Concerned About Unconventional Mental Health Interventions?

Concerned About Unconventional Mental Health Interventions?
Alternative Psychotherapies: Evaluating Unconventional Mental Health Treatments

Monday, May 23, 2011

Reactive Attachment Disorder: Mistakes in a Master's Paper

NOTE: No sooner had I posted this comment than a message forwarded to me stated that UW staff had intended to take the paper down and somehow the process had not worked. I am going to leave this post in place in case there is some mysterious archive or cache where the paper I discuss remains, but I want to give credit where it is due for a good decision.

Some months ago, I came across a master’s thesis from the University of Wisconsin, with the title “Effective Interventions for Children With Reactive Attachment Disorder”. I read the document, which was on the Internet, and felt very disturbed by the misconceptions that it passed on to the public. Most unpublished master’s theses never really see the light of day and quickly tumble into the academic abyss, but when things are available on the Internet it’s a different story. I was concerned that this paper would be read, believed, and repeated in the form of undergraduate psychology or education papers handed in to unwary instructors who didn’t use This would mean that the misunderstandings contained in the paper would multiply and multiply further, following the psychological version of Gresham’s law-- “bad ideas drive out good.”

Because of these concerns, I contacted the department that awarded the master’s degree and stated my concerns. They were very polite and said they would take down the document and discuss the matter, and I suppose they did. They didn’t tell me, and I could hardly expect them to.

But guess what: here’s the paper on line again, at

The author begins her paper by referring to a claim by Nancy Thomas to the effect that Ted Bundy, Saddam Hussein, and Adolf Hitler probably all had Reactive Attachment Disorder. Thomas is a former dog trainer who has achieved a considerable following among a group of foster and adoptive parents by stating, among other things, that the way you know whether people are good parents to foster or adopted children is that the children still have their arms, legs, and heads attached. She is completely without training in child development or clinical psychology and is a most inappropriate source for a master’s thesis to quote as an authority. As for the statement about the three frightening figures, little accurate information about their childhoods exists, particularly about the preschool period in which it might be possible to diagnose Reactive Attachment Disorder, a problem that is difficult to identify in any case (as the author herself later notes).

The master’s candidate goes on to discuss Reactive Attachment Disorder, citing a couple of published sources. She then lists without citation characteristics that she attributes to RAD, including tantrums, destructive behavior toward self or property, problems making eye contact, and being affectionate toward strangers while failing to show affection to parents. None of these are characteristics of Reactive Attachment Disorder as it is described in the Diagnostic and Statistical Manual of the American Psychiatric Association. They are, however, included in various checklists available on line and recommended by their promulgators for use by parents deciding whether their child needs therapy for attachment problems or for diagnosis of the entirely notional “Attachment Disorder” suggested by various unconventional therapists. Our author, incidentally, does not reference DSM-IV-Tr and presumably has not read it; her only citation to this important volume is in a secondary source edited by Dziegielewski (of which the first edition recommended Holding Therapy and failed to discuss criticisms of that method).

By p. 5, the master’s candidate states that children with RAD have been unable to complete the “attachment cycle”, a term she fails to define or cite a source for, and one that is completely unknown to John Bowlby’s attachment theory. Although she refers to Bowlby, she does not reference his work and it is fairly clear that she has only come across it in secondary sources.

The author eventually concludes that there is no evidence supporting any of the methods of treatment she outlines, nor, for that matter, is there any clear method of diagnosing RAD. While I would certainly agree with these conclusions, I must point out that she discusses none of the efforts that have been made at testing the methods she refers to, nor does she touch on the numerous critiques of that research and of diagnostic approaches that have been published in the last 10 or 12 years. Neither does she refer to the 2006 report of the APSAC Task Force on Attachment Disorders, published in Child Maltreatment; instead, she cites authors who were specifically mentioned in that report as using inappropriate treatments. In addition, she omits to mention evidence-based treatments like Parent-Child Interaction Therapy.

I am especially concerned about the flaws in this master’s thesis (of which I have mentioned only a small portion) because the degree is in school psychology, an area where it is all too easy for professionals’ misunderstandings to spread to teachers, parents, and children themselves. The fact that a school psychology professional means well is not a sufficient saving grace when harm can be done in this way. As authors writing about fads in special education have pointed out, meaning well can be dangerous; “politically correct treatments are… adopted… because they resonate in their purported nature and effects with ideological perspectives, or because their use contributes to the realization of other, perhaps tangible, socially progressive goals… The rationale… may be no more complex than ‘ to do the right thing’ “ (Jacobson, J.W., Foxx, R.M., & Mulick, J.A. (2005). Preface. In J.W. Jacobson, R.M. Foxx, & J.A. Mulick [Eds.], Controversial therapies for developmental disabilities [pp.xi-xvii]. Mahwha, NJ: Erlbaum, p. xv).

It’s hard to see what motive other than political correctness allowed this paper to be approved and a degree awarded, or indeed any reason why the paper should be on the Internet to confuse and mislead readers who are unlikely to know how to critique it. What those reasons may be, I leave to others to consider. My sole hope is that when students or parents Google and find the master’s thesis, they will also find my comments-- and perhaps be warned by them.


  1. Glad you got that article removed. It's too bad that it is probably not possible for them to require remediation of some kind for the student, probably now graduated and practicing -- a scary thought.

    By the way, that myth about serial killers and the like, having attachment disorders is now being extended to cult leaders and Osama Bin Laden. Here, "cult expert" Steven Hassan, proclaims (regarding Bin Laden and cult leaders):

    "It comes back to the lack of successful organized attachments with the mother," said Hassan, author of the book, "Releasing the Bonds: Empowering People to Think for Themselves."
    "Basically, because of a lack of healthy attachment, they have an inability to have empathy...They can't put themselves in another person's shoes."

    Once these myths are out there, the press fall for them when repeated by so-called "experts" and it seems there's no going back and correcting them, but we can keep trying.

  2. Symptoms of reactive attachment disorder generally appears in the children before age 5, and is thought to result from a lack of consistent care and the nurturing in early years. The disorder is characterized by the inability of a child or infant to establish age appropriate social contact and relationships with the others.

  3. Basically it's pseudoscience and a regular mealticket for 'therapists'. Neurodevelopmental conditions, and autism in particular, often provide a more economical and therapeutically useful explanation of such bizarre behavior.