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.
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