Reactive Attachment Disorder and Autism Spectrum Disorder: Diagnosis and Care in a Cultural Context

Abstract

As conceptualized by psychodynamic and object relations theory, autism spectrum disorder (ASD) and reactive attachment disorder (RAD) are clustered very closely together as a set of possible responses to emotionally cold and distant mothering. In the present-day mainstream US healthcare system, ASD has since been recast as a neurobiologically mediated condition, assumed to be present from birth, that more likely arises from genetic inborn factors and hypothesized environmental teratogens rather than a particular parenting style; RAD has similarly been recast as a trauma- and stressor-related disorder with its own neurobiological correlates and insufficient caregiving being a necessary, but by no means the only, etiological factor. In Korea and Spain, however, psychodynamic conceptualizations of ASD and RAD—including mother-blaming—have continued into the present. We explore the historically and culturally mediated reasons for these persisting diagnostic traditions and how they affect the relationship between mothers and the mental health systems of those particular countries.