Reactive attachment disorder
The broad theoretical framework for current versions of RAD is attachment theory, based on work conducted from the 1940s to the 1980s by John Bowlby, Mary Ainsworth and René Spitz. Attachment theory is a framework that employs psychological, ethological and evolutionary concepts to explain social behaviors typical of young children. Attachment theory focuses on the tendency of infants or children to "seek proximity" to a "particular attachment figure" (familiar caregiver), in situations of alarm or distress, behavior which appears to have survival value. This is known as a discriminatory or selective attachment. Subsequently, the child begins to use the caregiver as a base of security from which to explore the environment, returning periodically to the familiar person. Attachment is not the same as love and/or affection although they are often associated. Attachment and attachment behaviors tend to develop between the ages of six months and three years. Infants become attached to adults who are sensitive and responsive in social interactions with the infant, and who remain as consistent caregivers for some time. Caregiver responses lead to the development of patterns of attachment, that in turn lead to internal working models which will guide the individual's feelings, thoughts, and expectations in later relationships. For a diagnosis of reactive attachment disorder, the child's history and atypical social behavior must suggest the absence of formation of a discriminatory or selective attachment.
Attachment measures
The MCAST is a semi-structured doll play 'story stem' methodology, developed by Jonathan Green, Charlie Stanley, Ruth Goldwyn and Vicky Smith, to evaluate and understand the internal (mental) representations of their attachment relationship with a specific primary caregiver in children of 4 to 8.5 years. The concepts and procedures used have a basis in the Strange Situation Procedure and Adult Attachment Interview, and involves 4 story stem vignettes involving two dolls representing the caregiver-child dyad of interest and a dolls house, presented with affective arousal to mobilise attachment representations in a way that children of this age range find accessible and engaging. Responses are usually videotaped in order to reliably rate aspects of the child's represented narrative content and behaviour, and the child's own behaviour, to ascertain an attachment classification, with a particular focus on disorganised attachment, as well as providing other supporting ratings. Clinical development of the MCAST started in 1992, validation was published in 2000, and it has been since used in a range of cultural contexts and clinical and at-risk groups. Training is required for its use.