attachment disorder treatment.



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Differential Diagnosis

Frequently children with Reactive Attachment Disorder are mis-diagnosed with Attention Deficit/Hyperactivity Disorder (ADHD), Oppositional Defiant Disorder (ODD), or Conduct Disorder (CD).  On the other hand, approximately 505 to 60% of the abused and neglected children in the U.S. foster care system with Reactive Attachment Disorder also have Bipolar I disorder.  This table summarizes some of the major differences between ADHD and Bipolar I disorder, with which is frequently confused.





BiPolar I Disorder


- Break things carelessly

-Non-Aggressive destructiveness

- Occurs in anger

- During Temper Tantrums

Temper Tantrums

- Calm doing in 20 – 30 minutes

- May act and feel angry for hours


- Rarely in an angry ADHD

- Child disorganized

-  Disorganized thinking and behavior


- Sensory & Emotional Overstimulation

- Limit setting



- Dysphoria is not predominant mood

- Tend to arouse quickly & become alert within minutes of awakeness

- Dysphoria is prominent

- Irritability is prominent, especially in morning

- Slow arousal upon awakeness



-Night terrors will theme of gore


- Accidental, caused by lack of attention


-Intentionally provoke or misbehave.

- Bully other children

Thrill Seeking

-May engage in harmful behavior because is not aware of the danger

- Risk seeking




- Strong early sexual interest and behavior

Mood Stabilizers:

Lithium, Carbamazepine Valproic Acid, Verapamil

Atypical Anti-Psychotics: Risperdal, Seroquol

-  No effect

- Improves behavior.  Atypical anti-psychotics often reduce aggressiveness and temper tantrums.


Ritalin, Dexedrine, Cylert, Adderal, Wellbutrin

- Improves behavior

- No effect, worsens


SSRI’S (Paxil, Prozac, Zoloft), Wellbutrin,

- May have some effect (Wellbutrin, for example)

- WARNING: May bring on mania