Psych CASC / OSCE · General adult psychiatry — reactive attachment and disinhibited social engagement
Explain residual DSED risk and refuse coercive attachment therapy — CASC communication station
MRCPsych/FRANZCP-style communication station: explain RAD vs DSED, residual course, caregiving and boundary coaching, refuse coercive therapies, and plan depression/comorbidity care without attachment-targeted drugs.
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Station brief
Format. Communication station, approximately 7–10 minutes active time after reading. You are the psychiatry registrar in a transition/outpatient clinic. [1]
Candidate instructions. Explain the difference between RAD and DSED, why residual disinhibited features can persist after good care without meaning the parents failed, why holding/rebirthing therapies are not recommended, how to manage stranger risk and low mood, and what adult residual risk means without promising a lifelong "RAD" label. Check understanding. The examiner plays the adoptive parents. [1][2][3]
References4ShowHide
- [1]Zeanah CH, Chesher T, Boris NW; AACAP Committee on Quality Issues 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, Nichols T, et al. Report of the APSAC task force on attachment therapy, reactive attachment disorder, and attachment problems Child Maltreat, 2006.PMID 16382093
- [3]Sonuga-Barke EJS, Kennedy M, Kumsta R, Knights N, et al. Child-to-adult neurodevelopmental and mental health trajectories after early life deprivation: the young adult follow-up of the longitudinal English and Romanian Adoptees study Lancet, 2017.PMID 28237264
- [4]O'Connor TG, Rutter M; English and Romanian Adoptees Study Team Attachment disorder behavior following early severe deprivation: extension and longitudinal follow-up J Am Acad Child Adolesc Psychiatry, 2000.PMID 10846304