Barge, Lydia Christina Gay; (2023) Reactive Attachment Disorder in UK children looked after. Doctoral thesis (Ph.D), UCL (University College London).

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Abstract

This PhD aimed to contribute evidence that can inform improvements in the identification, understanding of, and future research into, the treatment of Reactive Attachment Disorder (RAD). This thesis includes a systematic review to understand attachment security and disorganisation rates in children in foster care or adopted without experience of institutional care (chapter 2). The results indicated rates of secure attachment similar to normative samples and rates of disorganisation were seen at higher levels than normative samples, but lower than samples that had experienced institutional care. Findings suggested that having a sensitive, autonomous caregiver was associated with attachment security. An exploratory factor analysis of a new screening measure was carried out with a community and a children looked after sample (chapter 3). Following amendments and further psychometric analysis, this thesis concludes the measure has the potential to be a useful screening tool for research and clinical purposes. The prevalence and predictors of RAD behaviours were investigated (chapter 4). The rates of RAD behaviours were high (34.5%), but the number of children expected to receive a diagnosis was very low. A higher age into care and a shorter time in current placement were found to be significant predictors of RAD behaviours. The feasibility of conducting a randomised control trial using attachment focused measured was described (chapter 5). Findings demonstrated the feasibility and acceptability of the measures and the intervention, and insights into recruitment are discussed. Finally, the foster carers’ perspectives of the intervention were examined in qualitative interviews (chapter 6). Thematic analysis uncovered 4 themes; motivation for taking part, experience of the sessions, learnings and future improvements which demonstrated that carers found the intervention acceptable. The findings of this thesis are discussed in terms of their clinical, methodological, and theoretical implications followed by future directions for research (chapter 7).

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