One piece of the puzzle: Treatment of fostered and adopted children with RAD and DSED

Reactive attachment disorder (RAD) and disinhibited social engagement disorder (DSED) are two interrelated diagnoses emerging from pathogenic and insufficient care during the first few years of life. They have been reported in children who were fostered or adopted after experiencing severe early deprivation through institutionalisation, as well as youth with foster care and maltreatment histories. Substantial comorbid and overlapping difficulties often coexist with both disorders, which complicates their identification. Despite a consensus that RAD and DSED are distinctive diagnoses that capture relational behaviours not elsewhere described, many questions remain about their development and treatment. Research probing underlying mechanisms for both disorders is scarce, and only a few studies exist that chronicle potential interventions. Extant treatments tend to focus on parent management training rather than attachment-based interventions and often do not incorporate assessment of the child’s relational schemata and comorbid difficulties into interventions. This article expands on earlier interventions by detailing the current state of knowledge about RAD and DSED and their common comorbidities in children with foster care and adoption histories and by suggesting how to weave that knowledge into comprehensive assessment and treatment. Two case vignettes are presented.