Reactive Attachment Disorder

These guidelines offer evidence-based recommendations on psychotherapeutic and pharmacological interventions of reactive attachment disorder in children. The recommendations are intended to provide psychiatrists and mental health professionals with practical guidance and improve mental health outcomes for children with reactive attachment disorder and their caregivers.

·  Caregivers of children with RAD must be patient, remain positive, and have realistic expectations about what is achievable. It is also important that caregivers take care of their own mental and physical health and seek support from others where necessary (strong recommendation).

·  The most important part of management is to improve the child-carer relationship where this is possible and relevant. Developing a nurturing parent-child relationship is the cornerstone to overcoming the damage caused by severe neglect and abuse. Child individual psychotherapy will help them come to terms with an abusive parent and so improve their attachment security in relation to that person, by enabling them to talk about them in a balanced and coherent way (strong recommendation)

· Parenting skills classes: education for parents and caregivers about attachment styles, attachment disorders as well as other necessary parenting skills. Parent education focuses on developing positive, non-punitive behavior management strategies, ways of responding to nonverbal communication, anticipation and coping strategies for when triggers arise (conditional recommendation).

·  Comprehensive psychiatric evaluation and specific treatment plans developed by professionals including both individual and family interventions (strong recommendation).

· Multi-Disciplinary Approach: Effective treatment often involves a team of professionals, including clinical psychologists, psychiatrists, and social workers (conditional recommendations).

·  Child−parent psychotherapy focuses primarily on the caregiver’s and child’s experience of one another and on altering patterns of emotional communication in the dyad to improve the attachment bond. The therapist helps the caregiver to appreciate the emotional experience of the child and its connection to the emotional experience of the caregiver (conditional recommendation).

· Attachment-Based Family Therapy (ABFT): typical therapy for attachment problems includes both children and their caregivers. Therapy often involves fun and rewarding activities that enhance the attachment bond as well as help parents and other children in the family understand the symptoms of the disorder and effective interventions. Implementing ABFT in practice requires a comprehensive understanding of the family's attachment patterns, dynamics, and needs (conditional recommendation).

·  Play therapy. Help children to learn appropriate skills for interacting with peers and handling other social situations (conditional recommendation).

·  Special education services specifically designed programs within your child’s school can help them learn skills required for academic and social success, while also addressing behavioral and emotional difficulties (conditional recommendation).

· Secure Living Situation: Ensuring the child has a consistent and safe home environment is crucial. This may involve placement with foster parents or adoptive parents who can provide a nurturing and predictable environment. Avoiding as much as possible the transit of the child from one placement to another and from one caregiver to another, encouraging the most stable measures possible from the moment the child leaves his or her biological family (conditional recommendation).

·  Social Skills Interventions: These interventions help children learn appropriate social behaviors and interactions with peers (conditional recommendation).

· Trauma-Focused Therapies: For children with RAD who have experienced trauma, trauma-focused therapies such as Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) are crucial for processing traumatic memories and promoting healing (conditional recommendation).

·  Medication: While there is no specific medication for RAD, psychiatric medication is prescribed to address co-occurring conditions, such as depression or anxiety, if present (Strong recommendation).