Part One
Part Two
Part Three

Continuing on with my commentary on the APSAC report, I will continue to share some of the highlights of the report verbatim. I am picking and choosing what I think will fit most of my readership, but I am not censoring or only picking comments of a positive or negative bent. After I have shared the gist of the report, I will share some of my own thoughts and those of others who share my space…


Regarding the diagnosis of RAD, the report had this to say:

RAD is one of the least researched and most poorly understood disorders in the DSM. There is very little systematically gathered epidemiologic information on RAD. In its absence, much of what is believed about RAD is based on theory, clinical anecdotes, case studies, and extrapolated from laboratory research on humans and animals. Similarly, the course of RAD is not well established. Long-term longitudinal data on the outcomes of children diagnosed with RAD have not been gathered (Hanson & Spratt, 2000). It appears difficult to diagnose RAD accurately. No generally accepted standardized tools for assessing RAD exist, and several interview procedures in the literature misdiagnose inappropriately high numbers of children as having RAD who, in fact, appear to have only mild to moderate symptoms (O’Connor, Rutter, Beckett, Keaveney, & Kreppner, 2000). In addition, several other disorders share substantial symptom overlap with RAD and, consequently, are often comorbid with or confused with RAD. For example, disorders such as conduct disorder, oppositional defiant disorder, and some of the anxiety disorders, including posttraumatic stress disorder (PTSD) and social phobia, all share some features with RAD. Symptom overlap can lead to a failure to diagnose RAD correctly when it is present, and to overdiagnose RAD when it is not present.

The report then addresses web pages that list symptoms of RAD or characteristics of children believed to have attachment difficulties:

Many of the controversial attachment therapies have promulgated quite broad and nonspecific lists of symptoms purported to indicate when a child has an attachment disorder. For example, Reber (1996) provided a table that lists “common symptoms of RAD.” The list includes problems or symptoms across multiple domains (social, emotional, behavioral and developmental) and ranges from DSM-IV criteria for RAD (e.g., superficial interactions with others, indiscriminate affection toward strangers, and lack of affection toward parents), to nonspecific behavior problems including destructive behaviors; developmental lags; refusal to make eye contact; cruelty to animals and siblings; lack of cause and effect thinking; preoccupation with fire, blood, and gore; poor peer relationships; stealing; lying; lack of a conscience; persistent nonsense questions or incessant chatter; poor impulse control; abnormal speech patterns; fighting for control over everything; and hoarding or gorging on food. Others have promulgated checklists that suggest that among infants, “prefers dad to mom” or “wants to hold the bottle as soon as possible” are indicative of attachment problems (Buenning, 1999). Clearly, these lists of nonspecific problems extend far beyond the diagnostic criteria for RAD and beyond attachment relationship problems in general. These types of lists are so nonspecific that high rates of false-positive diagnoses are virtually certain. Posting these types of lists on Web sites that also serve as marketing tools may lead many parents or others to conclude inaccurately that their children have attachment disorders.

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