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Monday 16 April 2012

DSM5 - THE REAL DESCRIPTORS FOR THE CHILDHOOD AND ADOLESCENT CONDITIONS "REACTIVE ATTACHMENT DISORDER" AND "DISINHIBITED SOCIAL ENGAGEMENT DISORDER" COURTESY OF THE DSM5 WEBSITE -JUDGE FOR YOURSELVES AS TO THE LEVEL OF SUBJECTIVITY AND SCIENTIFIC RIGOR E.G. FREQUENCY, DURATION AND INTENSITY CRITERIA. 'PATHOGENIC CARE' IS A DAMNING LABEL DOESN'T IT NEED TO BE A BIT BETTER DEFINED!

http://www.dsm5.org/MeetUs/Pages/ChildhoodAdolescent.aspx


CLICK ON LINK ABOVE TO SEE ALL THE CHILDHOOD DISORDER DESCRIPTORS AND JUDGE FOR YOURSELF AS TO THE SCIENTIFIC VALIDITY AND RIGOR OF THE NEW 'HANDBOOK,' FOR PSYCHIATRISTS AND PAEDIATRICIANS.


Proposed DSM-V Criteria for Reactive Attachment Disorder of Infancy or Early Childhood

A.   A pattern of markedly disturbed and developmentally inappropriate attachment behaviors, evident before 5 years of age, in which the child rarely or minimally turns preferentially to a discriminated attachment figure for comfort, support, protection and nurturance. The disorder appears as a consistent pattern of inhibited, emotionally withdrawn behavior in which the child rarely or minimally directs attachment behaviors towards any adult caregivers, as manifest by both of the following:

1)     Rarely or minimally seeks comfort when distressed.

2)     Rarely or minimally responds to comfort offered when distressed.

B.   A persistent social and emotional disturbance characterized by at least 2 of the following:

1)     Relative lack of social and emotional responsiveness to others.

2)     Limited positive affect.

3)     Episodes of unexplained irritability, sadness, or fearfulness which are evident during nonthreatening interactions with adult caregivers.

C.   Does not meet the criteria for Autistic Spectrum Disorder.

D.   Pathogenic care as evidenced by at least one of the following:

1)     Persistent disregard of the child’s basic emotional needs for comfort, stimulation, and affection (i.e., neglect).

2)     Persistent disregard of the child’s basic physical needs.

3)     Repeated changes of primary caregiver that prevent formation of stable attachments (e.g., frequent changes in foster care).

4)     Rearing in unusual settings such as institutions with high child/caregiver ratios that limit opportunities to form selective attachments.

E.   There is a presumption that the care in Criterion D is responsible for the disturbed behavior in Criterion A (e.g., the disturbances in Criterion A began following the pathogenic care in Criterion D).

F.   The child has a developmental age of at least 9 months.
Proposed DSM-V Criteria for Disinhibited Social Engagement Disorder


A.   A pattern of behavior in which the child actively approaches and interacts with unfamiliar adults by exhibiting at least 2 of the following:

1)     Reduced or absent reticence to approach and interact with unfamiliar adults.

2)     Overly familiar behavior (verbal or physical violation of culturally sanctioned social boundaries).

3)     Diminished or absent checking back with adult caregiver after venturing away, even in unfamiliar settings.

4)     Willingness to go off with an unfamiliar adult with minimal or no hesitation.

B.   The behavior in A. is not limited to impulsivity as in ADHD but includes socially disinhibited behavior.

C.   Pathogenic care as evidenced by at least one of the following:

1)     Persistent failure to meet the child’s basic emotional needs for comfort, stimulation, and affection (i.e., neglect)

2)     Persistent failure to provide for the child’s physical and psychological safety.

3)     Persistent harsh punishment or other types of grossly inept parenting.

4)     Repeated changes of primary caregiver that limit opportunities to form stable attachments (e.g., frequent changes in foster care).

5)     Rearing in unusual settings that limit opportunities to form selective attachments (e.g., institutions with high child to caregiver ratios).

D.   There is a presumption that the care in Criterion C is responsible for the disturbed behavior in Criterion A (e.g., the disturbances in Criterion A began following the pathogenic care in Criterion C).

E.   The child has a developmental age of at least 9 months.

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