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Report of the APSAC Task Force on Attachment Therapy, Reactive Attachment Disorder, and Attachment Problems

NCJ Number
Child Maltreatment Volume: 11 Issue: 1 Dated: February 2006 Pages: 76-89
Mark Chaffin; Rochelle Hanson; Benjamin E. Saunders; Todd Nichols; Douglas Barnett; Charles Zeanah; Lucy Berliner; Byron Egeland; Elana Newman; Tom Lyon; Elizabeth LeTourneau; Cindy Miller-Perrin
Date Published
February 2006
14 pages
This report presents the American Professional Society on the Abuse of Children's (APSAC's) position on the assessment, treatment, and management of children with "attachment disorder," which has also been endorsed by the American Psychological Association's Division 37 and the Division 37 Section on Child Maltreatment.
The APSAC's recommendations focus on the diagnosis and assessment of attachment problems in children, along with treatments and interventions as well as recommendations for child welfare agencies. Regarding diagnosis and assessment, the APSAC advises that attachment problems, including but extending beyond RAD, are an appropriate concern for professionals who work with maltreated children and should be carefully considered when these children are assessed. The term "attachment disorder" is not part of any accepted system for classifying behavioral or mental disorders; however, there is a narrower and better accepted condition called "reactive attachment disorder" (RAD), which is described in the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV). The core feature of RAD is severely inappropriate social relating that begins before age 5 years. RAD symptoms typically involve one of two extreme behaviors: indiscriminate and excessive attempts to receive comfort and affection from any available adult or extreme reluctance to initiate or accept comfort and affection, even from familiar adults, especially when distressed. RAD is one of the least researched and least understood disorders in the DSM. Although RAD and the concept of attachment disorder are poorly understood in the research field, controversial attachment therapies have emerged, some of which have resulted in the deaths of children being treated. This article presents the APSAC's assessment guidelines. Regarding treatment, the APSAC rejects therapies that involve physical coercion and restraint, physical domination of the child, the ventilation of rage, humiliation, and withholding or forcing food or water intake. Behavioral interventions that increase parental sensitivity are recommended. 64 references