View Full Version : What are the differences between ADHD Spectrum and RAD Spectrum ?


Peripheral
11-12-11, 04:33 PM
I really have a hard time understanding the differences between ADHD(AttentionDeficit Hyperactivity Disorder) and RAD or DAD(Reactive Attachment Disorder).



Is the only difference between ADHD and RAD at least one Adult in the life of a child who develops RAD (DAD)?



Would people with RAD have ADHD if they had a parent?



I can't see it any other way?


Input?








GBYR

Dizfriz
11-12-11, 06:19 PM
I really have a hard time understanding the differences between ADHD(AttentionDeficit Hyperactivity Disorder) and RAD or DAD(Reactive Attachment Disorder).

Let me try.

Is the only difference between ADHD and RAD at least one Adult in the life of a child who develops RAD (DAD)? There is a huge difference between ADHD and RAD. RAD (Reactive Attachment Disorder) is a very specific diagnosis and has to do with a pathological level of care when very young. Many show characteristics of ADHD but not necessarily so.

Some of this is that the parents could be ADHD or perhaps bipolar resulting is the pathological care methods resulting in RAD. Both ADHD and bipolar have a strong genetic factor and both could be passed on to the children but that is not what causes RAD.

Selected from the DSM (with comments by me)

The essential feature of Reactive Attachment Disorder is markedly disturbed and developmentally inappropriate social relatedness in most contexts that begins before age 5 years and is associated with grossly pathological care (Criterion A). The DSM defines pathological care with the following description:

By definition, the condition is associated with grossly pathological care that may take the form of persistent disregard of the child's basic emotional needs for comfort, stimulation, and affection (Criterion C1);

persistent disregard of the child's basic physical needs (Criterion C2);

or repeated changes of primary caregiver that prevent formation of stable attachments (e.g., frequent changes in foster care) (Criterion C3). This is not a condition that results in ADHD. Many ADHD kids have wonderful attentive parents and caregivers. RAD kids don't.

Just to get the details right:

There are two types of presentations.

In the Inhibited Type, the child persistently fails to initiate and to respond to most social interactions in a developmentally appropriate way. The child shows a pattern of excessively inhibited, hypervigilant, or highly ambivalent responses (e.g., frozen watchfulness, resistance to comfort, or a mixture of approach and avoidance) (Criterion A1).

In the Disinhibited Type, there is a pattern of diffuse attachments. The child exhibits indiscriminate sociability or a lack of selectivity in the choice of attachment figures (Criterion A2).

By definition, the condition is associated with grossly pathological care that may take the form of persistent disregard of the child's basic emotional needs for comfort, stimulation, and affection (Criterion C1);


The pathological care is presumed to be responsible for the disturbed social relatedness (Criterion D). The important part in the next section (at least to me):

However, grossly pathological care does not always result in the development of Reactive Attachment Disorder; some children may form stable attachments and social relationships even in the face of marked neglect or abuse. In reference to your questions of RAD and ADHD:

The Disinhibited Type must be distinguished from the impulsive or hyperactive behavior characteristic of Attention-Deficit/Hyperactivity Disorder. In contrast to Attention-Deficit/Hyperactivity Disorder, the disinhibited behavior in Reactive Attachment Disorder is characteristically associated with attempting to form a social attachment after a very brief acquaintance. Here are the basic criteria for RAD from the DSM-IV:

DIAGNOSTIC CRITERIA FOR 313.89 REACTIVE ATTACHMENT DISORDER OF INFANCY OR EARLY CHILDHOOD

A. Markedly disturbed and developmentally inappropriate social relatedness in most contexts, beginning before age 5 years, as evidenced by either (1) or (2):

(1) persistent failure to initiate or respond in a developmentally appropriate fashion to most social interactions, as manifest by excessively inhibited, hypervigilant, or highly ambivalent and contradictory responses (e.g., the child may respond to caregivers with a mixture of approach, avoidance, and resistance to comforting, or may exhibit frozen watchfulness)

(2) diffuse attachments as manifest by indiscriminate sociability with marked inability to exhibit appropriate selective attachments (e.g., excessive familiarity with relative strangers or lack of selectivity in choice of attachment figures) B. The disturbance in Criterion A is not accounted for solely by developmental delay (as in Mental Retardation) and does not meet criteria for a Pervasive Developmental Disorder.

C. Pathogenic care as evidenced by at least one of the following:

(1) persistent disregard of the child's basic emotional needs for comfort, stimulation, and affection

(2) persistent disregard of the child's basic physical needs

(3) repeated changes of primary caregiver that prevent formation of stable attachments (e.g., frequent changes in foster care)

D. There is a presumption that the care in Criterion C is responsible for the disturbed behavior in Criterion A (e.g., the disturbances in Criterion A began following the pathogenic care in Criterion C). Specify type: In recap, RAD is a very specific diagnosis and has little relation to ADHD although a child could be both ADHD and RAD. ADHD must be ruled out as a cause of the RAD behaviors so they are, by definition separate. In other words,ADHD cannot cause RAD and RAD cannot cause ADHD.

I have presented, would you believe, a simplified post on the subject. RAD is not simple to explain but it is very real. There have been a number of books written on the subject and if anyone wants to get deeper into this, then the books need to be read.

The rest of your questions seem to be based on a misunderstanding of RAD. Perhaps what I posted may be of some help in understanding the disorder.

Just a detail but the proposed DSM5 is revising RAD and giving two separate diagnosis but the dynamics are not changed.

Take care,

Dizfriz


Is the only difference between ADHD and RAD at least one Adult in the life of a child who develops RAD (DAD)?

Would people with RAD have ADHD if they had a parent?

I can't see it any other way?

Input?


GBYR

LynneC
11-12-11, 07:05 PM
Geronimoo, Dizfriz has given a clear explanation of RAD, I think.

Another way to think about it is that RAD does not have any genetic predisposition. You see RAD frequently in adopted children who had a very traumatic early life prior to adoption. (I'm just using this as an example; RAD can also occur with a child who is still with his/her birth parents)

ADHD can accompany RAD, but it doesn't necessarily...

Most kids with ADHD do not have RAD...