Talk:Reactive attachment disorder/Archive 1

I have removed the entire previous article and replaced it with the current Wiki article. The reason why I have done this is because the previous article was 'owned' and controlled by an editor who used at least 5 socks to own and control attachment related pages on Wiki for over a year. The apparent purpose for this was to obfuscate the nature of 'attachment therapy', promote attachment therapy views and definitions of attachment and, above all, advertise an obscure form of attachment therapy called 'Dyadic Developmental Psychotherapy'. The editor concerned, User:DPeterson has been banned for one year after ArbCom proceedings and his 5 socks, User:RalphLender, User:SamDavidson, User:JohnsonRon, User:JonesRD and User:MarkWood have been banned from Wiki indefinitely. Fainites See []16:35, 17 September 2007 (UTC)

Warning
To all professional and other readers of pages relating to attachment, its theory, disorders and therapies. Also complex post traumatic stress disorder and emotional dysregulation in children. All these pages and topics on Wikipedia were, until a recent arbitration, dominated by an army of sockpuppets promoting an attachment therapy theoretical base, diagnosis and treatments. "Attachment therapy" is a largely American based, non-mainstream, unvalidated and highly controversial form of therapy for children, frequently adopted or fostered children. Following arbitration in July and August 2007 the sockpuppets were banned. However it is likely that similar attempts will be made to promote the same views and therapies on Psychology Wikia. The promotion included misrepresentation and misquotation of sources, edits designed to obscure the nature or even existence of attachment therapy, smear campaigns against opponents, edit warring and mass sockpuppetry to achieve fake 'consensus'. Anybody reading these pages would be well advised to be cautious and to consult reputable sources on the subject such as the Taskforce Report commissioned by the American Professional Society on the Abuse of Children (APSAC) on Attachment Therapy, Reactive Attachment Disorder, and Attachment Problems. This report was compiled by Mark Chaffin, Rochelle Hanson, Benjamin E. Saunders, Todd Nichols, Douglas Barnett, Charles Zeanah, Lucy Berliner, Byron Egeland, Elana Newman, Tom Lyon, Elizabeth Letourneau and Cindy Miller-Perrin and covers the whole topic. Also the follow up letters and the Taskforce Reply to Letters. Other reputable sources include a special issue of Attachment & Human Development devoted to the subject, at September 2003, vol. 5, issue 3, pp219-326 by Zeannah and O'Connor, a 2006 publication by the Royal College of Psychiatrists Research and Training Unit (Jessica Kingsley Publishers) called "Understanding Attachment and Attachment Disorders" by Vivien Prior and Danya Glaser  and "Enhancing Early Attachments" edited by Lisa Berlin, Yair Ziv, Lisa Amaya Jackson and Mark T. Greenberg, part of the Duke series in Child Development and Public Policy, with particular reference to the chapter at p.313 by Thomas O'Connor and Wendy Nilson.Fainites 15:11, 20 September 2007 (UTC)

Somewhat extreme claims have just been inserted into this article stating DDP is 'evidence based', the study is 'important' and that it shows that "usual treatments" for RAD are ineffective. These are rather extreme claims and require a very sound evidential foundation. Certainly more than one study cited by its author. Particularly when the methodology was criticised by the authors of the Taskforce report in their Reply and they specifically stated it fell far short of meeting criteria for designation as evidence based.Fainites 23:01, 20 September 2007 (UTC)

Cicchetti & Barnett
The removal of the C & B (1991) article is correct. The assessment was of insecure attachment status, not of RAD.Jean Mercer 23:45, 20 September 2007 (UTC)

and they use the term attachment disorder/disorder of attachment in their article, if I recall correctly, yes?  Dr. Becker-Weidman  Talk 23:50, 20 September 2007 (UTC)

They specifically refer to assessing problems by means of the Strange Situation, which gives a measure of attachment status, not a diagnosis. Can you quote any statement that shows they meant Reactive Attachment Disorder? If not, I think we must assume that the paper is not relevant to this article.Jean Mercer 00:41, 21 September 2007 (UTC)

Would you like to comment on the connection between the bold-faced Dr. Becker-Weidman and the more modestly-typefaced AWeidman? If this is a professional production, I don't think we need multiple identities. Perhaps it would be as well for everyone to know how many of you there are. This would be less important, but for the fact that you have quoted some of your own work verbatim in the DDP article.Jean Mercer 01:00, 21 September 2007 (UTC)

Herewith abstract from Cicchetti, D. [this is Dante C., not Dominic], & Barnett, D. (1991). Attachment organization in maltreated preschoolers. Development and Psychopathology, 3(4), 397-411.


 * Examined the attachment patterns of 65 maltreated and 60 nonmaltreated preschoolers with low socioeconomic status... Ss were assessed in the Strange Situation... at 30, 36, and 48 mo. of age. Several subsamples of Ss were observed longitudinally across a 6-18 mo. period. At each age, maltreated Ss were significantly more likely to evidence insecure patterns of attachment to their caregivers. Longitudinally, the high percentage of nonmaltreated Ss who were classified as securely attached were likely to remain securely attached at subsequent assessments. In contrast, the small number of maltreated Ss who evidenced secure attachments were unlikely to be classified as secure at later assessments.

Both this and the Attachment disorder article have been written with some care so as to distinguish between definitions of RAD and either the clinical or 'loose' use of the term attachment disorder. Please do not confuse the issue by simply describing insecure attachment as a 'disorder' without the context when quoting from older papers. The loose use of the term 'attachment disorder' is a significant problem in the field. Please see Attachment disorder and also the paragraphs in both that and the RAD article on issues of diagnosis. Fainites 06:18, 21 September 2007 (UTC)

Re "Likely to develop RAD
Dr Becker-Weidman. I cannot find support for this statement "These children are likely to develop Reactive Attachment Disorder" in the refs you give for Cassidy and Shaver pp 469 to 496 (Greenberg) or 520 to 554 (Lyons-Ruth and Jacobvitz). Can you please point me to the relevent page? The latter ref in particular is dealing with disorganized attachments and the assorted factors/sequalae etc. Wouldn't this discussion of disorganized attachment and its 'fallout' as it were fit better on the Attachment disorder page rather than the RAD page as RAD is a very specific diagnosis. Disorganized attachment is a risk factor for clinical attachment disorder but not in itself a clinical disorder though it can have significant effects. It would also fit better with the more extensive discussion of Zeannahs proposed alternative classification system perhaps and there is already some discussion of the nature and effect of disorganised attachment on that page.Fainites 13:48, 21 September 2007 (UTC)

Hi Dr Becker-Weidman. I see you have replaced this statement about children being 'likely to develop RAD' in the article without discussion. I've left a message on your talkpage. Please indicate where in the refs you provide is the support for the statement you make as I have been through both chapters and can't find it. Also the Taskforce specifically state that it should not be assumed that RAD underlies all or even most of the behavioral and emotional problems seen in foster children, adoptive children, or children who are maltreated. Rates of child abuse and/or neglect or problem behaviors should not serve as a benchmark for estimates of RAD. Fainites 13:36, 26 September 2007 (UTC)

You are correct, I was providing a summary and paraphrasing, not direct quotes. Don't neglect to look at V. Carlson et. Al, (1989) study that found 82% of maltreated infants in their sample were classified as having a disorganized pattern of attachment (Ainsworth) compared with 18% in their low-income sample. Or, Lyons-Ruth et. al, (1990) who found 55% of maltreated infants having a disorganized pattern of attachment etc. "These children (those with disorganized patterns of attachment) are likely to develop Reactive Attachment Disorder (Greenberg, M. (1999). Attachment and psychopathology in childhood. In J. Cassidy & P. Shaver (Eds.), Handbook of attachment (pp. 469–496). NY: Guilford Press.) & (Lyons-Ruth, K., & Jacobvitz, D. (1999). Attachment disorganization: Unresolved loss, relational violence and lapses in behavioral and attentional strategies. In J. Cassidy & P. Shaver (Eds.), Handbook of attachment (pp. 520–554). NY: Guilford Press.). You can find this also described more explicitly in Geddes, H., (2006) Attachment in The Classroom, London: Worth Publishing."  Dr. Becker-Weidman  Talk 22:04, 26 September 2007 (UTC)

These older papers are cited in Cassidy and Shaver. I included the Lyons Ruth statistics in the article several days ago. I don't think anyone would argue with a statement that disorganized attachment carries an increased risk of RAD as indeed it carries an increased risk of a range of psychopathologies. Its the 'likely' bit after the sentence on risks of psychiatric harm I'm concerned about. The Minnesota project and others with long follow ups did not include the later category of disorganized/disoriented attachment. This latter pattern is predictive of a range of problems and disorders, particularly if combined with other factors. Cassidy and Shaver says ' 'the insecure pattern that was most closely related to later problems was.... disorganization/disoriented or D.....Disorganized attachment may be a general vulnerability factor for later problems in adaptation....may set a trajectory that, along with other risk factors, increases the risk for either externalising or internalising psychopathology'. p477. Also on p481 and 482. The only mention I can find of RAD is in a section called historical context on p 470. (This is still the 1999 version isn't it?) The Lyons Ruth chapter deals mainly with disorganized attachment. If you look at their table of longitudinal outcomes on pps 533-536, there is a broad range of problematical outcomes but no mention of RAD. If the statement 'These children (those with disorganized patterns of attachment) are likely to develop Reactive attachment disorder ' is within pps 469-496 or 520-554 please can you give the exact page as I cannot not find this either stated or implied within either the Greenberg or the Lyons Ruth chapters. Fainites 09:26, 27 September 2007 (UTC)

Please re-read my comment above regarding a direct quote. regards. Dr. Becker-Weidman  Talk 12:47, 27 September 2007 (UTC)

Whether it is a direct quote or a paraphrase, please provide the page number and context from where you are deriving the statement you make that these children are 'likely to develop RAD'. Neither author says or implies that children with disorganized attachment patterns are 'likely to develop RAD'. An authority is needed as to the liklihood or otherwise of children with disorganized attachments developing RAD. Also in the article, it is not linked to disorganized attachments but comes immediately after the statement that maltreated children are likely to suffer serious psychiatric problems and thus implies maltreated children are likely to suffer RAD.Fainites 13:18, 27 September 2007 (UTC)

Dr Becker-Weidman. it may well be that someone notable, somewhere has said 'these children are likely to develop RAD' meaning maltreated children, but it isn't said, or implied, in the two chapters you cite - or if you say it is, paraphrase, summary or quote, please give the page number and context. Fainites 15:44, 28 September 2007 (UTC)

Need for special care
I hope people editing this topic will be especially careful about their statements and the implications of what they say. Parents and entry-level practitioners who read material here may not be capable of sorting out speculation from evidence. RAD is currently a fashionable diagnosis in some parts of the United States (although I gather that it may be replaced by a newly-invented category), and some readers may simply be seeking confirmation of popular beliefs. It behooves editors to be not only accurate, but completely transparent in their work on this and related topics. I've already seen some of this material repeated in a blog-- it can't be edited there, so be sure what you put here is as accurate as possible. Jean Mercer 12:08, 22 September 2007 (UTC)

Is the 'newly invented category' CPTSD? I've noticed that somebody has complained on the Wiki talk page that the article has been written as if its all about childhood maltreatment. Fainites 20:41, 22 September 2007 (UTC)

That's what I meant, although a new one may have appeared by now!Jean Mercer 20:04, 27 September 2007 (UTC)

Changes and proposed changes
I've inserted some comments which I hope point up the circularity of reasoning about the connections between maltreatment or separation and RAD. Applying the DSM criteria, it would be difficult to have a RAD diagnosis without evidence of poor early social history, so there seems to be little point in discussing whether the prevalence is higher among maltreated children than among the general population.

I suggest removing the "theoretical base" section. Why would a disorder have a theoretical base? A theory might be derived from evidence about a disorder, but not the other way around.

An important piece missing from this article is information about the role of temperament both in diagnosis and in the development of atypical attachments of all degrees of severity.Jean Mercer 20:02, 27 September 2007 (UTC)

I agree with your changes in broad terms The refs provided by Dr Becker-Weidman do not appear to support his edit. I'm not sure they're relevent to yours. Neither Greenberg or Lyons-Ruth really deal with RAD. The latter deals entirely with disorganized attachment (which is a risk factor for both RAD and a broad range of other pyschopathologies, although she does not mention RAD). The authorities in general make it clear that although poor social history is required for diagnosis of RAD, poor social history does not lead to such a diagnosis and the Taskforce is very specific about not conflating statistics on maltreatment with statistics on RAD which is considered to be rare. Fainites 20:42, 27 September 2007 (UTC)

Re the theoretical base section - I put that into the original article on the basis that people reading the article may not necessarily know about attachment. Many mental health professionals who think they know about attachment confuse it with bonding and affectional relationships, so one should not assume the lay person understands the basic principles. I agree it is a fairly parsimonious description of attachment though. What do you suggest? Fainites 20:45, 27 September 2007 (UTC)

I've taken the liberty of wikifying your refs. Fainites 20:58, 27 September 2007 (UTC)

Thank you--- but you shouldn't encourage me to take advantage of your good nature!Jean Mercer 23:01, 27 September 2007 (UTC)

Temperament is not part of the DSM criteria for diagnosis of this disorder. Best to keep the article focused on the subject: the diagnostic category of Reactive Attachment Disorder.  Dr. Becker-Weidman  Talk 21:10, 27 September 2007 (UTC)

In which case its important not to confuse attachment styles, such as insecure or disorganized attachment, with clinical attachment disorders ie RAD. I also notice that you have removed another editors sourced edits under the edit summary 'cleanup' and without discussion which is not appropriate. You have also replaced the claim about 'these' children being likely to develop RAD. Please can I have a reply to my above query about the Cassidy and Shaver citations for this statement which do not support it?Fainites 22:12, 27 September 2007 (UTC)

My my, it's all so familiar, people not answering questions and making changes without discussion. Makes me feel quite nostalgic for the old pre-arbitration days. Of course, it's a shame to waste anything one's written by using it only once, and we can think of these replacements as a form of recycling.

Nobody said temperament is part of the DSM criteria, but it certainly can have a lot to do with diagnosis nevertheless-- just as diagnosis can be influenced by things like whether the child is in a familiar or unfamiliar place.

Fainites, what you've written about theory is perfectly reasonable as far as it goes, but it seems to me you either have to write a lot more to present a theory of how various atypical attachments occur, or else you have to keep it down to a minimum-- maybe just by defining attachment and linking to more material about that. But can you or anyone explain to me why it's "Reactive"? Are there thought to be attachment disorders that are not reactive to social history? or does this term date back to when autism was thought to be an attachment problem? Jean Mercer 23:01, 27 September 2007 (UTC)

Well I must say, this process of not answering a query and then repeatedly claiming to have answered it was making me feel a bit deja vu-ey. On the theory -I've also provided a link to the attachment theory page. I tried to aim for a very quick tutorial on what attachment is - partly because of the misconceptions about it. Feel free to add or reduce if you think it will improve it! There's a bit more discussion on the attachment disorder page. No reason I suppose why it shouldn't be here too. (By the way, I only wrote paras 1, 2, and 4 of the theory section. Para 3 was a leftover from the old page that someone put back in and which got cleaned up).

As for why its called 'Reactive', I believe that's a historical leftover. I saw this in that Kansas paper;
 * "In a thorough critique of RAD definitions, Zeanah (1996) argues that the term ‘reactive’ was merely an attempt to differentiate RAD from Pervasive Developmental Disorder (PDD) which can present with similar symptoms. While PDD was thought to have organic causes, RAD was conceptualized as a functional impairment brought about by adverse rearing conditions. Yet, this dichotomy of organic versus functional holds very little value given research findings about the interactive nature of social factors and brain development. In this way of thinking, RAD is no more or less “reactive” than other psychiatric disorders, and children with PDD may very well also suffer from attachment disturbances." Fainites 23:09, 27 September 2007 (UTC)

That's interesting, because it's certainly a long time since PDD was thought to be related to attachment.I guess it's true that actual systematic evidence about this is only in the last ten years or so, though. Seems to me that the ideas that PDD was functional and that it was connected with attachment were overlapping-- if it's organic, unless you're thinking stress-diathesis, it wouldn't be connected with attachment.Jean Mercer 20:56, 30 September 2007 (UTC)

Children with Autistic spectrum disorder clearly have a severely disordered attachment behavior system. However, the cause of that difficulty is different that children who may show the same behaviors but who have Reactive Attachment Disorder. Symptoms do not necessarily relate to etiology and since treatment focuses on causes, this is important.  Dr. Becker-Weidman  Talk 21:33, 30 September 2007 (UTC)

Please reply to the repeated request to indicate where in the two Cassidy and Shaver chapters you cite is the claim about children being likely to suffer RAD. Is it really necessary to continue to attempt to insert this unsupported passage when a genuine reference as to prevalence of RAD, by Zeanah et al has been found? Fainites 21:42, 30 September 2007 (UTC)

I have replied several times to you regarding this matter. I can see you disagree with my summary and paraphrasing, as I said I am not providing a direct quote, hence no page numbers. However, I believe my reading of the material provides ample support for the statement. You can also look at page 110 of Attachment in the Classroom by Dr. Geddes (2006), if you want a specific page and reference for the statement. Hope this helps. cheers.  Dr. Becker-Weidman  Talk 21:48, 30 September 2007 (UTC)

You have not replied with any information at all. I have read both chapters. One does not mention RAD at all. The other only in a historical context. If you claim there is suppport for your statement (which actually would be very significant if supported by research) then it must be possible to do better than simply give the page numbers of two lengthy chapters. Give a page number or passage or context. I have the book. Indicate where the information is please. (Geddes is irrelevent to this. You would need specific studies - like the one Zeanah et al did on maltreated toddlers which is at the bottom of the studies section).) Fainites 23:02, 30 September 2007 (UTC)

I am sorry you have not found my several responses adequate. However, I do beleive they are quite sufficient, being well sourced and relevant. Dr. Geddes research and publications are quite relevant as they make this point and provide you the specificity you seem to be requiring and is on point here. cheers.  Dr. Becker-Weidman  Talk 00:47, 1 October 2007 (UTC)

You have made no attempt whatsoever to answer the point. The situation remains the same. You cite two substantial chapters in support of a statement and have done nothing to clarify from what parts of these extensive chapters you derive your claim. Repetition on the talkpage of 'I've already answered this' is a familiar old tactic which may work on a passing editor, but won't work with the questioner. Given that you also cited Ciccetti as givng a figure of 82% for RAD when Ciccetti was in fact entirely about disorganised attachment and not RAD, it is not unreaso9nable to ask from where you derive you statement about RAD from Cassidy and Shaver, when one of the extensive chapters you cite is entirely about disorganised attachment and not RAD. Exaggerating the incidence of RAD and conflating problematical attachment styles with RAD is an attachment therapy promotion technique that the Taskforce specifically warn against. Fainites 06:27, 1 October 2007 (UTC)Fainites 06:23, 1 October 2007 (UTC)

Prevalence section
The last part of this section either started, or has become, very repetitious and disorganized. Can the author clarify? The idea seems to have been to trace possible connections between atypical attachment status and RAD, yet items about disorganized attachment still show up at the end of the para.This would be quite confusing to the unfortunate naive reader who stumbled into this. How about putting all the atypical attachment material at the beginning of the para, then stating evidence about precursors for RAD? Jean Mercer 20:56, 30 September 2007 (UTC)

Good idea. The link between atypical attachment and RAD needs to be very carefully set out. Currently its a bit random. It is a struggle to prevent RAD and disorganised attachment being run together here. Fainites 21:44, 30 September 2007 (UTC)

Actually it flows nicely...going from some material about RAD to stats on maltreated children, a group a great risk of developing this disorder, to a final paragraph on maltreated children and RAD. But if you think a re-ordering of the paragraphs would flow better, let's take a look, by all means. Cheers.  Dr. Becker-Weidman  Talk 21:52, 30 September 2007 (UTC)

The section being discussed does not flow. I don't think reordering paras is being suggested - its the jumble of cites which mix up RAD, disorganized attachment and trauma. By the way - as you're obviously reading this - please can you provide the page, passage, sentence or whatever that you say supports the two citations you give for you claim that 'these children are likely to develop RAD'. Thanks. Fainites 22:58, 30 September 2007 (UTC)

I see we have quite different perspectives on this question. <font color="#FF9933" face="monotype"> Dr. Becker-Weidman  <font color="#00FF00">Talk 00:49, 1 October 2007 (UTC)

We certainly have different perspectives on the propriety of certain editing practises such as removing sourced material without discussion, altering sourced material so that it no longer represents its source and refusing to back up cites when asked. I see nothing has been learned and nothing has changed. Fainites 06:19, 1 October 2007 (UTC)

Lets see if we cant move on here. A number of you have asked me to get involved to see if I can help. As you know I favour the strategy of breaking the article up into smaller topic areas where we can then develop a clearer account of the different approaches to some of the issues. The organization on other diagnosis pages has followed the deliniation of the main ICD 10 and DSM criteria with branches to other articles along the following lines.

Generally the justification of moving content to a seperate page depends on there being a complex argument to pursue or a substantive literature to reflect. It might not be necessary in all cases and some of the topics might not be relevant. This format might entail the rejigging of the order and might give us the opportunity to move some of the contentious material for deeper consideration. I await your thoughts. In the meantime I will put some links into the material and make some formatting changes which might make some things clearer for readers. Dr Joe Kiff 15:22, 1 October 2007 (UTC)

Having made a number of changes which I hope are not controversial can we agree that we will discuss all problematic changes here first to try and get an agreement so we can move beyond the edit/redit cycle. Small major changes first :
 * I think RAD Should not be hyperlinked as it only redirects to the page
 * I think assessment should come before diagnosis as that seems more logical
 * the section on the Romanian study at the end should go into a seperate epidemiological page with the other prevalence material
 * The discussion of the Dyadic Developmental study should be moved to the DDP page
 * There should be seperate treatment page to prepare the way for a fuller review of the various treatment approaches. Dr Joe Kiff 16:32, 1 October 2007 (UTC)


 * I think that makes a lot sense. Hyper-linking to relevant additional articles for fuller discussion would make for a more readable article.  For example, discussions of etiology and treatment of this disorder are complex and inclusion of such material would make for a very cumbersome article.  I think if we move at a measured pace proposing and discussing changes here, instead of on the page, we can produce some fine material.  <font color="#FF9933" face="monotype"> Dr. Becker-Weidman   <font color="#00FF00">Talk 19:34, 1 October 2007 (UTC)

Hi. Great idea. This article, like attachment disorder and attachment theory are in a way almost like portals, leading on to detailed evidence and discussions. Each section does however have to have sufficient information to actually lead the reader on. I'll swap round the mainstream/non-mainstream methods of assessment as in general in each section it deals with manistream first.Fainites 22:33, 1 October 2007 (UTC)

I've linked the various AT's to the AT page for now. It may be that at some point it might be appropriate to have individual articles on the more notable versions. It also occurs to me that one of these things is called 'DAD' which hardly anybody outside the business has heard of! (Thats the ICD version of disinhibited RAD) We could probably use disambiguation pages to resolve this problem. Fainites 22:42, 1 October 2007 (UTC)

Prevalence Section II
The second to last paragraph needs to be rewritten I think. As this is the RAD page it could simply say that disorganized attachment (or whatever else for which there is evidence) carries an increased risk of a range of psychopathologies including RAD.(cite cite cite) Disorganized attachment is worth an article all to itself. The last paragraph duplicates material already in the study section. We could say the study found the 38-40% but the details of all the research go in the research article. I think we need to be very careful about statements like "these children are likely to develop RAD". It appears twice in two sentences which is odd, its not clear what it relates to from the preceding sentences and the citations given do not support it. The section already describes the fact that disorganized attachment is a risk factor. Relevent cites could go there. Zeanahs statistic could go at the top with the other estimates of prevalence. The rest of that second to last paragraph could go elsewhere as it does not directly relate to RAD. Can I quote Zeanah from 2005? he says 'Although it has been described formally in the psychiatric nosologies for nearly 25 years, RAD has been studied only recently. There are fewer than a dozen studies involving only 7 samples of young children...two samples of internationally adopted childre....two amples of children currently institutionalized....one sample of maltreated toddlers....one sample of maltreated, homeless and young children attending Head Start... and one sample of clinic referred toddlers.' Its very nice of Zeanah to do this helpful list! We need to be careful not to cite studies on other things as if they were studies on RAD.Fainites 07:17, 2 October 2007 (UTC)

Suggestion
I'd suggest the following for the Prevalence section:

There are no precise statistics on prevalence.

RAD is considered to be "very uncommon" under the DSM-IV-TR criteria although there is an estimate of prevalence amongst children freed for adoption within the USA foster care system of 10%. Other estimates include a prevalence of less than 1% in the general population [citation: Richters,M.M., & Volkmar, F. (1994)....] There has been considerable recent research into prevalence amongst children cared for in orphanages, particularly in Romania, where conditions of extreme deprivation were not uncommon.

Carlson,et. al. (1989) found that 82% of maltreated children displayed disorganized/disoriented pattern of attachment, when measured using the Strange Situation procedure developed by Mary Ainsworth. Lyons-Ruth et al (1990) obtained figures of 55% among maltreated infants and 34% amongst low income controls (with clinical social work involvement). Children with histories of maltreatment, such as physical and psychological neglect, physical abuse, and sexual abuse, are at risk of developing severe psychiatric problems. These children are likely to develop Reactive Attachment Disorder. ,, . These children may be described as experiencing trauma-attachment problems and are likely to develop Reactive Attachment Disorder<Geddes, H., (2006). Attachment in the classroom. London: Worth, which is a psychiatric diagnosis. The clinical formulation of [Complex post traumatic stress disorder]] is a clinical perspective on this set of problems. The trauma experienced is the result of abuse or neglect, inflicted by a primary caregiver, which disrupts the normal development of secure attachment. As was mentioned earlier, such children are at risk of developing a disorganized attachment. Disorganized attachment is associated with a number of developmental problems, including dissociative symptoms, as well as depressive, anxiety, and acting-out symptoms.

According to one prevalence report, in interviews with clinicans treating 94 maltreated toddlers, 38-40% of the children were thought to show either inhibited or disinhibited forms of Reactive Attachment Disorder, whether or not they had experienced separation from caregivers or multiple caregivers

This covers the main points and has substantial and relevant citations to support the various statements from a broad range of sources. <font color="#FF9933" face="monotype"> Dr. Becker-Weidman  <font color="#00FF00">Talk 14:33, 2 October 2007 (UTC)

I don't think it helps to mix up statistics on RAD, statistics on disorganized attachments and speculation on traumas. Prevalence ought to provide what is known of the prevalence of RAD. I would suggest leaving paragraphs 1 to 3 and removing paragraph 4. Issues of the incidence of disorganised attachment which is a risk factor for a range of psychopathologies of which RAD is only one should be dealt with separately. Similarly if there is any connection between attachment matters, RAD and CPTSD that should have its own section. Unvalidated staements should be removed. I also do not understand the logic behind your proposed removal of passages from the Taskforce and Prior and Glaser on the prevalence of RAD. It is important for people to be aware of the current state of research and the over and under diagnosis of RAD and the circumstances in which that arises.Fainites 15:53, 2 October 2007 (UTC)


 * Since the clinical or research category, disorganized attachment, is likely to be a precursor of, or lead to the development of Reactive Attachment Disorder, this is important and useful information. I think most clinicians and professionals in the field would agree.  Maybe the material could go under the etiology section.  Cheers.  <font color="#FF9933" face="monotype"> Dr. Becker-Weidman   <font color="#00FF00">Talk 16:30, 2 October 2007 (UTC)


 * We need a sourced passage that states that disorganised attachment is a risk factor for RAD. If you look further up the page you will see this already exists. Statements like 'likely' or any actual figures as to RAD arising as a consequence of disorganised attachment need to be sourced and presented in a way that does not confuse RAD, disorganised attachment and trauma in a jumble.Fainites 18:09, 2 October 2007 (UTC)


 * Yes, I see that we disagree. I believe that I have provided ample citations and references and you disagree that I have.  I have provided ample support with material that, while not direct quotes, are an accurate summary and paraphrasing of the material and implications...speaking here as a researcher and practitioner.  Cheers. <font color="#FF9933" face="monotype"> Dr. Becker-Weidman   <font color="#00FF00">Talk 19:17, 2 October 2007 (UTC)


 * I don't think you have actually read what I have written. This isn't about numbers of citations. They have to be a) relevent (ie on the subject), b) accurate and c) presented in a way that presents a coherent narrative. By the way, I'm still waiting for details of where in those two chapters from Shaver and Cassidy you find support for your statement about 'these children being likely to develop RAD'. Its not a question of disagreeing with you. You have provided no support for your assertion that it is an accurate summary or paraphrase. If you point us to the relevent passages we may well agree - but the second chapter makes no mention of RAD at all and the first makes no mention of predictors, liklihood or statistics. You have also not responded to my query as to why you propose to remove all the material from the Taskforce and Prior and Glaser on prevalence from the section on prevalence.Fainites 20:57, 2 October 2007 (UTC)


 * Yes, I did read your various comments and it is clear that we disagree. I appreciate your zeal and ardor on this subject.  You are very clear in your point of view and in pressing that fully and single-mindedly.  I think that can lead to good discussions and the clarification of points that may be less than clear.  At this point I've provided a variety of relevant and accurate citations regarding the relationship between disorganized attachment (the research and clinical formulation) and the psychiatric diagnosis of Reactive Attachment Disorder.  I am sorry you don't see my point here.  Cheers <font color="#FF9933" face="monotype"> Dr. Becker-Weidman   <font color="#00FF00">Talk 22:23, 2 October 2007 (UTC)


 * Actually its not leading to discussion at all, nor disclosure of material from your sources. Just personal remarks and perseveration. Fainites 06:17, 3 October 2007 (UTC)

I agree that we ought to have a seperate article on disorganised attachment. Which might lead to a bridging article on the link between disorganised attachment and RAD. I also think the Prevalence article here should only include the RAD articles. The aim is to focus each section or article on a particular question. I feel that the different points of view between practitioners (and practised based evidence) and researchers and (evidenced based practice) need to be articulated and respected. From the conversation on Shaver and Cassidy it seems to come down to the fact that there is no clear hard scientific evidence about the link between RAD and disorganised attachment but it is inferred by an experienced practitioner in the field. There should be a way of seperating out the formal evidence discussion while preserving the range of experienced professional opinion. I am particularly keen that such opinion should lead to discussion of designs for studies that might then illuminate the question.All this might be done in the bridging article. Does this give us space to move forward? Dr Joe Kiff 22:37, 2 October 2007 (UTC)


 * Who's the experienced practitioner? Is there a published source for that person's opinion? Jean Mercer 23:14, 2 October 2007 (UTC)

The passage I provided saying that disorganised attachment is a risk factor for RAD came from Prior and Glaser. They also point out that some aspects of RAD (inhibited type) closely resemble some aspects of disorganized attachment. Some researchers have posited that RAD may be viewed as an extreme indication of disorganisation. There is absolutely no consensus on this and it is ongoing discussion within the field. Prior and Glaser, like Zeanah, point out how recent the proper research is into RAD and how little there is of it. If it were possible to say from research that certain groups of children (and its not clear which ones are being referred to) were likely to develop RAD rather than being at greater risk I'd be most interested to see the research. Its a fast moving field and I agree that we need to distinguish clarly between what is research and what is respected expert opinion.Fainites 06:14, 3 October 2007 (UTC)

I agree with you Dr Kiff that only RAD articles should be in the prevalence section. Fainites 15:35, 3 October 2007 (UTC)

Another reference regarding the Disorganized-RAD link
Howes, P., & Cicchetti, D., (1995). In Cicchetti, D., & Toth, S., (Eds.) (1995), Child Abuse, Child Development and Social Policy: Advances in Applied Developmental Psychology, volume 8, Norwood, NJ: Ablex. pp.249-299. We know that maltreated children frequently form Disorganized/Disorientated patterns of attachment (Carlson, V., Chicchetti, D., Barnett, D., & Brunswald, K (1989) Finding order in disorganization. In D. Cicchetti & V. Carlson (Eds.) Child maltreatment: Theory and research on the causes and consequences of child abuse and neglect pp. 494-528.  NY: Cambridge U Press. <font color="#FF9933" face="monotype"> Dr. Becker-Weidman   <font color="#00FF00">Talk 23:34, 2 October 2007 (UTC)


 * Can you please post here the passage that claims that children with disorganised attachment or whatever are likely to develop RAD. Fainites 06:19, 3 October 2007 (UTC)


 * I suggest you read the chapter, book, and article. That makes it all clear.  For example, the material describes how maltreated youngsters often from Type D disorganized/disoriented attachment relationships with their caregivers.  The section in the text on "A relationship perspective" is a good section to read.  You should also read the chapter on Disorders of Attachment in C. Zeanah's text, Handbook of Infant Mental Health.  I know this is a lot to read for a lay person...but you do seem to have a real zeal for the topic and this may help expand and inform your point of view with some mainstream treatments of the subject by some very well known and well respected writers.  I'd also direct your attention to the Special Issue of the Journal of Attachment and Human Development on this subject.  Cheers.  <font color="#FF9933" face="monotype"> Dr. Becker-Weidman   <font color="#00FF00">Talk 13:03, 3 October 2007 (UTC)

I have read the chapters and the book which is why I am querying from which passages you derive your assertions. Yet again you are referring to material on disorganised attachments. I am asking you to pinpoint from where you derive your claim in the article that 'these (after your sentence about psychiatric disorders) children are likely to develop RAD' from those two particular chapters. Prove me wrong by all means, but you'll have to do it with supported evidence, not a ref. to a whole chapter in Cassidy that doesn't even mention RAD and another that does not make the claim you attribute to it. Its not rocket science. A page number would do. If you say Ciccetti says this, then post the passage here. The confusion of attachment styles with attachment disorders, and the inappropriate diagnosis of RAD are significant problems and I really don't think editors here should be adding to it, for whatever purpose. Fainites 15:43, 3 October 2007 (UTC)

I have made a number of changes that I hope met with peoples approval. I have tried to take out all the disorganized attachment material into a bridging article where we can examine the issue in more detail. I have also made a few minor formatting changes and reordered the sections to make it flow more logically and took out some extraneous material and included it elsewhere (Randolph assessment instrument). Let me know if there are any problems with this solution Dr Joe Kiff 18:41, 3 October 2007 (UTC)


 * Looks fine to me Dr Joe! The only concern I have about the article is about treatments. The statement that 'all treatments with a sound evidential and theoretical base concentrate on increasing caregiver sensitivity ( or if that is not possible changing the caregiver)' comes from Prior and Glaser. They then cite a number of therapies namely Cohen, van den Boom, Benoit, Toth and Marvin although they make the point that the latter (Circle of Security) has not yet achieved validated status. Studies are ongoing. They also cite a number of studies on change of caregiver. (Mary Dozier in particular does a fascinating one about the correlation beteween a a foster carers attachment status and the attachment status of the child! She developed a treatment based on this which is currently in mid study as it were.)

Parent Child Psychotherapy is even better known, and earlier (its Lieberman - one of the big names) and the source for this is AAPAC who set out their views on the necessity for evidence based practice. Somewhere in all the messing around and reverting and whatnot the refs have got a little confused and also Floortime and Dyadic developmental psychotherapy have been added into the list. Floor time, though reasonably well known, does not rank as evidence based I believe. (Its primarily directed at autism or PDD). DDP is minor and not only does not rank as evidence based, Hughes is specifically put in Prior and Glasers non-evidence based section and you have already seen what the Taskforce say about it. Nothing wrong in not being evidence based as such - proper research etc takes time, but it can't really go in as part of the list under Prior and Glasers statement about sound evidential basis and increasing carer sensitivity. I would suggest two lists - one for those whom notable sources describe as evidence based and others. Or we could say 'Prior and Glaser say this - O'Connor etc say this - AAPAC say this' ie secondary sources about evidence base. Or we could list treatments and say nothing about them at all but link them to their own articles. I don't mind which really as long as its accurate.Fainites 21:16, 3 October 2007 (UTC)


 * Fainites, your POV is showing here. Dyadic Developmental Psychotherapy's reference in the article is precisely where it belongs based on the citations and references provided. Craven & Lee and various other citations support this.  <font color="#FF9933" face="monotype"> Dr. Becker-Weidman   <font color="#00FF00">Talk 22:12, 3 October 2007 (UTC)


 * It does not belong as part of a paraphrase from Prior and Glaser as they do not cite is as such. The original paragraaph contained sourced information from P & G and AAPAC. It is not appropriate to add non-original extras to existing sourced statements. They should have their own source. Either we set out what secondary sources such as P & G or Chaffin or AAPAC or the Taskforce or whoever say about treatments, or we list them without comment and link them to their own articles. What we can't do is describe treatments as evidence based or whatever based on OR, or add in treatments to a citation that didn't contain them. This isn't a POV. Its basic editing rules. Fainites 22:29, 3 October 2007 (UTC)

Elsewhere we are trying to get some guidance on the criteria for assessing studies and we can think about our own judgements as well. My understandingis that Art has done additional work since Prior and Glaser which we are looking at in detail on DPP. I think we should be sensitive to his position it is a bit much having put a lot of effort into studies (and I know how difficult doing active research in a clinical setting is) to be told you have provided no evidence base. It would perhaps be best at this stage to have a list of legitimate approaches, then we can critique each in turn (drawing together all the references). We are doing this with DPP and I am hoping this will help undo some of the knots we have got into
 * I am hoping we will produce a balanced professional evaluation of DPP, as we will of the other approaches in time, that will enable people to make their own minds up. I dont think we should hold DPP to a higher standard than Prior and Glaser and if we are satisfied that subsequent work meets the criteria I feel we should be honest enough to make the case.
 * As an outsider I would like a list of all the approaches in the field with enough infomation to help me make judgements about their evidence base. Dr Joe Kiff 23:15, 3 October 2007 (UTC)

All the secondary sources in relation to treatments should be clearly set out. Its not so much about there being 'no evidence'. Thats clearly not the case. Its the designation 'evidence based' which has a fairly specific meaning which is the problem and we do not have the power to award it! Nor should this site designate things as evidence based when there is no evidence that they have been accepted by the wider psychology community as such.

In relation to the list, I'm quite happy for the list to just list the treatments all linked to their own article. But I am not happy about DDP or Floor time staying in a list under a cited paraphrase from Prior and Glaser as if they had referred to it as such when they did not. That would utterly misleading and scientifically dishonest. We cannot take a passage from a paper or book and then add our own judgements on other treatments within that passage. Our own judgements have to be set out clearly as that. I've removed the passage from Prior and Glaser about 'attachment theory' 'all the therapies with a sound evidential base' 'caregiver sensitivity'. The treatments that this assessement of theirs relates to an have this reference in their seperate articles. Fainites 06:36, 4 October 2007 (UTC).

As I've previously stated, with references, "evidence-based" is not a unitary concept (not like being pregnant) it has various levels. The term applies quite well in this context. Cheers. <font color="#FF9933" face="monotype"> Dr. Becker-Weidman  <font color="#00FF00">Talk 12:14, 4 October 2007 (UTC)


 * If that were the case, why do the Taskforce make such a big point of it? Why did you write to them in an open letter and why do they take the trouble to devote a substantial part of their Reply to it? (Bearing in mind of course who is on the Taskforce).Fainites 14:54, 4 October 2007 (UTC)


 * I understand that as a lay-person you may not be familiar with the literature on this subject and the complexities involved. Let me direct your attention to the following references for further reading:
 * Saunders, B., Berliner, L., & Hanson (2004, april 26). Child physical and sexual abuse: Guidelines for treatments.
 * http://www.bmj.com/cgi/content/full/312/7023/71
 * Oxford Centre for Evidence-based Medicine Levels of Evidence and Grades of Recommendation
 * http://www.ahrq.gov/clinic/3rduspstf/ratings.htm
 * http://www.ncbi.nlm.nih.gov/sites/entrez?cmd=Retrieve&db=PubMed&list_uids=11728302&dopt=AbstractPlus
 * Evidence based medicine
 * Cheers. <font color="#FF9933" face="monotype"> Dr. Becker-Weidman  <font color="#00FF00">Talk 15:46, 4 October 2007 (UTC)

I take it that on that basis you'd argue that the Taskforce weren't familiar with the literature either - and of course they're lay-persons to a man. What good company I'm in! Fainites 20:31, 4 October 2007 (UTC)

Article does not exist
Art has inserted a reference to his article that was submitted to CAMH. This article will not appear in print and has been taken down from the on line version, because it involved self-plagiarism. The reference must be removed from this page, whose integrity it compromises.Jean Mercer 16:41, 21 October 2007 (UTC)

See: <font color="#FF9933" face="monotype"> Dr. Becker-Weidman   <font color="#00FF00">Talk 17:06, 21 October 2007 (UTC)


 * Be that as it may, the editor of CAMH has taken the article itself down. There's really no point showboating about this. Jean Mercer 19:24, 21 October 2007 (UTC)


 * I still see the article there and available. <font color="#FF9933" face="monotype"> Dr. Becker-Weidman  <font color="#00FF00">Talk 19:33, 21 October 2007 (UTC)


 * It did disappear for some months because I noticed it had gone when I checked all the refs on Wiki. There was no explanation for its disappearance, just a page with blanks in it. The page with the abstract is there on Blacks Synergy but if you try and go to the main article or purchase or download it, its still all blank so its not 'available'. Very odd. I don't think it can be cited as a ref though if you can't get the article. Is it possible for someone to find out whether this article is published in CAMHS or not? Fainites 21:51, 21 October 2007 (UTC)


 * I've been able to access the article, but rather than debate this, it seems the easiest course is to merely delete the reference, which I have done, OK? Two citations are just fine and the contents are quite similiar so the one citation (Sturt) should suffice, OK?.  <font color="#FF9933" face="monotype"> Dr. Becker-Weidman   <font color="#00FF00">Talk 23:09, 21 October 2007 (UTC)

Very wise, I'd say.Jean Mercer 13:32, 22 October 2007 (UTC)