{"id":32,"date":"2018-10-23T20:34:03","date_gmt":"2018-10-24T03:34:03","guid":{"rendered":"https:\/\/blogs.ubc.ca\/radteacherresources\/?page_id=32"},"modified":"2018-11-28T07:52:34","modified_gmt":"2018-11-28T14:52:34","slug":"assessments","status":"publish","type":"page","link":"https:\/\/blogs.ubc.ca\/radteacherresources\/assessments\/","title":{"rendered":"Assessments"},"content":{"rendered":"

The assessment protocol for RAD is one of unique nature. RAD is one of the few diagnoses in the DSM-V where very little is known about the disorder, so a valid, universal assessment protocol has yet to be established. This lack a universal assessment protocol, along with the lack of knowledge regarding RAD, has led to 3 overarching problems.<\/p>\n

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Three General Issues with Assessment for RAD:<\/span><\/p>\n

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  1. There is a lack of assessment tools that are made <\/span>specifically<\/span><\/i> for RAD<\/span><\/li>\n
  2. \u00a0There is no consensus amongst the research community regarding which assessment tools are most valid to use when assessing for RAD<\/span><\/li>\n
  3. Confusion with other disorders vs. RAD<\/span><\/li>\n<\/ol>\n

    It is very problematic that there are limited resources and tools to assess for RAD. RAD is already a difficult diagnosis to make with it being rare and having subtle symptoms that\u00a0<\/span>are easily missed, and the lack of resources adds to the difficulty for practitioners to identify children with RAD. Assessment is a key piece to putting the puzzle of RAD together, and any diagnosis for that matter, because an official diagnosis helps identify and offers some answers to the problems that are occurring for a child, it helps guide treatment plans and assists in obtaining any funding. It is critical that the research community works to establish a universally, accepted assessment protocol for RAD so that practitioners\u00a0and clinicians are confident when assessing and diagnosing\u00a0this disorder.<\/p>\n

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    Potential Assessment Tools for RAD:<\/span><\/p>\n

    There are several assessment tools that are applicable when assessing RAD. However, it is crucial to note that these assessments were not<\/strong> made\u00a0specifically for RAD<\/em>; they were created to identify other diagnoses. These assessments may be utilized because they observe similar\u00a0behaviors and presentation of symptoms as RAD, but the validity of these tests for accurately assessing RAD is questionable.<\/span><\/p>\n

    In general, these tools aim to assess these three components of the child and their life: <\/span><\/p>\n

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    1. The child\u2019s patterns of attachment:<\/span><\/li>\n<\/ol>\n
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      • Attachment is the primary component when diagnosing RAD, as it is a diagnosis based on whether the child has developed healthy attachments to their parents\/caregivers or not. For RAD, clinicians would be specifically looking for a lack of attachment<\/em>.<\/span><\/li>\n
      • \u00a0Attachment assessments are intended to cover the spectrum of attachment-related behaviors, such as:\n
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        • Whether the child has a secure, avoidant, ambivalent, or disorganized attachment<\/li>\n
        • Healthy exploratory behaviors<\/li>\n
        • Emotional withdrawal\/inhibited from caregiver<\/li>\n
        • Self-protective behaviors<\/li>\n
        • If they identify caregiver as a source of danger or protection<\/li>\n
        • Affective responses and social cognition<\/li>\n<\/ul>\n<\/li>\n
        • Examples of attachment assessments: <\/span>\n
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          • The Strange Situation Procedure (SSP)<\/span><\/li>\n
          • Preschool Assessment of Attachment<\/span><\/li>\n
          • Disturbances of Attachment Interview (DAI)<\/span><\/li>\n<\/ul>\n<\/li>\n<\/ul>\n

            2.\u00a0 Children\u2019s representations of relationships:<\/p>\n

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            • Children with RAD are presumed to have grossly disturbed internal working models of relationships that may lead to interpersonal and behavioral difficulties in later life. <\/span><\/li>\n
            • By analyzing children\u2019s mental representations of relationships gives us another glimpse into understanding what type of relationships\/attachment they consider typical and the type of relationships they have been exposed to as well.<\/span><\/li>\n
            • To identify children’s representations of relationships, practitioners may:\n
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              • Ask about the child’s memories and perceptions of their caregivers<\/li>\n
              • May conduct role-play with puppets<\/li>\n
              • May conduct “what happens next” scenario tests where the child finishes a scenario about relationship interactions.<\/li>\n<\/ul>\n<\/li>\n
              • Examples of attachment assessments:<\/span>\n
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                • MacArthur Story Stem Battery<\/span><\/li>\n
                • Story Stem Assessment Profile<\/span><\/li>\n
                • Child Attachment Interview<\/span><\/li>\n<\/ul>\n<\/li>\n<\/ul>\n

                  3. The child’s behavioral, psychological and emotional attributes<\/p>\n

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                  • For a RAD diagnosis, clinicians (psychiatrist, psychologist, doctor, mental health professional) would be looking for signs such as:<\/span>\n
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                    • \u00a0A lack of social approach where they fail to initiate or respond to social interaction in developmentally appropriate ways<\/span><\/li>\n
                    • Unexplained withdrawal, fear, sadness, or irritability by others<\/span><\/li>\n
                    • Sad and listless appearance<\/span><\/li>\n
                    • Failure to smile<\/span><\/li>\n
                    • Frozen watchfulness<\/span><\/li>\n
                    • Not seeking comfort or no response when comfort is given<\/span><\/li>\n
                    • Failing to ask for support or help<\/span><\/li>\n
                    • Failure to reach out when being picked up<\/span><\/li>\n
                    • No interest in social interaction with interactive games<\/span><\/li>\n
                    • Oversociable<\/span><\/li>\n
                    • Fail to show selective attachments<\/span><\/li>\n
                    • Demonstrate clinging and\/or indiscriminate friendliness, even in their interactions with strangers<\/span><\/li>\n<\/ul>\n<\/li>\n
                    • Examples of attachment assessments:<\/span>\n
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                      • The Strengths and Difficulties Questionnaire (SDQ)<\/span><\/li>\n
                      • Behavioural Assessment System for Children (BASC)<\/span><\/li>\n<\/ul>\n<\/li>\n<\/ul>\n

                        Additional Potential Assessments for RAD:<\/p>\n

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                        Sheperis, C. J., Doggett, R. A., Hoda, N. E., Blanchard, T., Renfro-Michel, E. L., Holdiness, S. H., & Schlagheck, R. (2003). The development of an assessment protocol for reactive attachment disorder.<\/span>\u00a0Journal of Mental Health Counseling,\u00a025<\/span><\/i>(4), 291-310.\u00a0<\/span><\/p>\n

                        Assessment tools created for RAD:<\/span><\/span><\/p>\n

                        Unfortunately, RAD only has 3 assessment tools that were specifically designed to identify the disorder. This severely limits clinicians on the types of methods they may utilize to identify RAD, confidently knowing that the assessments they administer are valid for RAD. However, since there are much debate and division amongst the researcher community and clinicians on the characteristics of RAD, much of the disorder is suspected to be unknown, and these 3 tools are fairly new, many question the validity and reliability of the tools that were designed with for RAD.<\/p>\n

                        There are two questionnaires:<\/p>\n

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                        • The Relationship Problems Questionnaire &\u00a0<\/span>The Reactive Attachment Disorder Questionnaire<\/span>\n
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                          • Both aim to assess and screen symptoms of the inhibited and disinhibited subtypes ofRAD<\/span><\/li>\n

                          • \nParents, guardians, foster parents, and teachers are able to answer these questionnaires<\/span><\/li>\n
                          • There is little published pertaining to the reliability and validity of these measures<\/span><\/li>\n<\/ul>\n<\/li>\n<\/ul>\n
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                            • Rating of Inhibited Attachment Behaviour Scale (RInAB)<\/span>\n