Reactive Attachment Disorder (RAD) is another condition that has behavioural overlaps with PDA, but perhaps what really distinguishes these two conditions from each other is the underlying cause. PDA behaviours are as a result of an underlying Autism Spectrum Condition causing high anxiety. RAD behaviours are, as described by the DSMV manual, as a result of a pattern of insufficient care.
DSMV Criteria for RAD, Criteria 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)
Also according to the DSMV, criteria E, specifies that ‘The criteria are not met for autism spectrum disorder’.
‘A number have had their child’s difficulties wrongly attributed to an attachment disorder, in spite of the fact that there is no evidence of what the DSM describes as ‘pathogenic care’ (e.g. disregard of the child’s basic emotional or physical needs, repeated changes in caregiver or bringing up in ‘unusual settings’). Clearly this can have a devastating impact on the family as a whole and lead to unhelpful interventions for the child.’ Phil Christie et al, p.g. 53, Understanding PDA in Children
‘Initially, it was suggested that Vicky was suffering from Attachment Disorder and both she and I underwent counselling to help ‘repair’ our relationship. This was a very difficult time, as to be told that your daughter does not have the ability to form healthy attachments due to your actions is very hard to hear. My husband and I had just separated and this basically supported his belief that I was too soft. Once the sessions were ended we were literally discharged and left on our own.’Phil Christie et al, p.g. 97, Understanding PDA in Children
The differences between PDA and RAD is also discussed on p.g. 14 of the PDA Society’s Clinician’s Booklet.
These areas of overlap, and the potential for behavioural profiles being interpreted in different ways, underline the importance of a detailed and comprehensive assessment being carried out by experienced practitioners. Assessments should include the taking of a detailed developmental history as it is vital to know not just how a child presents now but how they developed up until now. This is not always easy with an older child, or a child who grew up in adverse circumstances, as that information might be hard to come by. Assessments should also include detailed observation of the child looking at all areas of development, information about how they behave in a range of different situations, the views of other professionals and consideration of other relevant factors and circumstances, such as their health and family relationships. Phil Christie, May 2014, Clinician’s Booklet