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Talmón-Knuser F, Soler M, González-Sala F, Lacomba-Trejo L, Samper-García P. A Systematic Review on Assessing Assessments: Unveiling Psychometric Properties of Instruments for Reactive Attachment Disorder and Disinhibited Social Engagement Disorder in Minors under Protective Measures. CHILDREN (BASEL, SWITZERLAND) 2024; 11:144. [PMID: 38397256 PMCID: PMC10887385 DOI: 10.3390/children11020144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Revised: 01/12/2024] [Accepted: 01/19/2024] [Indexed: 02/25/2024]
Abstract
BACKGROUND Reactive attachment disorder (RAD) and disinhibited social engagement disorder (DSED) manifest in individuals facing attachment system challenges, particularly observed in minors under protective measures. The lack of standardized tools for assessing these difficulties and uncertainty about the most effective instruments from a psychometric perspective prompted this study. AIM Using the COSMIN checklist, we systematically reviewed instruments assessing RAD, adhering to PRISMA. METHODOLOGY Examined tools included the Disturbance Attachment Interview, Preschool Age Psychiatric Assessment, Relationship Patterns Questionnaire, Assessment of RAD and DSED, Development and Well-Being Assessment, and Reactive Attachment Disorder Questionnaire. RESULTS Of the 10 articles analyzed, the results highlight a research emphasis on internal consistency and structural and construct validity, sidelining other properties. CONCLUSION Most articles review structural validity and internal consistency. These measures are satisfactory but insufficiently evaluated. It is necessary to evaluate these tools using other indicators such as cross-cultural validity, measurement error, or responsiveness in adolescents under protective measures.
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Affiliation(s)
- Florencia Talmón-Knuser
- Department of Developmental Psychology and Education, Faculty of Health Science, Catholic University of Uruguay, Montevideo 11600, Uruguay
| | - Miriam Soler
- Faculty of Psychology and Speech Therapy, Universitat de València, 46010 Valencia, Spain
| | - Francisco González-Sala
- Department of Developmental and Educational Psychology, Faculty of Psychology and Speech Therapy, Universitat de València, 46010 Valencia, Spain
| | - Laura Lacomba-Trejo
- Department of Developmental and Educational Psychology, Faculty of Psychology and Speech Therapy, Universitat de València, 46010 Valencia, Spain
| | - Paula Samper-García
- Department of Basic Psychology, Faculty of Psychology and Speech Therapy, Universitat de València, 46010 Valencia, Spain
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Talmón-Knuser F, González-Sala F, Lacomba-Trejo L, Samper-García P. Reactive Attachment Disorder and Its Relationship to Psychopathology: A Systematic Review. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1892. [PMID: 38136094 PMCID: PMC10741566 DOI: 10.3390/children10121892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Revised: 12/01/2023] [Accepted: 12/04/2023] [Indexed: 12/24/2023]
Abstract
This study aimed to determine, through a systematic review, the relationship between Reactive Attachment Disorder (RAD) and the presence of psychopathology in children and adolescents, and to determine the existence of differences in terms of internalising and externalising psychological problems between the RAD group and groups with other disorders or with typical development. Following the PRISMA methodology, a search was carried out in the Web of Science, PubMed and Scopus databases. The search yielded 770 results, of which only 25 met the inclusion criteria. The results indicate a relationship between the presence of RAD and/or disinhibited social engagement disorder (DSED), with the presence of internalising and externalising problems. These difficulties are more present in children with RAD compared to children without personal difficulties, or children with DSED, children with autism, children with intellectual disabilities or children with hyperactivity. It can be concluded that the presence of RAD has negative consequences on the mental health of children and adolescents, with these being greater in the inhibited group than in the disinhibited group, and with respect to children with autism or hyperactivity.
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Affiliation(s)
- Florencia Talmón-Knuser
- Department of Developmental Psychology and Education, Faculty of Health Science, Catholic University of Uruguay, Montevideo 11600, Uruguay;
| | - Francisco González-Sala
- Department of Developmental and Educational Psychology, Faculty of Psychology and Speech Therapy, Universitat de València, 46010 Valencia, Spain; (F.G.-S.); (L.L.-T.)
| | - Laura Lacomba-Trejo
- Department of Developmental and Educational Psychology, Faculty of Psychology and Speech Therapy, Universitat de València, 46010 Valencia, Spain; (F.G.-S.); (L.L.-T.)
| | - Paula Samper-García
- Department of Basic Psychology, Faculty of Psychology and Speech Therapy, Universitat de València, 46010 Valencia, Spain
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Cassibba R, Balenzano C, Silletti F, Coppola G, Costantini A, Giorgio S, Taurino A, Cheah CSL, Musso P. The Placement of Children in Need of Out-of-Home Care: Forms of Care and Differences in Attachment Security and Behavioral Problems in the Italian Context. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:7111. [PMID: 38063541 PMCID: PMC10706020 DOI: 10.3390/ijerph20237111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 11/12/2023] [Accepted: 11/20/2023] [Indexed: 12/18/2023]
Abstract
The current paper investigated differences in secure attachment levels and behavioral problems among four groups of children in out-of-home care in Italy: closed adoption (child and birth parents not in contact following adoption), open adoption (child and birth parents still in contact after placement), foster care (child living temporarily with relatives or unrelated foster parents) and institutional care (child in residential care for large groups of children). One hundred and thirty children aged 10-19 were included in this study. The Attachment Interview for Childhood and Adolescence and the Achenbach Youth Self-Report were employed to measure participants' secure attachment levels and behavioral problems. Both a multivariate analysis of covariance and measured variable path analysis were performed. Age, gender and time elapsed between the request for child protection and placement on out-of-home care were used as covariates. The results showed that adolescents in closed adoption had higher secure attachment scores than those in foster care and institutional care, while adolescents in open adoption scored significantly higher on problem behaviors than those in the other out-of-home care groups. Findings were discussed in terms of limitations and implications for future research.
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Affiliation(s)
- Rosalinda Cassibba
- Department of Educational Sciences, Psychology, Communication, University of Bari Aldo Moro, 70122 Bari, Italy; (F.S.); (G.C.); (S.G.); (A.T.); (P.M.)
- Interdepartmental Training and Research Centre for Care and Protection of Children and Families, University of Bari Aldo Moro, 70122 Bari, Italy; (C.B.); (A.C.)
| | - Caterina Balenzano
- Interdepartmental Training and Research Centre for Care and Protection of Children and Families, University of Bari Aldo Moro, 70122 Bari, Italy; (C.B.); (A.C.)
- Department of Political Sciences, University of Bari Aldo Moro, 70122 Bari, Italy
| | - Fabiola Silletti
- Department of Educational Sciences, Psychology, Communication, University of Bari Aldo Moro, 70122 Bari, Italy; (F.S.); (G.C.); (S.G.); (A.T.); (P.M.)
| | - Gabrielle Coppola
- Department of Educational Sciences, Psychology, Communication, University of Bari Aldo Moro, 70122 Bari, Italy; (F.S.); (G.C.); (S.G.); (A.T.); (P.M.)
- Interdepartmental Training and Research Centre for Care and Protection of Children and Families, University of Bari Aldo Moro, 70122 Bari, Italy; (C.B.); (A.C.)
| | - Alessandro Costantini
- Interdepartmental Training and Research Centre for Care and Protection of Children and Families, University of Bari Aldo Moro, 70122 Bari, Italy; (C.B.); (A.C.)
- Department of Political Sciences, University of Bari Aldo Moro, 70122 Bari, Italy
| | - Stefania Giorgio
- Department of Educational Sciences, Psychology, Communication, University of Bari Aldo Moro, 70122 Bari, Italy; (F.S.); (G.C.); (S.G.); (A.T.); (P.M.)
- Interdepartmental Training and Research Centre for Care and Protection of Children and Families, University of Bari Aldo Moro, 70122 Bari, Italy; (C.B.); (A.C.)
| | - Alessandro Taurino
- Department of Educational Sciences, Psychology, Communication, University of Bari Aldo Moro, 70122 Bari, Italy; (F.S.); (G.C.); (S.G.); (A.T.); (P.M.)
| | - Charissa S. L. Cheah
- Department of Psychology, University of Maryland, Baltimore County, Baltimore, MD 21250, USA;
| | - Pasquale Musso
- Department of Educational Sciences, Psychology, Communication, University of Bari Aldo Moro, 70122 Bari, Italy; (F.S.); (G.C.); (S.G.); (A.T.); (P.M.)
- Interdepartmental Training and Research Centre for Care and Protection of Children and Families, University of Bari Aldo Moro, 70122 Bari, Italy; (C.B.); (A.C.)
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Hamadi L, Fletcher HK. Are people with an intellectual disability at increased risk of attachment difficulties? A critical review. JOURNAL OF INTELLECTUAL DISABILITIES : JOID 2021; 25:114-130. [PMID: 31362566 DOI: 10.1177/1744629519864772] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Attachment difficulties are associated with a range of adverse outcomes in mental health, and people with intellectual disabilities (IDs) may be at greater risk of experiencing difficulties in their attachment relationships. This review critically evaluated recent research measuring the prevalence of attachment difficulties in people with ID. Eight studies met the inclusion criteria, and a higher prevalence of insecure and disorganized attachment classifications, and symptoms of attachment disorder, was found across a number of subgroups of people with diagnoses of ID. However, the validity and reliability of measures of attachment have not been empirically established in this population, and control groups were not always appropriate. These findings indicate the need to (1) develop reliable and standardized assessments of attachment for people with ID and (2) evaluate the efficacy of attachment-based interventions in relation to reducing psychological distress, mental health problems and expression of behaviours experienced by others as challenging.
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Affiliation(s)
| | - Helen K Fletcher
- 7482Hertfordshire Partnership University NHS Foundation Trust, UK
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Bruce M, Young D, Turnbull S, Rooksby M, Chadwick G, Oates C, Nelson R, Young-Southward G, Haig C, Minnis H. Reactive Attachment Disorder in maltreated young children in foster care. Attach Hum Dev 2018; 21:152-169. [DOI: 10.1080/14616734.2018.1499211] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Molly Bruce
- Department of Clinical Psychology, NHS Lothian, Edinburgh, Scotland
| | - David Young
- Institute of health and wellbeing, University of Glasgow, Scotland
| | - Susan Turnbull
- Institute of health and wellbeing, University of Glasgow, Scotland
| | - Maki Rooksby
- Institute of health and wellbeing, University of Glasgow, Scotland
| | - Guy Chadwick
- Institute of health and wellbeing, University of Glasgow, Scotland
| | - Catriona Oates
- Institute of health and wellbeing, University of Glasgow, Scotland
| | - Rebecca Nelson
- Institute of health and wellbeing, University of Glasgow, Scotland
| | | | - Caroline Haig
- Institute of health and wellbeing, University of Glasgow, Scotland
| | - Helen Minnis
- Institute of health and wellbeing, University of Glasgow, Scotland
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Mayes SD, Calhoun SL, Waschbusch DA, Breaux RP, Baweja R. Reactive attachment/disinhibited social engagement disorders: Callous-unemotional traits and comorbid disorders. RESEARCH IN DEVELOPMENTAL DISABILITIES 2017; 63:28-37. [PMID: 28254669 DOI: 10.1016/j.ridd.2017.02.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/16/2016] [Revised: 02/16/2017] [Accepted: 02/20/2017] [Indexed: 06/06/2023]
Abstract
BACKGROUND DSM-5 Reactive Attachment Disorder (RAD) and Disinhibited Social Engagement Disorder (DSED) are rare, understudied, and controversial disorders. METHODS Comorbidity in children diagnosed with RAD or DSED was compared with comorbidity in ADHD and autism to determine if RAD/DSED comorbidity differed from that for the two most common disorders in child psychiatric clinics. Samples included 4-17-year-olds, 20 with RAD and/or DSED, 933 with autism, and 895 with ADHD. Children with RAD/DSED were removed from their neglectful environments at a mean of 4 years and were a mean 10 years when studied. Mothers rated the children on the Pediatric Behavior Scale assessing oppositional behavior, conduct problems, ADHD, anxiety, depression, and other symptoms. RESULTS Five of the 20 children with RAD/DSED had DSED without RAD, 15 had RAD with DSED, and none had RAD without DSED. All children with RAD had callous-unemotional traits (CU) and 73% had conduct disorder (CD). No children with DSED-no RAD had CU or CD. Children with RAD+DSED were considerably more impaired than children with DSED-no RAD, autism, and ADHD. CONCLUSIONS Findings are consistent with other studies indicating high CD/CU comorbidity in RAD and extreme rarity of RAD without DSED, findings which are not noted in the DSM-5.
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Affiliation(s)
| | - Susan L Calhoun
- Department of Psychiatry, Penn State College of Medicine, Hershey, PA, USA
| | | | - Rosanna P Breaux
- Department of Psychiatry, Penn State College of Medicine, Hershey, PA, USA
| | - Raman Baweja
- Department of Psychiatry, Penn State College of Medicine, Hershey, PA, USA
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Zeanah CH, Chesher T, Boris NW. Practice Parameter for the Assessment and Treatment of Children and Adolescents With Reactive Attachment Disorder and Disinhibited Social Engagement Disorder. J Am Acad Child Adolesc Psychiatry 2016; 55:990-1003. [PMID: 27806867 DOI: 10.1016/j.jaac.2016.08.004] [Citation(s) in RCA: 79] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2016] [Accepted: 08/14/2016] [Indexed: 11/16/2022]
Abstract
This Practice Parameter is a revision of a previous Parameter addressing reactive attachment disorder that was published in 2005. It reviews the current status of reactive attachment disorder (RAD) and disinhibited social engagement disorder (DESD) with regard to assessment and treatment. Attachment is a central component of social and emotional development in early childhood, and disordered attachment is defined by specific patterns of abnormal social behavior in the context of "insufficient care" or social neglect. Assessment requires direct observation of the child in the context of his or her relationships with primary caregivers. Treatment requires establishing an attachment relationship for the child when none exists and ameliorating disturbed social relatedness with non-caregivers when evident.
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