Neural basis of reactive attachment disorder (RAD)using fMRI

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Maltreated children with Reactive Attachment Disorder (RAD) have severe problems with social relationships and affect regulation. Despite appearing in DSM since 1980 and in the DSM-IV and the ICD-10, there was little formal study of the disorders until the past 10 to 12 years. Recently, there has been a growing literature examining indiscriminant social behaviors in children exposed to caregiving adversity, but there is no study examined the neural basis for indiscriminately social/disinhibited and emotionally withdrawn/inhibited reactive attachment disorder (RAD) using functional MRI (fMRI). Thus, we evaluated brain activation with fMRI during a reward sensitivity paradigm that consists of high monetary reward and low monetary reward conditions in 17 children and adolescents with ADHD (mean age, 13.3 ± 2.2), 17 age- and sex-matched healthy controls (mean age, 13.0 ± 1.9), and 6 children and adolescents with RAD (mean age, 12.5 ± 1.9). We found that before treatment there was decreased activation of the nucleus accumbens and thalamus in patients with ADHD during only the low monetary reward condition, which was improved to same level as those of the healthy controls after the treatment. However, there was decreased activation of the dorsal striatum and thalamus in patients with RAD during both of the low and high monetary reward condition. These results suggest that it is possible that RAD has a low reward processing based on a decrease in dopaminergic function.