SpringerBriefs in Child Development

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1 SpringerBriefs in Child Development For further volumes:

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3 Daniel F. Shreeve Reactive Attachment Disorder A Case-Based Approach

4 Daniel F. Shreeve The Carilion Clinic Rehab Building 2017 South Jefferson Street Roanoke, VA 24014, USA ISSN X e-issn ISBN e-isbn DOI / Springer New York Dordrecht Heidelberg London Library of Congress Control Number: Springer Science+Business Media, LLC 2012 All rights reserved. This work may not be translated or copied in whole or in part without the written permission of the publisher (Springer Science+Business Media, LLC, 233 Spring Street, New York, NY 10013, USA), except for brief excerpts in connection with reviews or scholarly analysis. Use in connection with any form of information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed is forbidden. The use in this publication of trade names, trademarks, service marks, and similar terms, even if they are not identified as such, is not to be taken as an expression of opinion as to whether or not they are subject to proprietary rights. Printed on acid-free paper Springer is part of Springer Science+Business Media (

5 Acknowledgments I would like to thank my colleagues at Kennebec Behavioral Health Clinic in Waterville Maine, also at the Carilion Clinic in Roanoke, Virginia for their advice, suggestions, and encouragement during this project. I owe a particular debt to Gary Curtis, Child Psychologist, at Carilion Clinic for his critical reading of my manuscript and for his many helpful recommendations. For her excellent and steadfast support of the literature review, I am grateful to Jane Burnette, Hospital Librarian at Carilion Roanoke Hospital. I would also like to thank my wife Marikje Shreeve, Advanced Practice Nurse in Psychiatry, for her professional review of the many drafts, as well as for her patience and inspiration throughout the process of writing and revising. v

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7 Contents 1 Introduction... 1 Format of the Exercise... 1 What Is Attachment?... 2 The Place of Attachment in Nature... 3 The Process of Attachment in Early Childhood... 4 Definition of Reactive Attachment Disorder (RAD)... 6 Differential Diagnosis... 7 Comorbidity Vignette of Jorge Part 1: Jorge as a Toddler Case Point: International Adoption Part 2: Jorge at Preschool Age Case Point: Neglect, Growth, and Medical Problems Part 3: Jorge in Kindergarten Case Point: The Retrospective Evaluation of Child Abuse Part 4: Jorge in First Grade Case Point: Alexythymia and Attachment Part 5: Jorge in Second and Third Grades Case Point: Longitudinal Course and the Trait of Indiscriminate Friendliness Part 6: Jorge in fourth and fourth Grades Test #1: Case-Related Questions Theories for the Origin of RAD Part 1: Biological Basis Genetic Coding of Attachment Epigenetic Models Biological Effect of Maternal Stress Maturation and Lesions of Early Limbic Pathways Stress Tolerance and the Developing Brain Physiological Measurement of Attachment Disorder vii

8 viii Contents Part 2: Psychological Factors A Deficit Model The Application of Joint Attention to Attachment Avoidance and Detachment The Phenomenon of Shame The Impact of Trauma Part 3: Social Origins Attachment and Social Impairment Theory of Mind and the False Belief Test Anticipatory Interactive Planning A Discussion and Critique of RAD Therapy for RAD Test #2: Theory Questions B. Matching Section Appendix A Appendix B References About the Author... 85