Reactive attachment and DSED — structured clinical viva

This is a transition-age residual DSED case after extremes of insufficient care, not an inhibited RAD presentation. Core tasks: reproduce DSED criteria and insufficient-care aetiology; separate disorder from insecure style and from ASD/ADHD; manage stranger/absconding risk; refuse holding therapy (APSAC); treat mood comorbidity; and explain that residual early-deprivation burden into adult life (ERA trajectories) does not equal a freestanding lifelong "adult RAD" stamp.^[1][2][3][5]

Immediate management. Environmental supervision plan for stranger risk; safety discussion with carers and leaving-care workers; depression risk assessment; multiagency transition plan.^[1]

Definitive plan. Caregiver/support-network coaching on boundaries; psychological care for mood and social skills; no medication for attachment itself; if major depression criteria are met, standard SSRI pathway with young-person monitoring; explicit refusal of coercive attachment therapies.^[1][2]

Evidence soundbites. AACAP caregiving-first parameter; APSAC safety line; BEIP environment/timing; ERA young-adult residual ND/MH risk for some after early severe deprivation.^[1][2][3][4]