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Dec 6, 2023

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Reactive Attachment Disorder and Play Therapy Problem and Needs Statement Reactive Attachment Disorder, or RAD, is defined by a pattern of developmentally abnormal attachment behaviors. While prevalence is unknown, it is considered rare. RAD is most often seen among populations of children who have experienced severe abuse and/or neglect, although, in rare cases, a child who has not experienced trauma may develop RAD[ CITATION Ame13 \l 1033 ]. Reactive Attachment Disorder is considered by many a difficult disorder to treat, and in fact O’Connor and Zeanah in 2003 stated that there were no established clinical guidelines for treatment of attachment disorders, and further, that no treatment methods had been found effective [ CITATION OCo03 \l 1033 ]. In years since, various methods including attachment therapy and play therapy have been found to mitigate some symptoms of RAD. Play Therapy for Reactive Attachment Disorder The Association for Play Therapy defines the treatment modality as such: “the systematic use of a theoretical model to establish an interpersonal process wherein trained Play Therapists use the therapeutic powers of play to help clients prevent or resolve psychosocial difficulties and achieve optimal growth and development."[ CITATION Ass23 \l 1033 ]. In short, the client is able to utilize specific methods of play to narrate and process trauma, explore relationships, and develop coping skills. There are many evidence-based benefits to play therapy, including improvement to relationships, academics, and developmental and social- emotional concerns. Play therapy’s effectiveness is in part due to the basis of meeting a child where they are. Traditional talk-therapy is beyond the developmental ability of most children, whereas play therapy meets them at their developmental level. It is the natural language in which children speak. Further, many children who have experienced trauma experience developmental delays. For a child who has been neglected or abused and suffers from cognitive, expressive, or social emotional delays, play therapy may give them the tools to share feelings and thoughts for which they otherwise may not have the language. The feelings of joy and love that arise from developmentally appropriate play contrast the disorganization and feelings of chaos that are typical of a child diagnosed with RAD [ CITATION Wie07 \l 1033 ]. As stated above, cases of Reactive Attachment Disorder are most often seen in children who have experienced severe abuse or neglect. As such, many of these children have insecure/avoidant attachments to their caregivers. Play therapy can be further utilized to train the caregivers in developmentally appropriate ways to play with their child, giving them a tool to build the parent-child bond and begin to repair the attachment between them. This piece is crucial, as studies show that the attachment style formed in early childhood affects a person’s relationships even throughout their adult life [ CITATION Jef \l 1033 ]. Adults who experienced an attachment-related disorder as a child are very likely to continue the behaviors as an adult, and have an increased risk versus the general population to develop personality disorders. It can be clearly demonstrated that it is beneficial to all children to build the most secure attachment possible. Play therapy that involves caregivers could begin to mitigate some of the symptoms of RAD.
Cultural and Special Considerations Cultural considerations for the diagnosis and treatment of reactive Attachment Disorder include the culture of origin of the child being treated. Worldwide, understanding of attachment and the implications on parenting vary greatly, and may have great effect on the parent-child relationship, as well as the views of relationships between the child and other significant adults. While play is the universal language of the child, effective play therapy must include consideration for the child’s background in order to allow them the freedom of expression and acceptance, which is crucial to the therapeutic environment. Carol Hinman tells us in her article that building rapport with the child’s parents plays a strong role in crafting the environment and is an indicator of the outcomes of play therapy [ CITATION Car03 \l 1033 ]. Culturally, parental involvement in play is wide and varied. There may be differences in involvement depending on the gender, race, ethnicity, or beliefs of the caregivers. Effective play therapists meet not just a child where they are, but also the caregiver. The caregivers can be trained in developmentally appropriate play, as well as creating an environment which is inclusive. An inclusive environment may include many options for pretend play, such as dolls of many different races and genders, a variety of seating options, and a wide array of cultures represented in books. References (2023, March 6). Retrieved from Association for Play Therapy: https://www.a4pt.org American Psychological Association. (2013). Diagnostic and Statistical Manual of Mental Disorders 5th ed. Arlington: American Psychiatric Association. Hinman, C. (2003). Multicultural Considerations in the Delivery of Play Therapy Services. International Journal of Play Therapy, , 107-122. Jeffry Simpson, W. A. (n.d.). Attachment and the Experience and Expression of Emotion in Romantic Relationships: A Developmental Perspective. Journal of Personaloty and Social Psychology . O’Connor, T. G. (2003). Attachment disorders: Assessment strategies and treatment approaches. Attachment and Human Development , 223-244. Wier, K. (2007). Using integrative play therapy with adoptive families to treat reactive attachment disorder: A case example. Journal of Family Psychotherapy , 1-16.
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