Good News for Old School Behaviorists

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 that are encouraging to proponents of the classic reward-and-punishment system, and will likely lead to larger control studies.

RAD is a severe childhood issue 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 uninhibited 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 of 1% of children, among neglected children between 10% and 20% 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 issue undoubtedly caused almost entirely by environmental factors.

And a disturbing issue 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 7-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 issues facing children today.

© Copyright 2008 by Daniel Brezenoff, Licensed Clinical Social Worker. All Rights Reserved. Permission to publish granted to

The preceding article was solely written by the author named above. Any views and opinions expressed are not necessarily shared by Questions or concerns about the preceding article can be directed to the author or posted as a comment below.

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  • Justin

    August 31st, 2008 at 12:58 PM

    Children just seem to be getting the raw end of the deal in so many ways these days. Just another manifestation that poor parenting and abuse can bring about, as if they needed something else on their plate already. Jeez I am really kind of tired of hearing all of the bad things yet that is constantly what makes the news! I am glad to hear though that there can be hope for these kids when they are given the right treatment.

  • Ian Pratt

    September 3rd, 2008 at 7:17 PM

    Hi, I was attracted to this article through a management blog and as a beleiver in behavioral leadership theories I am interested to read articles on effective use of prositive reinforcement (Reward) and the effect it can have on people.

    It is great to see that someone is interested in these poorly treated children, it is a great article for all levels of managers and leader to read an understand the power of reward

    I hope more children can benefit from this research.

  • Carolyn

    September 5th, 2008 at 3:14 AM

    Have they seen that behavior modification such as this really has positive long term results in these cases?

  • Kathy

    September 10th, 2008 at 1:13 AM

    Parental bonding shouldnt end with the cradle. I believe most people dont know what happens in their children’s lives. Out of sight is definitely out of mind. We dont know how they are treated at daycare or at school. We dont know who bullies them in the john. We also dont know what keeps them awake when they are pretending to sleep. The core of most psychological problems with children is we dont try putting ourselves in their small feet.

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