{"id":7374,"date":"2026-06-20T02:33:33","date_gmt":"2026-06-20T02:33:33","guid":{"rendered":"https:\/\/gothi.gov.eg\/?page_id=7374"},"modified":"2026-06-20T02:38:12","modified_gmt":"2026-06-20T02:38:12","slug":"%d8%b7%d8%a8-%d9%86%d9%81%d8%b3-%d8%a7%d9%84%d8%a3%d8%b7%d9%81%d8%a7%d9%84-%d9%88%d8%a7%d9%84%d9%85%d8%b1%d8%a7%d9%87%d9%82%d9%8a%d9%86","status":"publish","type":"page","link":"https:\/\/gothi.gov.eg\/?page_id=7374","title":{"rendered":"\u0637\u0628 \u0646\u0641\u0633 \u0627\u0644\u0623\u0637\u0641\u0627\u0644 \u0648\u0627\u0644\u0645\u0631\u0627\u0647\u0642\u064a\u0646"},"content":{"rendered":"\t\t<div data-elementor-type=\"wp-page\" data-elementor-id=\"7374\" class=\"elementor elementor-7374\" data-elementor-settings=\"{&quot;element_pack_global_tooltip_width&quot;:{&quot;unit&quot;:&quot;px&quot;,&quot;size&quot;:&quot;&quot;,&quot;sizes&quot;:[]},&quot;element_pack_global_tooltip_width_tablet&quot;:{&quot;unit&quot;:&quot;px&quot;,&quot;size&quot;:&quot;&quot;,&quot;sizes&quot;:[]},&quot;element_pack_global_tooltip_width_mobile&quot;:{&quot;unit&quot;:&quot;px&quot;,&quot;size&quot;:&quot;&quot;,&quot;sizes&quot;:[]},&quot;element_pack_global_tooltip_padding&quot;:{&quot;unit&quot;:&quot;px&quot;,&quot;top&quot;:&quot;&quot;,&quot;right&quot;:&quot;&quot;,&quot;bottom&quot;:&quot;&quot;,&quot;left&quot;:&quot;&quot;,&quot;isLinked&quot;:true},&quot;element_pack_global_tooltip_padding_tablet&quot;:{&quot;unit&quot;:&quot;px&quot;,&quot;top&quot;:&quot;&quot;,&quot;right&quot;:&quot;&quot;,&quot;bottom&quot;:&quot;&quot;,&quot;left&quot;:&quot;&quot;,&quot;isLinked&quot;:true},&quot;element_pack_global_tooltip_padding_mobile&quot;:{&quot;unit&quot;:&quot;px&quot;,&quot;top&quot;:&quot;&quot;,&quot;right&quot;:&quot;&quot;,&quot;bottom&quot;:&quot;&quot;,&quot;left&quot;:&quot;&quot;,&quot;isLinked&quot;:true},&quot;element_pack_global_tooltip_border_radius&quot;:{&quot;unit&quot;:&quot;px&quot;,&quot;top&quot;:&quot;&quot;,&quot;right&quot;:&quot;&quot;,&quot;bottom&quot;:&quot;&quot;,&quot;left&quot;:&quot;&quot;,&quot;isLinked&quot;:true},&quot;element_pack_global_tooltip_border_radius_tablet&quot;:{&quot;unit&quot;:&quot;px&quot;,&quot;top&quot;:&quot;&quot;,&quot;right&quot;:&quot;&quot;,&quot;bottom&quot;:&quot;&quot;,&quot;left&quot;:&quot;&quot;,&quot;isLinked&quot;:true},&quot;element_pack_global_tooltip_border_radius_mobile&quot;:{&quot;unit&quot;:&quot;px&quot;,&quot;top&quot;:&quot;&quot;,&quot;right&quot;:&quot;&quot;,&quot;bottom&quot;:&quot;&quot;,&quot;left&quot;:&quot;&quot;,&quot;isLinked&quot;:true}}\">\n\t\t\t\t<div class=\"elementor-element elementor-element-e78b21e e-flex e-con-boxed e-con e-parent\" data-id=\"e78b21e\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t\t\t\t<div class=\"e-con-inner\">\n\t\t\t\t<div class=\"elementor-element elementor-element-4b83d7d elementor-widget__width-initial elementor-invisible elementor-widget elementor-widget-heading\" data-id=\"4b83d7d\" data-element_type=\"widget\" data-e-type=\"widget\" data-settings=\"{&quot;_animation_delay&quot;:250,&quot;_animation&quot;:&quot;fadeInUp&quot;}\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<h2 class=\"elementor-heading-title elementor-size-default\">\u0637\u0628 \u0646\u0641\u0633 \u0627\u0644\u0623\u0637\u0641\u0627\u0644 \u0648\u0627\u0644\u0645\u0631\u0627\u0647\u0642\u064a\u0646\n<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-75ef342 ui-e-animation-acc-basic ui-e-animation-ico-fade elementor-widget elementor-widget-uicore-accordion\" data-id=\"75ef342\" data-element_type=\"widget\" data-e-type=\"widget\" data-settings=\"{&quot;collapsible&quot;:&quot;true&quot;,&quot;active_hash&quot;:&quot;no&quot;,&quot;accordion_animation&quot;:&quot;ui-e-animation-acc-basic&quot;}\" data-widget_type=\"uicore-accordion.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t        <div class=\"ui-e-accordion\" >\n\n                            <div class=\"ui-e-accordion-item ui-e-item ui-open\" role=\"button\" tabindex=\"0\" aria-expanded=\"true\" aria-controls=\"ui-e-acc-1\" id=\"ui-e-reactive-attachment-disorder\">\n\n                    <h5 class=\"ui-e-accordion-title ui-e-title ui-right\">\n\n                                                    <span class=\"ui-e-accordion-icon ui-e-icon ui-e-right\" aria-hidden=\"true\">\n\n                                <span class=\"ui-e-accordion-icon-closed\">\n                                    <svg aria-hidden=\"true\" class=\"e-font-icon-svg e-fas-chevron-down\" viewBox=\"0 0 448 512\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M207.029 381.476L12.686 187.132c-9.373-9.373-9.373-24.569 0-33.941l22.667-22.667c9.357-9.357 24.522-9.375 33.901-.04L224 284.505l154.745-154.021c9.379-9.335 24.544-9.317 33.901.04l22.667 22.667c9.373 9.373 9.373 24.569 0 33.941L240.971 381.476c-9.373 9.372-24.569 9.372-33.942 0z\"><\/path><\/svg>                                <\/span>\n\n                                                                    <span class=\"ui-e-accordion-icon-opened\">\n                                        <svg aria-hidden=\"true\" class=\"e-font-icon-svg e-fas-chevron-up\" viewBox=\"0 0 448 512\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M240.971 130.524l194.343 194.343c9.373 9.373 9.373 24.569 0 33.941l-22.667 22.667c-9.357 9.357-24.522 9.375-33.901.04L224 227.495 69.255 381.516c-9.379 9.335-24.544 9.317-33.901-.04l-22.667-22.667c-9.373-9.373-9.373-24.569 0-33.941L207.03 130.525c9.372-9.373 24.568-9.373 33.941-.001z\"><\/path><\/svg>                                    <\/span>\n                                \n                            <\/span>\n                        \n                                                <span class=\"ui-e-accordion-title-text ui-e-title-text\" >\n                                                        Reactive Attachment Disorder                        <\/span>\n\n                    <\/h5>\n\n                    <div class=\"ui-e-accordion-content ui-e-content\" style=\"\" aria-labelledby=\"ui-e-reactive-attachment-disorder\" id=\"ui-e-acc-1\">\n                        <h5 id=\"yui_3_18_1_1_1781921605225_34\"><span id=\"yui_3_18_1_1_1781921605225_33\"><strong id=\"yui_3_18_1_1_1781921605225_32\">\u00a0 \u00a0<a href=\"https:\/\/lms.ehc.gov.eg\/lms\/pluginfile.php\/1387\/mod_book\/intro\/Reactive%20attachment%20%20H%20Salah%20%20Final%20FINAL%20.pdf\"><u>Download Guideline<\/u><\/a><\/strong><\/span><\/h5><h3 class=\" ccnMdlHeading\"><br \/><br \/>&#8211; Executive Summary<\/h3><div class=\"no-overflow\"><p dir=\"ltr\">\u00a0<\/p><p>These guidelines offer evidence-based recommendations on psychotherapeutic and pharmacological interventions of reactive attachment disorder in children. The recommendations are intended to provide psychiatrists and mental health professionals with practical guidance and improve mental health outcomes for children with reactive attachment disorder and their caregivers.<\/p><p><a name=\"_Hlk204857320\"><\/a>\u00b7\u00a0\u00a0Caregivers of children with RAD must be patient, remain positive, and have realistic expectations about what is achievable. It is also important that caregivers take care of their own mental and physical health and seek support from others where necessary<b>\u00a0<\/b><b>(strong recommendation).<\/b><\/p><p><a name=\"_Hlk205978372\"><\/a><a name=\"_Hlk205978525\"><\/a>\u00b7\u00a0\u00a0The most important part of management is to improve the child-carer relationship where this is possible and relevant.\u00a0<a name=\"_Hlk204784148\"><\/a>Developing a nurturing parent-child relationship is the cornerstone to overcoming the damage caused by severe neglect and abuse.<b>\u00a0<\/b>Child individual psychotherapy will help them come to terms with an abusive parent and so improve their attachment security in relation to that person, by enabling them to talk about them in a balanced and coherent way<b>\u00a0(strong recommendation)<\/b><b><\/b><\/p><p><a name=\"_Hlk205978444\"><\/a><a name=\"_Hlk205979280\"><\/a>\u00b7\u00a0Parenting skills classes:\u00a0education for parents and caregivers about attachment styles, attachment disorders as well as other necessary parenting skills. Parent education focuses on developing\u00a0positive, non-punitive behavior management strategies, ways of responding to nonverbal communication, anticipation and coping strategies for when triggers arise\u00a0<b>(conditional recommendation).<\/b><\/p><p><a name=\"_Hlk205978664\"><\/a>\u00b7\u00a0\u00a0Comprehensive psychiatric evaluation and specific treatment plans developed by professionals including both individual and family interventions\u00a0<b>(strong recommendation).<\/b><\/p><p><a name=\"_Hlk205978806\"><\/a>\u00b7\u00a0Multi-Disciplinary Approach: Effective treatment often involves a team of professionals, including clinical psychologists, psychiatrists, and social workers\u00a0<b>(conditional recommendations).<\/b><b><\/b><\/p><p><a name=\"_Hlk205979037\"><\/a>\u00b7\u00a0\u00a0Child\u2212parent psychotherapy focuses primarily on the caregiver\u2019s and child\u2019s experience of one another and on altering patterns of emotional communication in the dyad to improve the attachment bond. The therapist helps the caregiver to appreciate the emotional experience of the child and its connection to the emotional experience of the caregiver\u00a0<b>(<\/b><b>conditional\u00a0<\/b><b>recommendation).<\/b><\/p><p>\u00b7\u00a0Attachment-Based Family Therapy (ABFT): typical therapy for attachment problems includes both children and their caregivers. Therapy often involves fun and rewarding activities that enhance the attachment bond as well as help parents and other children in the family understand the symptoms of the disorder and effective interventions. Implementing ABFT in practice requires a comprehensive understanding of the family&#8217;s attachment patterns, dynamics, and\u00a0<a name=\"_Hlk205990249\"><\/a>needs\u00a0<b>(<\/b><b>conditional\u00a0<\/b><b>recommendatio<\/b><b>n).<\/b><i><\/i><\/p><p>\u00b7\u00a0\u00a0<a name=\"_Hlk205979140\"><\/a>Play therapy.\u00a0Help children to learn appropriate skills for interacting with peers and handling other social situations\u00a0<a name=\"_Hlk205976098\"><\/a><b>(conditional recommendation)<\/b><b>.<\/b><b><\/b><\/p><p><a name=\"_Hlk205979594\"><\/a>\u00b7\u00a0\u00a0Special education services specifically designed programs within your child\u2019s school can help them learn skills required for academic and social success, while also addressing behavioral and emotional difficulties\u00a0<b>(conditional recommendation).<\/b><\/p><p><a name=\"_Hlk205979633\"><\/a>\u00b7\u00a0Secure Living Situation: Ensuring the child has a consistent and safe home environment is crucial. This may involve placement with foster parents or adoptive parents who can provide a nurturing and predictable environment. Avoiding as much as possible the transit of the child from one placement to another and from one caregiver to another, encouraging the most stable measures possible from the moment the child leaves his or her biological family\u00a0<b>(conditional recommendation).<\/b><\/p><p>\u00b7\u00a0<b>\u00a0<\/b><a name=\"_Hlk205981674\"><\/a>Social Skills Interventions: These interventions help children learn appropriate social behaviors and interactions with peers\u00a0<b>(conditional recommendation).<\/b><\/p><p><a name=\"_Hlk205981863\"><\/a>\u00b7\u00a0Trauma-Focused Therapies: For children with RAD who have experienced trauma, trauma-focused therapies such as Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) are crucial for processing traumatic memories and promoting healing\u00a0<b>(conditional recommendation).<\/b><a name=\"_Hlk205981903\"><\/a><b><\/b><\/p><p>\u00b7\u00a0\u00a0Medication: While there is no specific medication for RAD, psychiatric medication is prescribed to address co-occurring conditions, such as depression or anxiety, if present<b>\u00a0(Strong recommendation).<\/b><\/p><\/div>                    <\/div>\n\n                <\/div>\n                            <div class=\"ui-e-accordion-item ui-e-item\" role=\"button\" tabindex=\"0\" aria-expanded=\"false\" aria-controls=\"ui-e-acc-2\" id=\"ui-e-dissociative-disorders\">\n\n                    <h5 class=\"ui-e-accordion-title ui-e-title ui-right\">\n\n                                                    <span class=\"ui-e-accordion-icon ui-e-icon ui-e-right\" aria-hidden=\"true\">\n\n                                <span class=\"ui-e-accordion-icon-closed\">\n                                    <svg aria-hidden=\"true\" class=\"e-font-icon-svg e-fas-chevron-down\" viewBox=\"0 0 448 512\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M207.029 381.476L12.686 187.132c-9.373-9.373-9.373-24.569 0-33.941l22.667-22.667c9.357-9.357 24.522-9.375 33.901-.04L224 284.505l154.745-154.021c9.379-9.335 24.544-9.317 33.901.04l22.667 22.667c9.373 9.373 9.373 24.569 0 33.941L240.971 381.476c-9.373 9.372-24.569 9.372-33.942 0z\"><\/path><\/svg>                                <\/span>\n\n                                                                    <span class=\"ui-e-accordion-icon-opened\">\n                                        <svg aria-hidden=\"true\" class=\"e-font-icon-svg e-fas-chevron-up\" viewBox=\"0 0 448 512\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M240.971 130.524l194.343 194.343c9.373 9.373 9.373 24.569 0 33.941l-22.667 22.667c-9.357 9.357-24.522 9.375-33.901.04L224 227.495 69.255 381.516c-9.379 9.335-24.544 9.317-33.901-.04l-22.667-22.667c-9.373-9.373-9.373-24.569 0-33.941L207.03 130.525c9.372-9.373 24.568-9.373 33.941-.001z\"><\/path><\/svg>                                    <\/span>\n                                \n                            <\/span>\n                        \n                                                <span class=\"ui-e-accordion-title-text ui-e-title-text\" >\n                                                        Dissociative Disorders                        <\/span>\n\n                    <\/h5>\n\n                    <div class=\"ui-e-accordion-content ui-e-content\" style=\"display:none;\" aria-labelledby=\"ui-e-dissociative-disorders\" id=\"ui-e-acc-2\">\n                        <div id=\"mod_book-chapter\" class=\"box py-3 generalbox book_content\"><h5 id=\"yui_3_18_1_1_1781921814321_27\"><span id=\"yui_3_18_1_1_1781921814321_31\"><strong id=\"yui_3_18_1_1_1781921814321_30\">\u00a0\u00a0 \u00a0\u00a0<a href=\"https:\/\/lms.ehc.gov.eg\/lms\/pluginfile.php\/1399\/mod_book\/intro\/Dissociative%20Disorders.pdf\" target=\"_blank\" rel=\"noopener\"><u>Download Guideline<\/u><\/a><\/strong><\/span><\/h5><h3 id=\"yui_3_18_1_1_1781921814321_23\" class=\" ccnMdlHeading\"><br \/>&#8211; Executive Summary<\/h3><div class=\"no-overflow\"><p dir=\"ltr\">\u00a0<\/p><p>These guidelines provide\u00a0<b>evidence-based recommendations<\/b>\u00a0for the assessment and management of\u00a0<b>dissociative disorders in children and adolescents<\/b>. Dissociative disorders (DDs) are often misunderstood, underdiagnosed, and stigmatized, leading to delayed care and unnecessary suffering.<\/p><p align=\"left\">The recommendations emphasize:<\/p><ul type=\"disc\"><li><b>Exclusion of medical\/neurological conditions<\/b>\u00a0before psychiatric diagnosis.<\/li><li><b>Comprehensive psychiatric assessment<\/b>\u00a0incorporating trauma history, family context, and developmental needs.<\/li><li><b>Psychotherapy as first-line treatment<\/b>, delivered within a trauma-informed, family-inclusive framework.<\/li><li><b>Cautious use of medication only for comorbidities<\/b>\u00a0such as depression or anxiety.<\/li><li><b>System-level supports<\/b>\u00a0including anti-stigma interventions, psychoeducation, and clinician training.<\/li><\/ul><p align=\"left\">The ultimate goal is to standardize care, reduce misdiagnosis, and improve outcomes for children and families across Egypt and similar contexts.<\/p><p align=\"left\">\u25aa\ufe0f\u00a0<b>Comprehensive Medical and Neurological Assessment:<\/b><\/p><p align=\"left\">Children and adolescents presenting with dissociative symptoms must undergo a comprehensive medical and neurological evaluation to exclude organic causes such as epilepsy, syncope, metabolic disorders, migraines, and central nervous system pathology. This step is essential to prevent misdiagnosis and inappropriate psychiatric labelling. (<b>Strong Recommendation)<\/b><\/p><p>\u25aa\ufe0f<b>Comprehensive Psychiatric Assessment:<\/b>\u00a0Following medical clearance, children and adolescents with suspected dissociative disorders should receive a comprehensive developmentally informed psychiatric assessment. This should integrate information from multiple sources (child, caregivers, teachers), include trauma and attachment history, family context, and comorbid psychiatric conditions. (<b>Strong Recommendation)<\/b><\/p><p><a name=\"_Hlk211951090\"><\/a>\u25aa\ufe0f<b>Psychotherapy as First-Line<\/b><b>:\u00a0<\/b>The first-line treatment for dissociative disorders in children and adolescents is psychotherapy. Individual psychotherapy should be developmentally tailored and trauma-informed, incorporating techniques from cognitive-behavioral therapy (CBT), dialectical behavior therapy (DBT) skills adapted for youth, psychodynamic therapy, and\/or attachment-focused interventions. Family therapy should also be integrated to strengthen caregiver and relational support. Psychoeducation for the child, caregivers, and schools is essential to reduce stigma and improve coping. (<b>Strong Recommendation)<\/b><\/p><p><b>Acute Stress and Conversion Symptoms (First Month Post-Trauma):<\/b><br \/>For children and adolescents presenting with symptoms of dissociative (conversion) disorders within the first month after exposure to a potentially traumatic event, clinicians are not advised to initiate specialized psychological interventions, as evidence does not support their effectiveness. Instead, we advise that early management includes the following:<\/p><p><strong>-Exclusion of physical and neurological causes<\/strong><\/p><p>-Provision of\u00a0<strong>Psychological First Aid (PFA) f<\/strong>ocusing on comfort, stabilization, and safety<\/p><p><strong>-Psychoeducation<\/strong>\u00a0for the child and caregivers, explaining that symptoms may occur after extreme stress<\/p><p><strong>-Respectful, culturally appropriate engagement<\/strong>, including safe collaboration with traditional\/community supports<\/p><p>-Avoidance of reinforcing\u00a0<strong>secondary gain<\/strong>\u00a0from symptoms. (<b>Conditional Recommendation)<\/b><\/p><p>\u25aa\ufe0f\u00a0\u00a0<b>Pharmacological Management:<\/b>\u00a0Pharmacological treatment is not indicated for dissociation itself in children and adolescents. Medications should only be considered for comorbid conditions such as depression, anxiety, or severe behavioral dysregulation. Benzodiazepines should be avoided, as they may worsen dissociative symptoms. (<b>Strong Recommendation)<\/b><\/p><p>\u00a0<\/p><p>\u00a0<\/p><\/div><\/div><div class=\"mt-5 mb-5 activity-navigation\"><div class=\"row\"><div class=\"col-md-4\"><div class=\"float-left ui_kit_btn\">\u00a0<\/div><\/div><div class=\"col-md-4\"><div class=\"mdl-align\"><div class=\"urlselect\">\u00a0<\/div><\/div><\/div><\/div><\/div>                    <\/div>\n\n                <\/div>\n                    <\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t","protected":false},"excerpt":{"rendered":"<p>\u0637\u0628 \u0646\u0641\u0633 \u0627\u0644\u0623\u0637\u0641\u0627\u0644 \u0648\u0627\u0644\u0645\u0631\u0627\u0647\u0642\u064a\u0646 Reactive Attachment Disorder \u00a0 \u00a0Download Guideline &#8211; Executive Summary \u00a0 These guidelines offer evidence-based recommendations on psychotherapeutic and [&hellip;]<\/p>\n","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"class_list":["post-7374","page","type-page","status-publish","hentry"],"aioseo_notices":[],"_links":{"self":[{"href":"https:\/\/gothi.gov.eg\/index.php?rest_route=\/wp\/v2\/pages\/7374","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/gothi.gov.eg\/index.php?rest_route=\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/gothi.gov.eg\/index.php?rest_route=\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/gothi.gov.eg\/index.php?rest_route=\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/gothi.gov.eg\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=7374"}],"version-history":[{"count":4,"href":"https:\/\/gothi.gov.eg\/index.php?rest_route=\/wp\/v2\/pages\/7374\/revisions"}],"predecessor-version":[{"id":7381,"href":"https:\/\/gothi.gov.eg\/index.php?rest_route=\/wp\/v2\/pages\/7374\/revisions\/7381"}],"wp:attachment":[{"href":"https:\/\/gothi.gov.eg\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=7374"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}