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A GoodTherapy.org News Update Presented by Daniel Brezenoff, LCSW

Click here to contact Daniel and/or see his GoodTherapy.org Profile

A team of researchers – three at Florida State University and one at Yale – have completed a persuasive study of Behavior Management Training (BMT) for treating Reactive Attachment Disorder (RAD). The study, published in the journal Child Maltreatment, offers findings are encouraging to proponents of the classic reward and punishment system, and will likely lead to larger control studies.

RAD is a severe childhood disorder in which children display extremely inappropriate social behaviors, such as near total withdrawal and introversion (the inhibited form) or an almost complete lack of boundaries with strangers (the disinhibited form) sometimes with sexual or aggressive tendencies. These two ends of a behavioral spectrum may both be present in the same child at different times.

The disorder is rare, and its causes are well recognized. While in the general population it probably occurs in less than half a percent of children, among neglected children between ten and twenty percent are likely to develop RAD, and as many as one third of maltreated or abused children will meet the criteria for this diagnosis. In other words, this is an illness undoubtedly caused almost entirely by environmental factors.

And a very disturbing illness it is, given the utter disruption to a child’s functioning RAD can cause. RAD makes caring for a child extremely difficult, and if the personality traits that characterize it are not addressed, they will almost certainly cause severe social dysfunction for the adolescent and adult.

The case study by Buckner, Lopez, Dunkel and Joiner recorded the results of BMT as therapy for one seven year old girl. Offered a system of consistent rewards for appropriate behavior, and occasional minor punishments for acting out, the girl showed significant improvement. This may not be good news for advocates of psychodynamic approaches or play therapy – they have not shown this kind of measurable success in the past – but for clinicians more concerned with outcomes than with theory, this study is good reason for hopefulness regarding one of the more tragic disorders facing children today.

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