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Attachment Symptoms
by Deborah Hage

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For many years those who work closely with behaviorally and emotionally problematic children with a history of foster care, institutionalization, abuse and /or neglect have discovered these children appear to have many behaviors in common. Research done by Dr. Liz Randolph points to a specific list of behaviors which have a strong correlation to Reactive Attachment Disorder. The 30 item list , called the RADQ (Randolph Attachment Disorder Questionnaire), is used as a starting point for those interested in exploring the presence or absence of RAD in a child they live or work with. In and of itself this list cannot be used to diagnose RAD without the scoring information, the taking of a detailed history and the assessment of previous testing and diagnosis. The questionnaire, background to the research, scoring of the symptoms list and conclusions which might be drawn from the response to the questionnaire are available from Dr. Randolph.

Using the Questionnaire
There is some value to having the questionnaire filled out by a variety of people who see and work closely with the child with the understanding that, typically, children with attachment issues behave better for people with whom there is only a superficial relationship. The closer the child is to the adult, the more the child will act out with that adult. Thus, when looking at the disparity between reports, the professional must not assume that the adult who observes few behavioral issues is the "better" caregiver who utilizes "better" discipline techniques. It is far more likely that the child does indeed behave better for a teacher or other adult because the child has less investment in the relationship. A child who has attachment issues will demonstrate far more severe symptoms with their parent, particularly their mother, than with anyone else. Even fathers will observe behaviors which are far more benign than the mother will experience as children with attachment issues do not tend to be as invested in the paternal relationship as the maternal relationship.

It is critically important that the professional, when looking at the variety of responses to the same Symptom Checklist, take each response as an indication of the range of behaviors which the child is capable of and not triangulate the responders by giving any message, subliminal or otherwise, that the variety of responses is due in any way to the inability of the adult (particularly the mother) to be a loving, proficient, trusted caregiver. In other words, the variety of responses is reflective of the child's emotional liability. Grievous treatment errors could occur if it was assumed the variety of responses was reflective of the quality of care received at the hands of various caregivers.

The reality may rather be a negative correlation. That is, the better the behavior for a particular adult the more indifferent the attachment. The worse the behavior for a particular adult the more fearful the child is of forming an attachment and risking disappointment once again.

Other Uses for the Questionnaire
The Questionnaire is also useful to parents who have concerns regarding their child's behavioral patterns but have been unsuccessful in getting others, particularly educational and mental health professionals, to share their concern. Additionally, when the primary caregiver and/or teacher is given an opportunity to answer the Questionnaire at regular intervals it can be used to track the individual progress of the child as well as the effectiveness of the therapeutic intervention.

Some Thoughts on Differential Diagnosis
It may be worth noting to the mental health professional that many of the behaviors described on the Attachment Disorder Questionnaire would readily correspond to the DSM-IV general diagnostic criteria for an adult Personality Disorder, with particular attention to Anti-Social Personality Disorder. There are also similarities to DSM-IV diagnostic criteria for Conduct Disorder and Oppositional Defiant Disorder. The value of this particular set of questions is that the scored response will be able to assist in the differential diagnosis.

Additionally, children who have Attachment Disorder have many of the same symptoms as children with other childhood disorders such as ADD or Fetal Alcohol Syndrome. That is because, when the ability to attach and love is not present, it effects many other aspects of living, behaving and responding. As attachment takes place early in life, the history of the child with ADD or Fetal Alcohol Syndrome almost always shows early breaks in the mother child relationship so an overlap of diagnosis is possible. Thus, taking a complete history of the first two years of life is critical to an accurate diagnosis.

For more information regarding Parenting With Pizazz or
e-mail Deborah Hage for more info on differential diagnosis and the RADQ.

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Deborah Hage, MSW

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