Reactive Attachment Disorder in infants in foster care and associated mental health and cognitive functioning

Background: Reactive attachment disorder (RAD) has been described as one of the least researched and most poorly understood psychiatric disorders (Chaffin et al., 2006). Despite this, given what is known about maltreatment and attachment, it is likely that RAD has profound consequences for child development. Very little is known about the prevalence and stability of RAD symptoms over time. Until recently it has been difficult to investigate the presence of RAD due to limited measures for informing a diagnosis. However this study utilised a new observational tool Method: A cross sectional study design with a one-year follow-up explored RAD symptoms in maltreated infants in Scotland (n=55, age range= 16-62 months) and associated mental health and cognitive functioning. The study utilised the Rating of Inhibited Attachment Behavior Scale (Corval, et al., unpublished 2014) that has recently been developed by experts in the field along side The Disturbances of Attachment Interview (Smyke & Zeanah, 1999). Children were recruited as part of the BeST trial, whereby all infants who came in to the care of the local authority in Glasgow due to child protection concerns were invited to participate. The study sample was representative of the larger pool of data in terms of age, gender, mental health and cognitive functioning. Results: The sample was found to be representative of the population of maltreated children from which it was derived. Prevalence of RAD was found to be 7.3% (n=3, 95% CI [0.43 – 14.17]) at T1, when children are first placed in to foster care. At T2, following one year in improved care conditions, 4.3% (n=2, 95% CI [below 0 – 10.16]) met a borderline RAD diagnosis. Levels of observed RAD symptoms decreased significantly at T2 in comparison to T1 but carer reported symptoms of RAD did not. Children whose RAD symptoms did not improve were found to be significantly older and showed less prosocial behaviour. RAD was associated with some mental health and cognitive difficulties. Lower Verbal IQ and unexpectedly, prosocial behaviour were found to predict RAD symptoms. Conclusions: The preliminary findings have added to the developing understanding of RAD symptoms and associated difficulties however further exploration of RAD in larger samples would be invaluable.

Florilegium

This thesis is composed of two parts, encompassed in a third: a poetry collection; a critical dissertation; and an artist’s book. The thesis as a whole is entitled Florilegium. This title, from the Latin flos, or ‘flower’, and legere, ‘to gather’, refers to the medieval system of collecting extracts from various authors to form a larger body of work. It is also applicable to flower-treatises, dedicated to their ornamental nature rather than medicinal or scientific. The critical dissertation comes in the form of a glossary. It intends to show that the flower plays an essential role in linking Modernist poetics with that of its Romantic predecessors and beyond. In isolated and ‘illuminated’ examples from Aristotle to Zukofsky, it examines the lineage of botanical poetry, in the light of its unique linguistic makeup: a vernacularized scientific lexicon established in the Latin of Carl Linnaeus. While the critical component of the thesis is an interrogation of botanical language, the poetry collection is its living representation. To enhance the living nature of the text, I have designed and printed an artist’s book, which also acts as an herbarium for floral specimens collected and pressed over the duration of my degree. The design of the book is in keeping with traditional florilegia, incorporating historic binding techniques, typography, paper, and size.