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Examining the Relationship between Child Maltreatment and Severity of Attachment Difficulties among Children Five Years of Age and Older

The general problem that exists is that current diagnostic criteria for Reactive Attachment Disorder (RAD) in the DSM-5 limits a diagnosis of RAD to children who exhibited RAD symptoms and extreme insufficient care by/before age five potentially leaving children who are older than five and who exhibit attachment difficulties without appropriate diagnoses and treatment. RAD is defined as a mental health disorder where there is no attachment or evidence of bonding to a primary caregiver as a result of child maltreatment or complex trauma. Older children with attachment difficulties (AD) may not receive a diagnosis of RAD and/or their symptoms may go unnoticed if they are over the age of five when the symptoms present. The specific problem that was addressed by this study was that it was unclear whether RAD or not criteria could emerge in children older than five years of age. The purpose of this quantitative correlational study was to examine whether RAD criteria emerge in children who experience the prequelae associated with RAD after the age of five. The target population in this study were foster or adoptive parents across Florida who were caring for a child who had experienced child maltreatment and/or disruptions in a primary caregiver. Participants (N =223) were categorized as caring for a child who had a history of child maltreatment and/or disruptions in a primary caregiver before/by age 5 or as caring for a child who had a history of child maltreatment and/or disruptions in a primary caregiver after age 5. Participants were administered the Attachment Disorder Assessment Scale-revised (ADAS-R; Ziegler, 2006) to assess for the presence of attachment difficulties (AD) among the children that they were caring for. Two separate between groups Analysis of Variance (ANOVA) were conducted to examine the differences between the scores on the ADAS-R (the dependent variable) for those participants caring for a child who had 1) a history of child maltreatment before/by age 5 vs. after age 5 and/or 2) disruptions in a primary caregiver before/by age 5 vs. after age 5 (the independent variable). Results indicated that those children who were older than 5 when they experienced child maltreatment and/or disruptions in a primary caregiver actually had more substantial AD than those children who had these experiences by/before age 5. These results suggest RAD criteria can emerge in children who experience the prequelae associated with RAD after the age of five and that children who have these experiences after the age of 5 may actually develop more substantial attachment difficulties than those children who have similar experiences before/by age 5. The results from this study have the potential to increase diagnostic accuracy (as it is evident that attachment difficulties can develop even if the prequelae associated with RAD occurs after a child is 5 years old) and ultimately improve the quality of life of children who experience the prequelae of RAD (by virtue of increasing diagnostic accuracy treatment access can be improved).

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