Along with language, socialization is a unique feature of the human being. There is a continuous debate regarding whether the development of socialization is innate, and conducted by the environment in the growing process, or the result of the interaction of both aspects. If socialization is the result of the interaction with the environment or is an acquired developmental process, the following question rises. "Is there a 'critical period' for the development of socialization?" Although there are a huge number of studies seeking for treatment and solutions for developmental delay or deficits of socialization, it is very complicated question to answer. Historical figures such as 'Hugh Blair' of Borgue in England, and 'the wild boy of Aveyron' in France, seem to have innate socialization deficits. Nowadays patients with non-verbal learning disorder, social communication disorder, or autism spectrum disorder seem to have genetic defects. On the other hand, Harry Harlow's monkey experiments, hikikomori of Japan, Romanian orphans and patients with reactive attachment disorder seem to display social deficits due to environmental factors. However, it is not easy to clearly draw a line between innate or acquired factors. Therefore, rather than subdividing the diseases for etiological and pathophysiological approach to heterogenous groups with the common denominator of social deficit, and for the research of pathophysiology and treatment development, the authors suggest a comprehensive concept of "social dysfunction spectrum."
Autistic Disorder ; Child ; Autism Spectrum Disorder ; Child, Orphaned ; Communication Disorders ; England ; France ; Hand ; Haplorhini ; Humans ; Japan ; Learning Disorders ; Male ; Reactive Attachment Disorder ; Socialization

OBJECTIVE: We aimed to investigate the current diagnostic incidence, and medical and psychiatric comorbidities of reactive attachment disorder (RAD) using the National Health Insurance Review and Assessment (HIRA) claims data. METHODS: To examine the diagnostic incidence, we selected patients who were under 10-year-old and who had at least one medical claim containing a 10th revision of the International Statistical Classification of Diseases and Related Health Problems (ICD-10) code for RAD (F94.1 and F94.2) and who had not been diagnosed in the previous 360 days, from 2010 to 2012. In this study, we used the term ‘reactive attachment disorder’ representing for both RAD per se and Disinhibited social engagement disorder. Comorbid disorders were categorized according to ICD-10. RESULTS: Among 14,029,571, the total population under 10-year-old during 2010–2012, incident cases of RAD were 736. The mean diagnostic incidence of RAD was 5.25 per 100,000 annually. Language disorders (F80-84) were the most common psychiatric comorbidities in both boys and girls in age groups 0–3 years and 4–6 years, and attention deficit hyperactivity disorder was the most common in both sex aged 7–9 years. In non-psychiatric comorbidities, diseases of the respiratory system (J00–99) were the commonest in both sex in all age groups, and diseases of the digestive system (K00–99) were the next. CONCLUSION: RAD was very rare in practice and would be disguised as other psychiatric disorders. Children with RAD might have more medical comorbidities than typically developed children.
Attention Deficit Disorder with Hyperactivity ; Child ; Comorbidity ; Digestive System ; Female ; Humans ; Incidence ; International Classification of Diseases ; Korea ; Language Disorders ; National Health Programs ; Reactive Attachment Disorder ; Respiratory System

OBJECTIVES: This study aimed to reveal that severe disturbance of attachment relationship with primary care-giver can affect functional brain development by measuring with technetium-99m ethyl cysteinate dimer brain single-photon emission tomography. METHODS: Subjects were 12 children aged 2-6 years who met the diagnostic criteria of reactive attachment disorder. Diagnostic tools were DSM-IV, ICD-10, Strange Situation Procedure(SSP), Vineland Social Maturity Sclae(SMS), and Childhood Autism Rating Scale(CARS). Brain SPECT was performed in all sbjects and each SPECT scan was visually assessed by two nuclear medicine specilalists. RESULTS: Eleven of 12 children had abnormal brain perfusion on SPECT scans, revealing focal areas of decreased perfusions. Perfusion of thalamus was decreased in 10 subjects decreased perfusion of left thalamus(6/10), right thalamus(1/10), and both thalami(3/10). Perfusion of basal ganglia was decreased in 5 children. Four children had decreased perfusion of thalamus as well as of basal ganglia. Decreased perfusion of parietal area was noted in only one child on SPECT scan. All subjets had normal perfusion of frontal, temporal, occipital, cerebellar areas on SPECT scan. CONCLUSIONS: Perfusion abnormalities involving thalamus, basal ganglia in most children with attachment disorder were found in this study. These results suggest that brain development of infant could be impeded by severe pathologic care and early nurturing environment would be important for normal brain development.
Autistic Disorder ; Basal Ganglia ; Brain ; Child* ; Diagnostic and Statistical Manual of Mental Disorders ; Humans ; Infant ; International Classification of Diseases ; Nuclear Medicine ; Perfusion* ; Rabeprazole ; Reactive Attachment Disorder ; Thalamus ; Tomography, Emission-Computed, Single-Photon