Prompt

Adoptive parents of a 3-year-old previously institutionalised child attend distressed. They say a Facebook group diagnosed 'RAD' and urged paid holding therapy. They fear they have failed as parents because the child still approaches strangers. They also ask if tablets will 'create attachment.'

Station brief

Format. Communication station, approximately 7–10 minutes active time after reading. You are the CAMHS psychiatry registrar. ^[1]

Candidate instructions. Engage non-blaming parents; explain working diagnosis of disinhibited social engagement features after early institutional deprivation (clarify RAD vs DSED in plain language); explain that residual stranger approach does not mean they are failing; outline caregiving-first and carer-coaching plan; refuse coercive holding therapy with a clear safety rationale; address medication expectations honestly; check understanding and agree next steps. ^[1]^[2]

References5Show

[1]Zeanah CH, Chesher T, Boris NW Practice Parameter for the Assessment and Treatment of Children and Adolescents With Reactive Attachment Disorder and Disinhibited Social Engagement Disorder J Am Acad Child Adolesc Psychiatry, 2016.PMID 27806867
[2]Chaffin M, Hanson R, Saunders BE, et al. Report of the APSAC task force on attachment therapy, reactive attachment disorder, and attachment problems Child Maltreat, 2006.PMID 16382093
[3]O'Connor TG, Rutter M Attachment disorder behavior following early severe deprivation: extension and longitudinal follow-up J Am Acad Child Adolesc Psychiatry, 2000.PMID 10846304
[4]Yarger HA, Lind T, Raby KL, et al. Intervening With Attachment and Biobehavioral Catch-Up to Reduce Behavior Problems Among Children Adopted Internationally: Evidence From a Randomized Controlled Trial Child Maltreat, 2022.PMID 33882710
[5]Fox NA, Nelson CA 3rd, Zeanah CH The Effects of Psychosocial Deprivation on Attachment: Lessons from the Bucharest Early Intervention Project Psychodyn Psychiatry, 2017.PMID 29244624

Station brief

Format. Communication station, approximately 7–10 minutes active time after reading. You are the CAMHS psychiatry registrar. ^[1]

References5Show

[1]Zeanah CH, Chesher T, Boris NW Practice Parameter for the Assessment and Treatment of Children and Adolescents With Reactive Attachment Disorder and Disinhibited Social Engagement Disorder J Am Acad Child Adolesc Psychiatry, 2016.PMID 27806867
[2]Chaffin M, Hanson R, Saunders BE, et al. Report of the APSAC task force on attachment therapy, reactive attachment disorder, and attachment problems Child Maltreat, 2006.PMID 16382093
[3]O'Connor TG, Rutter M Attachment disorder behavior following early severe deprivation: extension and longitudinal follow-up J Am Acad Child Adolesc Psychiatry, 2000.PMID 10846304
[4]Yarger HA, Lind T, Raby KL, et al. Intervening With Attachment and Biobehavioral Catch-Up to Reduce Behavior Problems Among Children Adopted Internationally: Evidence From a Randomized Controlled Trial Child Maltreat, 2022.PMID 33882710
[5]Fox NA, Nelson CA 3rd, Zeanah CH The Effects of Psychosocial Deprivation on Attachment: Lessons from the Bucharest Early Intervention Project Psychodyn Psychiatry, 2017.PMID 29244624

Explain RAD/DSED and refuse coercive therapy — CASC communication station

Station brief

Explain RAD/DSED and refuse coercive therapy — CASC communication station

Station brief