HEALTH: Reactive attachment disorder

Reactive attachment disorder
From Wikipedia, the free encyclopedia


Reactive attachment disorder (RAD) is described in clinical literature as a severe and relatively uncommon attachment disorder that can affect children. RAD is characterized by markedly disturbed and developmentally inappropriate ways of relating socially in most contexts. It can take the form of a persistent failure to initiate or respond to most social interactions in a developmentally appropriate way—known as the "inhibited" form—or can present itself as indiscriminate sociability, such as excessive familiarity with relative strangers—known as the "disinhibited form". The term is used in both the World Health Organization's International Statistical Classification of Diseases and Related Health Problems (ICD-10)[1] and in the DSM-IV-TR, the revised fourth edition of the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (DSM).[2] In ICD-10, the inhibited form is called RAD, and the disinhibited form is called "disinhibited attachment disorder", or "DAD". In the DSM, both forms are called RAD; for ease of reference, this article will follow that convention and refer to both forms as reactive attachment disorder.

RAD arises from a failure to form normal attachments to primary caregivers in early childhood. Such a failure could result from severe early experiences of neglect, abuse, abrupt separation from caregivers between the ages of six months and three years, frequent change of caregivers, or a lack of caregiver responsiveness to a child's communicative efforts. Not all, or even a majority of such experiences, result in the disorder.[3] It is differentiated from pervasive developmental disorder or developmental delay and from possibly comorbid conditions such as mental retardation, all of which can affect attachment behavior. The criteria for a diagnosis of a reactive attachment disorder are very different from the criteria used in assessment or categorization of attachment styles such as insecure or disorganized attachment.

Children with RAD are presumed to have grossly disturbed internal working models of relationships which may lead to interpersonal and behavioral difficulties in later life. There are few studies of long-term effects, and there is a lack of clarity about the presentation of the disorder beyond the age of five years.[4][5] However, the opening of orphanages in Eastern Europe following the end of the Cold War in the early-1990s provided opportunities for research on infants and toddlers brought up in very deprived conditions. Such research broadened the understanding of the prevalence, causes, mechanism and assessment of disorders of attachment and led to efforts from the late-1990s onwards to develop treatment and prevention programs and better methods of assessment. Mainstream theorists in the field have proposed that a broader range of conditions arising from problems with attachment should be defined beyond current classifications.[6]

Mainstream treatment and prevention programs that target RAD and other problematic early attachment behaviors are based on attachment theory and concentrate on increasing the responsiveness and sensitivity of the caregiver, or if that is not possible, placing the child with a different caregiver.[7] Most such strategies are in the process of being evaluated. Mainstream practitioners and theorists have presented significant criticism of the diagnosis and treatment of alleged reactive attachment disorder or attachment disorder within the complementary and alternative medicine field commonly known as attachment therapy. Attachment therapy has an unconventional theoretical base and uses diagnostic criteria or symptom lists unrelated to criteria under ICD-10 or DSM-IV-TR, or to attachment behaviors. A range of treatment approaches are used in attachment therapy, some of which are physically coercive and considered to be antithetical to attachment theory.




Signs and symptoms


Pediatricians are often the first health professionals to assess and raise suspicions of RAD in children with the disorder. The initial presentation varies according to the developmental and chronological age of the child, though it always involves a disturbance in social interaction. Infants up to about 18–24 months may present with non-organic failure to thrive and display abnormal responsiveness to stimuli. Laboratory investigations will be unremarkable barring possible findings consistent with malnutrition or dehydration, while serum growth hormone levels will be normal or elevated.[9]

The core feature is that the style of social relating by affected children involves either indiscriminate and excessive attempts to receive comfort and affection from any available adult, even relative strangers—older children and adolescents may also aim attempts at peers—or extreme reluctance to initiate or accept comfort and affection, even from familiar adults, especially when distressed.[10] The disorder arises from a severe lack of developmentally appropriate attachment behaviors and, thus, appropriate social relatedness.

While RAD is likely to occur in relation to neglectful and abusive treatment, automatic diagnoses on this basis alone cannot be made, as children can form stable attachments and social relationships despite marked abuse and neglect.[11]

Assessment tools

There is as yet no universally accepted diagnostic protocol for reactive attachment disorder. Often a range of measures is used in research and diagnosis. Recognized assessment methods of attachment styles, difficulties or disorders include the Strange Situation Procedure (devised by developmental psychologist Mary Ainsworth),[12][13][14] the separation and reunion procedure and the Preschool Assessment of Attachment,[15] the Observational Record of the Caregiving Environment,[16] the Attachment Q-sort[17] and a variety of narrative techniques using stem stories, puppets or pictures. For older children, actual interviews such as the Child Attachment Interview and the Autobiographical Emotional Events Dialogue can be used. Caregivers may also be assessed using procedures such as the Working Model of the Child Interview.[18]

More recent research also uses the Disturbances of Attachment Interview (DAI) developed by Smyke and Zeanah (1999).[19] The DAI is a semi-structured interview designed to be administered by clinicians to caregivers. It covers 12 items, namely "having a discriminated, preferred adult", "seeking comfort when distressed", "responding to comfort when offered", "social and emotional reciprocity", "emotional regulation", "checking back after venturing away from the care giver", "reticence with unfamiliar adults", "willingness to go off with relative strangers", "self-endangering behavior", "excessive clinging", "vigilance/hypercompliance" and "role reversal". This method is designed to pick up not only RAD but also the proposed new alternative categories of disorders of attachment.




Diagnosis

RAD is one of the least researched and most poorly understood disorders in the DSM. There is little systematic epidemiologic information on RAD, its course is not well established and it appears difficult to diagnose accurately.[10] There is a lack of clarity about the presentation of attachment disorders over the age of five years and difficulty in distinguishing between aspects of attachment disorders, disorganized attachment or the consequences of maltreatment.[5]

According to the American Academy of Child and Adolescent Psychiatry (AACAP), children who exhibit signs of reactive attachment disorder need a comprehensive psychiatric assessment and individualized treatment plan. The signs or symptoms of RAD may also be found in other psychiatric disorders and AACAP advises against giving a child this label or diagnosis without a comprehensive evaluation.[20] Their practice parameter states that the assessment of reactive attachment disorder requires evidence directly obtained from serial observations of the child interacting with his or her primary caregivers and history (as available) of the child’s patterns of attachment behavior with these caregivers. In addition it requires observations of the child’s behavior with unfamiliar adults and a comprehensive history of the child’s early caregiving environment including, for example, pediatricians, teachers, or caseworkers.[4] In the US, initial evaluations may be conducted by psychologists, psychiatrists, specialist Licensed Clinical Social Workers or psychiatric nurses.[21]

In the UK, the British Association for Adoption and Fostering (BAAF), advise that only a psychiatrist can diagnose an attachment disorder and that any assessment must include a comprehensive evaluation of the child’s individual and family history.[22]

According to the AACAP Practice Parameter (2005) the question of whether attachment disorders can reliably be diagnosed in older children and adults has not been resolved. Attachment behaviors used for the diagnosis of RAD change markedly with development and defining analogous behaviors in older children is difficult. There are no substantially validated measures of attachment in middle childhood or early adolescence.[4] Assessments of RAD past school age may not be possible at all as by this time children have developed along individual lines to such an extent that early attachment experiences are only one factor among many that determine emotion and behavior.[23]

yakult....the yucky side







Back in the days when its either the magnolia guy that you're waiting for to pass by outside your house on a weekend or the yakult lady dressed up with blue cap and dragging the stroller filled with yakult packs in 5 that you would run to your mom and grab her skirt to go get you one. Those were the days then.

A couple of days ago me and my friend dropped by at mini stop just for snacks when we found a whole pack of Yakult on the shelve of the chilled section. We took one just savor it out of novelty. And Damn !@# it still does taste real good.. i could still remember one my sibling drinking it with a poked straw on its top.. while reminiscing the memories at the same time that yakult taste touches my tongue the 6 note melodic tune of its theme keeps playing background of my auidiobiotic thoughts. there was even a time way back in college that i was looking for a yakult ring tone in the days when phones were still monophonic ringers.


Me and my friend thought .. man, this stuff's good and it has been there for ages . Why didnt they thought of packaging it in litres or maybe in 500ml bottles. We thought why didnt they .. is there any known side effect of overdosing yourself with yakult..? we asked ourselves... yakult tastes really good and a lot of folks like it .. is it because its healthy or just because of its taste..? we asked ourselves again.

Then it occurred to me on what actual benefits we get in drinking this tiny bottle of health bomb.. We all do know that its healthy coz of this Lactobacilli Casei strain that some guy named Minuro Shirota discovered . which eventually helps in maintaining the balance of good bacteria and bad ones in our digestion. Ok we know that's healthy.. but crap ! lactobacilli casei shirota is already in our system ..! That's nothing new to a kid who grew up with medically inclined parents.. My dad took pre med school and worked as an area manager for MJ.. yah..we had endless stock of Enfalac,Enfamil and Enfapro at home when we were kids.. hahaha!@ My Moms a Medical. Tech and took nursing when i was already high school just coz he has nothing to do then.. but what's bothering me is why this lactobasilly has to do with its taste or not..?

as dicey would put it: Mmhhh Shirota. You imagine a legion of tiny brave samurai Shirota bacteria that patrol through your body and hack into every sick-making microorganism with their cute but deadly kitanas. "Now demon, I don't want to see your mitochondria near this colon or, by my honour, I shall smite thee with this cute but deadly polyprotein weapon." hahaha...

So i got online and began looking for answers.. which only sent me to oblivion and disappointment .. i went to every website of yakult in every known country who had managed to put up big yakult factories. Wow this company has indeed made it global. God !@ they even own a baseball team in Japan .

But what i was looking for was not quenched. Every info page in every website they have, in every different country keeps saying the same shit..!@ its healthy, drink it ! its good for you ! . damn..!..

But how.? Why? i became more interested in investigating how Dr. Shirota uncovered the strain.. i scrammed every page that has to do with Yakult ..


Stumbling upon wikipedia's entry for yakult the last line describes as : Today, Yakult is manufactured and sold in Japan, Asia, Australia, Latin America, and Europe, although its bacteria cultures are still imported from a mother strain in Japan regardless of production location.

and Guess what i found next.: The Real Deal .

No wonder it taste so good... freakin' sh@#! ..They have this huge basin like container in mother Japan that they store Human Fecal waste to rot. where they could extract the bacteria which will be used next to culture it. Damn right it is...


Come to think of it .. We Drink a tiny bottle of processed milk with 6bilion of that idy bity something of Lcs strain packed in it. that actually came from sh#@! collected from who knows who from the Japanese population. and distributed worldwide ! How's That ?

Damn Bastard Shirota-San you duped us.. !@#$
Maybe that's the reason why I'm so calcium deficient
i loved yakult more than a carton fresh milk when i was a kid..!
No wonder why they dont make Yakult Litro !@#
The Japs did it again !@ .. Bakero!

And Yes Dicey ; " Yakult ain't shit.. "

It's Freakin' Made from Shit !@#

Crap ! Me go get clusivol nlang, its cheaper than Yakult..


" if health is wealth.. I'm Broke ~ !!.



some of the references :

http://en.wikipedia.org/wiki/Yakult

http://cdli.asm.org/cgi/content/full/8/3/593#MaterialsMethods

http://www.yakult.com.au/resources/popups/pop_faqs01.htm