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1. Reactive Attachment Disorder (RAD) is a relatively new diagnosis, and, despite over 50 years of research on the importance of human relationships in child development, the diagnosis was created and refined without empirical evidence for the diagnostic criteria.
A. True
B. False
2. In the Diagnostic and Statistical Manual IV-TR, Reactive Attachment Disorder is defined as a condition of 'markedly disturbed and developmentally inappropriate social relatedness in most contexts', and:
A. Symptoms begin before age 8 years
B. It's associated with grossly pathological care
C. It often occurs with the presence of a pervasive developmental disorder
D. All of the above
3. Experts note that the inhibited pattern of RAD is often seen for quite awhile in institutionalized children once they have been adopted, and they tend to be leary of strangers long after they have developed a secure relationship with their primary caregivers.
A. True
B. False
4. The persistent disregard of a primary caregiver to the child's needs for emotional comfort, stimulation, and affection, and the persistent disregard of the child's physical needs is known as:
A. Negligent care
B. Unmindful care
C. Culpable care
D. Pathogenic care
5. Four normally-occurring types of attachment are secure, insecure avoidant, insecure resistant, or disorganized, and none of these are considered to be pathological because in each case, there is a primary caregiver with whom the child can attach in some way.
A. True
B. False
6. Each of the following is an accurate statement about affective attunement EXCEPT:
A. It refers to the process by which the mother's/caregiver's activities match the feeling states of the infant in terms of intensity and duration
B. With affective attunement, the caregiver's activities shape the infant's behavior in a manner reciprocal to how the infant's behavior shapes that of the caregiver in a different sensory modality
C. It exemplifies the feelings of love and protection that the primary caregiver has toward his or her newborn or newly adopted child
D. Affective attunement in the early relationship supports the development of empathy and emotional self-regulation in later childhood and adult life
7. The term "Attachment Disorder" is different from RAD in that it references more global symptomatology, combining elements of RAD with other DSM diagnoses, such as Conduct Disorder, Oppositional Defiant Disorder, ADHD, Anxiety Disorders, and PTSD.
A. True
B. False
8. Threat of loss of or actual abandonment by the attachment figure, either physically or emotionally, during child distress can be a source of terror, and this loss of the attachment figure can be conceptualized as ____________ or "attachment-related trauma".
A. Relational trauma
B. Association trauma
C. Alliance trauma
D. Dependency trauma
9. Hallmark symptoms of Disruptive Behavior Disorder and Borderline Personality Disorder, including negative or hostile behavior, instability and impulsivity, and difficulties with relationships, are often incorporated into the purported presentation of RAD in children.
A. True
B. False
10. Which of the following are NOT included in the assessment guidelines for Reactive Attachment Disorder?
A. Several direct observations and collateral history
B. Assessments across settings and psychological testing
C. Screening for developmental delays and differential diagnosis related to other disorders
D. Interviews with primary caregivers and other significant adults
11. A child with RAD requires a stable, safe, nurturing and loving primary caregiver, and treatment goals include enhancing the child's understanding emotions, social cues, and interpersonal situations, and general and specific _________________ interventions.
A. Environment altering
B. Behavior management
C. Conditioning and reinforcement
D. Conduct modification
12. Clinicians and caregivers should avoid talking about children's early experiences in order to assure them that those experiences are no longer a part of their lives and to avoid giving those experiences any power.
A. True
B. False
13. If a child is exhibiting unsafe or high-risk behaviors, such as suicidal or sexual acting out, those behaviors must be addressed immediately and directly and should not wait until parent child relationship-focused work is completed.
A. True
B. False
14. Controversies surrounding the diagnosis and treatment of Reactive Attachment Disorder include concerns about the safety of some treatment models that have been referred to as "attachment therapy" and concerns about the lack of scientific evidence for the effectiveness of such therapies.
A. True
B. False
15. Regardless of a potential diagnosis of RAD, children should receive care in the least restrictive environment possible that fosters their and their family members' participation in treatment, while ensuring:
A. The development of nurturing relationships
B. That the focus is on decreasing disturbing behaviors
C. Their physical safety
D. None of the above
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