Attachment Theory and Reactive Attachment Disorder:
Theoretical Perspectives and Treatment Implications”
Lynons T. Hardy
Reviewed by
Jason J. Smith
University of New Brunswick
ED 6175
Running head: A Review of “Attachment Theory and Reactive Attachment Disorder”
Attachment Theory and Reactive Attachment Disorder: Theoretical Perspectives and Treatment Implications
The article Attachment Theory and Reactive Attachment Disorder: Theoretical Perspectives and Treatment
Implications written by Lyons T. Hardy is a rich article in helping professionals identify and treat Reactive
Attachment Disorder. As an administrator in a K-12 school, I have the opportunity to see students at entry level to
exit level and transition through the school from level to level. In the past several years we have had students enter
our system whose parents and grand-parents identified their children as ADHD or Autistic and were actively
seeking diagnosis from family physicians, pediatricians and psychologists as well as seeking the school to write
letters and referrals in order to gain support for their children. In the cases I am referring to, as an ESST team, we
believed the students were not on the Autism or ADHD spectrums; however, did believe that attachment disorder
was a possibility based on the intimate knowledge we had of the children’s birth, parenting and environment. The
following is a review of the suggestions for treating and working with youth who have been diagnosed as Reactive
Attachment Disorder challenged youth.
Treatment, Strategies, Techniques and Plans Proposed by Hardy
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Hanson and Spratt (as cited in Hardy, 2007, p. 33) suggest the following strategies, which are
based in working with children who’ve been maltreated as this is a main criterion for the diagnosis of
RAD, cognitive behavioral management of mood symptoms, behavioral modification, and
psychoeducation, support and coaching techniques with peer relationships, self-esteem and self-efficacy
intervention techniques, connecting the child to a health and supportive adult (such as a mentor), and
involving the care-giver in the treatment process (assuming healthy enough to do so) may lead to positive
treatment results. Hardy also cites psychotherapeutic models whereby the child develops a healthy
attachment to the therapist using play therapy. In addition, Marvin and Whelan (as cited in Hardy, 2007,
p. 33) suggest programs that target care-givers ability to understand the behavior of children with RAD
also benefit treatment. This last approach suggested is particularly useful for foster-parents or adoptive
parents, who might be very sensitive in forming healthy relationships but not have had success and have
been frustrated by the behavior. Interpreting and addressing the meaning behind the behavior will lead to
better adaptation. Other forms of therapy, depending on severity of the behavior, may include individual
psychotherapy, family therapy, occupational therapy, recreational therapy, and as well as special
education services (Hardy, 2007).
In a particular case study cited by Hardy (p. 35), a young man had been institutionalized and
provided with a number of aforementioned treatment strategies, however, it was argued that he did not
meet with success and due to violent-aggressive behavior was discharged to a group-home. It was
discovered that the behavior modification intervention and punitive approaches were not successful;
however, interventions targeted at understanding the meaning behind his behavior were. In addition, due
to the patient’s history, the setting itself with constant changes in adults and peers disabled the satisfaction
in his need for emotional closeness, likely triggering his behavior as this was one of his attachment
difficulties. It was concluded that he needed to be in a home setting with the same individuals for a
period of years. By examining this peculiar case, it seems to speak to the need of individualized
treatment, wrap-around services (where the members of the multidisciplinary team agree on treatment and
strategies), and home/community based treatment for optimal success. Furthermore, seeking to understand
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Running head: A Review of “Attachment Theory and Reactive Attachment Disorder”
the meaning behind the behavior would be far more productive in prescribing treatment. It is also
suggested that motivation training and social skill training be considerations in treating students
(especially in school based settings), as well as determining the type of behavior management intervention
to apply as well as type of “disciplinary action” (avoiding punitive measures if possible).
In conclusion, through all research cited or consulted in this paper, three themes have come to the
forefront in diagnosis and treatment of Reactive Attachment Disorder: first, it is admitted that diagnosing
RAD is not particularly easy as symptoms may be co-morbid with other disorders that may already be
diagnosed or are more readily diagnosed; secondly, families can learn and recover. Research seems to
indicate that slipping in and out of foster-care or group homes can be debilitating and sometimes worse
than the home the child was in. Institutionalizing can have the same impact, thus where possible, keep the
child at home (if the family demonstrates willingness to learn/change), in same community and school,
but build a model of treatment that is inclusive and collaborative whilst seeking to understand meaning
behind behavior and that healthy protective attachment does not have to be with the care giving adult in
order for success in treatment to occur. An additional element that surfaced was the age which this
disorder could be recognized and treated starting as early as birth. However, in this writer’s discernment,
it would appear that the longer unrecognized and untreated the more likely co-morbidity and diagnosis of
other disorders including ADHD, Conduct Disorder and Oppositional Defiant Disorder (to name a few
repeated seen) will occur.
In parting, two connecting ideas that presented themselves in connection towards adults that serve
children who suffer from Reactive Attachment Disorder come from narrative stories in the research such
as was cited by Hardy in his story of “John”. Sometimes transferability works both ways, thus adults
become affected by the behavior exhibited by children in a negative way end up through verbal and nonverbal expression reinforcing the child’s belief about attachment. The implication to adults would be that
they are in-check of their emotions/feelings and cues when they work with these children whether it be in
the capacity of care-giver, therapist, or educator. Tailor made plans, therapies, or strategies that work for
students who suffer from RAD will work if the people that designed and implemented understood the
meaning of the behavior and worked synergistically in unison towards the same goals.
Reference
Hardy, Lyons T. (2007). Attachment Theory and Reactive Attachment Disorder: Theoretical
Perspectives and Treatment Implications. Journal of Child & Adolescent Psychiatric
Nursing. Feb2007, Vol. 20 Issue 1, p27-39, 13p
Additional Sources
Hanson, R.F., & Spratt, E.G. (2000). Reactive attachment disorder: What we know about the
and implications for treatment. Child Maltreatment, 5, 137–145.
disorder
Marvin, R. S., &Whalen,W. E (2003). Disordered attachments:Toward evidence-based clinical practice.
Attachment & Human Development, 5, 283—288.
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