What are childhood developmental disorders?

Childhood developmental disorders encompass neuro developmental, emotional, and behavioral disorders originating in childhood and have broad and serious adverse impacts on psychological and social well-being.

Children with these disorders require significant support from their families, educational systems and therapies. Unfortunately these disorders are noticed first in childhood and more frequently persist into adulthood. Children affected are more likely to experience a compromised developmental trajectory, withincreased need for medical and disability services. The list of childhood developmental disorders is a long

one and will not put here but a few examples are Autism Spectrum Disorder (ASD), Attention Deficit Hyperactivity Disorder (ADHD), and intellectual disability. Below is a discussion on Reactive Attachment Disorder RAD a childhood developmental disorder.

Reactive attachment disorder (RAD) is a psychiatric disorder developing in early or middle childhood as a consequence of significant failures in the caregiving environment. RAD results in children failing to relate socially, either by exhibiting markedly inhibited behaviour or by indiscriminate social behaviour and is associated with significant socio-behavioural problems in the longer term.

The Diagnostic and Statistical Manual of Mental Disorders V (DSM-5) Criteria for Reactive Attachment Disorder (RAD) is as follows:
A. A consistent pattern of inhibited, emotionally withdrawn behavior toward adult caregivers, manifested by both of the following:

•  The child rarely or minimally seeks comfort when distressed.
•  The child rarely or minimally responds to comfort when distressed.
  B. A persistent social or emotional disturbance characterized by at least two of the following:

•  Minimal social and emotional responsiveness to others
•  Limited positive affect
•  Episodes of unexplained irritability, sadness, or fearfulness that are evident even duringnonthreatening interactions with adult caregivers.
  C. The child has experienced a pattern of extremes of insufficient care as evidenced by at least one of the following:

• 

•  Social neglect or deprivation in the form of persistent lack of having basic emotional needs for comfort, stimulation, and affection met by caring adults
•  Repeated changes of primary caregivers that limit opportunities to form stable attachments (e.g., frequent changes in foster care)
•  Rearing in unusual settings that severely limit opportunities to form selective attachments (e.g., institutions with high child to caregiver ratios)E. The criteria are not met for autism spectrum disorder.
  F. The disturbance is evident before age 5 years.
  G. The child has a developmental age of at least nine months.
  The disorder has been present for more than 12 months.
  Reactive Attachment Disorder is specified as severe when a child exhibits all symptoms of the disorder, with each symptom manifesting at relatively high levels.Warning signs of Reactive Attachment DisordersSigns and symptoms of attachment issues are:

•  Avoids eye contact
•  Doesn’t smile
•  Doesn’t reach out to be picked up
•  Rejects your efforts to calm, soothe, and connect
•  Doesn’t seem to notice or care when you leave them alone
•  Cries inconsolably
•  Doesn’t coo or make sounds
•  Doesn’t follow you with their eyes
•  Isn’t interested in playing interactive games or playing with toys
•  Spends a lot of time rocking or comforting themselves

Diagnosis

A Pediatric Psychiatrist, Clinical Psychologist or a Pediatric Neurologist can make a diagnosis. Diagnosis isn’t usually made before 9 months of age. Signs and symptoms appear before the age of 5
Evaluation may include:

•  Direct observation of interaction with parents or caregivers
•  Details about the pattern of behavior over time
•  Examples of the behavior in a variety of situations
•  Information about interactions with parents or caregivers and others
•  Questions about the home and living situation since birth
•  An evaluation of parenting and caregiving styles and abilitiesOther psychiatric disorders need to be
  ruled out or and if any other mental health conditions co-exist, such as:

•  Intellectual disability
•  Other adjustment disorders
•  Autism spectrum disorder
•  Depressive disorders etc.TreatmentChildren with reactive attachment disorder are believed to have the capacity to form attachments, but this ability has been hindered by their experiences.
  Most children are naturally resilient and even those who have been neglected, lived in a children’s home or other institution, or had multiple caregivers can develop healthy relationships. Early intervention appears to improve outcomes.There’s no standard treatment for reactive attachment disorder, but it should involve both the child and parents or primary caregivers. Goals of treatment are to help ensure that the child:

•  Has a safe and stable living situation
•  Develops positive interactions and strengthens the attachment with parents and caregivers Treatment strategies include:

•  Encouraging the child’s development by being nurturing, responsive and caring
•  Providing consistent caregivers to encourage a stable attachment for the child
•  Providing a positive, stimulating and interactive environment for the child
•  Addressing the child’s medical, safety and housing needs, as appropriateServices that may benefit the child and the family include:

•  Individual and family psychological counseling
•  Education of parents and caregivers about the condition
•  Parenting skills classes

African Perspectives

‘It takes a village to raise a child’ is an African philosophy meaning a child grows up with a large support network and forming healthy relationships. The collectiveness of African communities means caregiving of a child is a shared task. However a lot of things have changed in the last couple of years that have affected this perspective like more women (primary caregivers) joining the work force, changes in the family unit (more single parent and child-headed family units emerging) and rural to urban migration etc.

Research points to the fact that children in low- and middle-income countries which most African countries fall into are exposed to multiple risks associated with poverty, HIV, trauma and conflict, which are widely associated with poor mental health and risk behavior. These changes and risk factors have introduced new challenges of childhood mental health in African communities; sadly these are met with denial due to lack of knowledge. And more often than not no help is ever sort.

Talent Adamson Behaviour Therapist

BA (Health and Social Services) Applied Psychology, BA Hon (HSS) Psychological Counselling – (UNISA)