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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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Davidson C, Turner F, Gillberg C, Campbell SL, Boyd S, Minnis H. Using the live assessment to discriminate between Autism Spectrum Disorder and Disinhibited Social Engagement Disorder. RESEARCH IN DEVELOPMENTAL DISABILITIES 2023; 134:104415. [PMID: 36634523 DOI: 10.1016/j.ridd.2022.104415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 11/21/2022] [Accepted: 12/29/2022] [Indexed: 06/17/2023]
Abstract
BACKGROUND Children with Autism Spectrum Disorder (ASD) and children with Disinhibited Social Engagement Disorder (DSED) may present with similar social problems, despite differing aetiologies, resulting in diagnostic conundrums. METHODS Thirty children: 10 with ASD, no maltreatment history, 10 with DSED and 10 typically developing children were assessed via 'gold standard' ASD assessments, including the Autism Diagnostic Observational Schedule (ADOS) and a unique unstructured observation known as the Live assessment. Live utilises a triadic interaction (2 assessors and child), playful teasing and social 'stress' scenarios to increase the social challenge. RESULTS The ADOS supported discrimination of DSED from ASD to a degree. Where additional neurodevelopmental problems created ambiguity, the Live assessment was more supportive than the ADOS for unpicking the underlying nature of the social problems. CONCLUSION Live supported differentiation between ASD, DSED and other neurodevelopmental problems. The greater social challenge presented by Live exacerbated core problems of ASD and, in DSED, core social skills stood out.
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Affiliation(s)
- Claire Davidson
- University of Glasgow, Academic CAMHS, West Glasgow Ambulatory Care Hospital, Glasgow G3 8SJ, United Kingdom.
| | - Fiona Turner
- University of Glasgow, Academic CAMHS, West Glasgow Ambulatory Care Hospital, Glasgow G3 8SJ, United Kingdom.
| | - Christopher Gillberg
- University of Glasgow, Academic CAMHS, West Glasgow Ambulatory Care Hospital, Glasgow G3 8SJ, United Kingdom; Gillberg Neuropsychiatry Service, University of Gothenburg, Gothenburg, Sweden.
| | - Sharon L Campbell
- NHS Greater Glasgow and Clyde, SCA, West Glasgow Ambulatory Care Hospital, Glasgow G3 8SJ, United Kingdom.
| | - Sheila Boyd
- NHS Greater Glasgow and Clyde, SCA, West Glasgow Ambulatory Care Hospital, Glasgow G3 8SJ, United Kingdom.
| | - Helen Minnis
- University of Glasgow, Academic CAMHS, West Glasgow Ambulatory Care Hospital, Glasgow G3 8SJ, United Kingdom.
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Wright B, Fearon P, Garside M, Tsappis E, Amoah E, Glaser D, Allgar V, Minnis H, Woolgar M, Churchill R, McMillan D, Fonagy P, O’Sullivan A, McHale M. Routinely used interventions to improve attachment in infants and young children: a national survey and two systematic reviews. Health Technol Assess 2023; 27:1-226. [PMID: 36722615 PMCID: PMC9900465 DOI: 10.3310/ivcn8847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Attachment refers to an infant's innate tendency to seek comfort from their caregiver. Research shows that attachment is important in promoting healthy social and emotional development. Many parenting interventions have been developed to improve attachment outcomes for children. However, numerous interventions used in routine practice have a limited evidence base, meaning that we cannot be sure if they are helpful or harmful. OBJECTIVES This research aimed to conduct a large-scale survey to identify what interventions are being used in UK services to improve child attachment; conduct a systematic review to evaluate the evidence for parenting attachment interventions; and develop recommendations for future research and practice. DESIGN AND METHODS We worked closely with our Expert Reference Group to plan a large-scale survey focused on relevant UK services. We then conducted two systematic reviews. One searched for all randomised controlled trial evidence for any attachment parenting intervention. The second searched for all research for the top 10 routinely used interventions identified from the survey. RESULTS The survey collected 625 responses covering 734 UK services. The results identified the 10 most commonly used interventions. The responses showed a limited use of validated measures and a wide variety of definitions of attachment. For the first review, seven studies were included from 2516 identified records. These were combined with results from previous reviews conducted by the team. Meta-analyses showed that, overall, parenting interventions are effective in reducing disorganised attachment (pooled odds ratio 0.54, 95% confidence interval 0.39 to 0.77) and increasing secure attachment (pooled odds ratio 1.85, 95% confidence interval 1.36 to 2.52). The second review searched the literature for the top 10 routinely used interventions identified by the survey; 61 studies were included from 1198 identified records. The results showed that many of the most commonly used interventions in UK services have a weak evidence base and those with the strongest evidence base are not as widely used. CONCLUSIONS There is a need for better links between research and practice to ensure that interventions offered to families are safe and effective. Possible reasons for the disparity include the cost and accessibility of training. There is also a need for improved understanding by professionals regarding the meaning of attachment. LIMITATIONS Although the survey had good geographical spread, most respondents were based in England. For review 2 we were unable to access a large number of papers; however, we conducted extensive reference checking to account for this. FUTURE WORK There is a need for robust research to test the efficacy of routinely used attachment interventions. Research could also explore why routinely used interventions are not consistently subject to thorough evaluation; how to embed dissemination, cost-effectiveness, fidelity and sustainability into research; and how to keep clinical practice up to date with research developments. STUDY REGISTRATION This study is registered as PROSPERO CRD42019137362. FUNDING This project was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 27, No. 2. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Barry Wright
- Hull York Medical School, University of York, York, UK
| | - Pasco Fearon
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Megan Garside
- Leeds and York Partnership NHS Foundation Trust, Leeds, UK
| | - Eleni Tsappis
- Leeds and York Partnership NHS Foundation Trust, Leeds, UK
| | - Elaine Amoah
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Danya Glaser
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Victoria Allgar
- Peninsula Medical School, Faculty of Health, University of Plymouth, Plymouth, UK
| | - Helen Minnis
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | | | - Rachel Churchill
- Centre for Reviews and Dissemination, University of York, York, UK
| | | | - Peter Fonagy
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
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McGuire R, Halligan SL, Meiser‐Stedman R, Durbin L, Hiller RM. Differences in the diagnosis and treatment decisions for children in care compared to their peers: An experimental study on post-traumatic stress disorder. BRITISH JOURNAL OF CLINICAL PSYCHOLOGY 2022; 61:1075-1088. [PMID: 35702815 PMCID: PMC9796033 DOI: 10.1111/bjc.12379] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Accepted: 05/17/2022] [Indexed: 12/30/2022]
Abstract
OBJECTIVES Despite evidence of high rates of diagnosable mental health difficulties in children in care, there remains ongoing debate around the appropriateness of traditional diagnoses and treatments. The aim of this study was to quantitatively explore whether mental health diagnosis and treatment decision-making differed when a young person was identified as being in care, specifically focused on post-traumatic stress disorder (PTSD). PTSD is a trauma-specific mental health disorder with rates substantially higher in children in care versus their peers. METHODS Participants were 270 UK mental health professionals who completed an online survey. Participants were randomized to receive one of two vignettes, which were identical in their description of a teenage boy experiencing PTSD symptoms, except in one he was in foster care and in the other he lived with his mother. Participants were asked to select a primary diagnosis, treatment approach, and potential secondary diagnosis. RESULTS Professionals were twice as likely to choose a primary diagnosis of PTSD and a National Institute for Clinical Excellence (NICE)-recommended PTSD treatment when randomized to the mother vignette versus the foster carer vignette. Selecting PTSD as the primary diagnosis made clinicians three times more likely to select a NICE-recommended treatment for PTSD. Developmental trauma was the most common 'diagnosis' for both groups, although this led to different treatment decisions. CONCLUSIONS In the context of PTSD, we found children in care face diagnosis and treatment decision-making biases. Practice implications are discussed.
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Affiliation(s)
| | - Sarah L. Halligan
- Department of PsychologyUniversity of BathBathUK,Department of PsychiatryUniversity of Cape TownCape TownSouth Africa
| | - Richard Meiser‐Stedman
- Department of Clinical Psychology & Psychological Therapies, Norwich Medical SchoolUniversity of East AngliaNorwichUK
| | - Lucy Durbin
- Department of PsychologyUniversity of BathBathUK
| | - Rachel M. Hiller
- Department of PsychologyUniversity of BathBathUK,Division of Psychology and Language SciencesUniversity College LondonLondonUK,Anna Freud National Centre for Children and FamiliesLondonUK
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Turner F, Venturini E, Kainth G, Crawford K, O'Connor R, Balestrieri M, MacDonald S, Minnis H. The expected and the unexpected in recovery and development after abuse and neglect: The role of early foster carer commitment on young children's symptoms of attachment disorders and mental health problems over time. CHILD ABUSE & NEGLECT 2022; 127:105585. [PMID: 35279447 DOI: 10.1016/j.chiabu.2022.105585] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Revised: 02/24/2022] [Accepted: 03/02/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND Whilst we know that foster care is better than institutional care for abused and neglected children, we know less about the specific qualities of foster care that are important for their development and recovery from maltreatment effects. OBJECTIVE This is the first study to investigate the effects of foster carer commitment on symptoms of Attachment Disorders (AD) and mental health problems in young children post-maltreatment. PARTICIPANTS & SETTING 144 children, age 0-5, recently accommodated into foster care as part of an ongoing Randomised Controlled Trial. METHODS Children were assessed using the Disturbances of Attachment Interview and the Strengths and Difficulties Questionnaire, then followed up 15 months and 2.5 years thereafter. Commitment of the foster carer was measured by 'This Is My Baby' interview. Multiple regression was used to analyse the data. RESULTS Higher initial foster carer commitment, measured shortly after entry to care, was associated with a reduction in Reactive Attachment Disorder symptoms 15 months after placement, with a modest (non-significant) association persisting 2.5 years later. Initial commitment was not associated with symptoms of Disinhibited Social Engagement Disorder at any follow-up time point, nor with symptoms of mental health problems at 15 months. However, higher initial commitment was unexpectedly associated with higher mental health symptom scores at 2.5 years post-accommodation. CONCLUSIONS This study highlights the complex and non-linear development of children in committed foster care, underscoring the need to examine multiple time-points and to consider symptoms of Attachment Disorders separately from those of other mental health problems.
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Affiliation(s)
- Fiona Turner
- Institute of Health & Wellbeing, University of Glasgow, Glasgow, UK.
| | | | - Gary Kainth
- Institute of Health & Wellbeing, University of Glasgow, Glasgow, UK.
| | - Karen Crawford
- Institute of Health & Wellbeing, University of Glasgow, Glasgow, UK.
| | - Rory O'Connor
- Institute of Health & Wellbeing, University of Glasgow, Glasgow, UK.
| | | | - Sara MacDonald
- Institute of Health & Wellbeing, University of Glasgow, Glasgow, UK.
| | - Helen Minnis
- Institute of Health & Wellbeing, University of Glasgow, Glasgow, UK.
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Reactive attachment disorder and disinhibited social engagement disorder in adolescence: co-occurring psychopathology and psychosocial problems. Eur Child Adolesc Psychiatry 2022; 31:85-98. [PMID: 33185772 PMCID: PMC8816327 DOI: 10.1007/s00787-020-01673-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Accepted: 10/23/2020] [Indexed: 11/09/2022]
Abstract
Insufficient care is associated with most psychiatric disorders and psychosocial problems, and is part of the etiology of reactive attachment disorder (RAD) and disinhibited social engagement disorder (DSED). To minimize the risk of misdiagnosis, and aid treatment and care, clinicians need to know to which degree RAD and DSED co-occur with other psychopathology and psychosocial problems, a topic little researched in adolescence. In a national study of all adolescents (N = 381; 67% consent; 12-20 years old; 58% girls) in Norwegian residential youth care, the Child and Adolescent Psychiatric Assessment interview yielded information about psychiatric diagnoses and psychosocial problems categorized as present/absent, and the Child Behavior Check List questionnaire was applied for dimensional measures of psychopathology. Most adolescents with a RAD or DSED diagnosis had several cooccurring psychiatric disorders and psychosocial problems. Prevalence rates of both emotional and behavioral disorders were high in adolescent RAD and DSED, as were rates of suicidality, self-harm, victimization from bullying, contact with police, risky sexual behavior and alcohol or drug misuse. Although categorical measures of co-occurring disorders and psychosocial problems revealed few and weak associations with RAD and DSED, dimensional measures uncovered associations between both emotional and behavioral problems and RAD/DSED symptom loads, as well as DSED diagnosis. Given the high degree of comorbidity, adolescents with RAD or DSED-or symptoms thereof-should be assessed for co-occurring psychopathology and related psychosocial problems. Treatment plans should be adjusted accordingly.
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Malik S, Joychan S, Zajac J, Sinisgalli S, Namerow L. Using an Attachment-Informed Framework in the Clinical Care of Children and Adolescents: A Review of Attachment Theory and Its Impact on Developmental Psychopathology. Psychiatr Ann 2021. [DOI: 10.3928/00485713-20210608-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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8
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Zephyr L, Cyr C, Monette S, Archambault M, Lehmann S, Minnis H. Meta-Analyses of the Associations Between Disinhibited Social Engagement Behaviors and Child Attachment Insecurity or Disorganization. Res Child Adolesc Psychopathol 2021; 49:949-962. [PMID: 33616810 DOI: 10.1007/s10802-021-00777-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/24/2021] [Indexed: 11/24/2022]
Abstract
Children with disinhibited social engagement disorder show reduced reticence with strangers, do not check back with their caregiver after venturing away, and may willingly leave with an unfamiliar adult. The recent DSM-5 has moved away from an attachment framework to understand disinhibited social engagement behavior (DSEB) due to studies indicating its presence in previously institutionalized children even after these children are adopted and show a selective, more secure attachment with their substitute caregiver (e.g. Chisholm et al., 1998). This meta-analysis aims to clarify the size of the associations between DSEB and attachment insecurity or disorganization. It also examines whether studies effect sizes differ according to various moderators (e.g., child age, type of attachment and DSEB measures). The results (k = 24) showed that the associations between DSEB and attachment insecurity (d = 0.48) or attachment disorganization (d = 0.47) were of small magnitude. There were no publication biases. As for moderator analyses on both attachment insecurity and disorganization, the effect sizes in studies using DSEB observational measures (respectively d = 0.63 and 0.57) were of moderate magnitude and stronger than those in studies not using an observational component (respectively d = 0.28 and 0.32). Given these small-to-moderate associations, attachment can be considered a relationship process associated with DSEB, and attachment-informed interventions could be potential tools to reduce DSEB in children. Nevertheless, given the sizable unshared portion of variance between DSEB and child attachment, future studies should examine other variables related to caregiving and noncaregiving contexts to further understand DSEB.
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Affiliation(s)
- Lory Zephyr
- Université du Québec à Montréal, Department of Psychology, Quebec, Canada
| | - Chantal Cyr
- Université du Québec à Montréal, Department of Psychology, Quebec, Canada. .,Institut-Universitaire Jeunes en Difficulté, CIUSSS du Centre-Sud-de-l'Île-de-Montréal, Montréal, Canada.
| | - Sébastien Monette
- Université du Québec à Montréal, Department of Psychology, Quebec, Canada.,Institut-Universitaire Jeunes en Difficulté, CIUSSS du Centre-Sud-de-l'Île-de-Montréal, Montréal, Canada
| | - Maude Archambault
- Université du Québec à Montréal, Department of Psychology, Quebec, Canada
| | - Stine Lehmann
- Department of Health Promotion and Development, Faculty of psychology, University of Bergen, Bergen, Norway
| | - Helen Minnis
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, Scotland, United Kingdom
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Monette S, Cyr C, Terradas MM, Couture S, Minnis H, Lehmann S. Development and Validation of a Measure of Attachment Disorders Based on DSM-5 Criteria: The Early TRAuma-Related Disorders Questionnaire (ETRADQ). Assessment 2020; 29:556-571. [PMID: 33380162 DOI: 10.1177/1073191120981763] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND A review of the scientific literature showed few valid tools for assessing reactive attachment disorder (RAD) and disinhibited social engagement disorder (DSED), two diagnostic entities traditionally grouped under "attachment disorders." The Early TRAuma-related Disorders Questionnaire (ETRADQ), a caregiver report, was developed to assess attachment disorders in school-age children based on the Diagnostic and Statistical Manual of Mental Disorders-Fifth edition criteria. This study sought to validate this instrument. METHOD Caregivers of school-age children from the community (n = 578) and caregivers of at-risk children adopted or in out-of-home care (n = 245) completed a sociodemographic questionnaire, the ETRADQ, the Relationship Problem Questionnaire, the RADA (RAD and DSED Assessment) interview, and the Barkley Functional Impairment Scale for Children and Adolescents. RESULTS Confirmatory factor analysis of the ETRADQ items supported the expected organization of the measure, that is, two second-order factors and five subfactors: (1) RAD scale (three subscales: Low selective attachment, Low social and emotional responsiveness, Emotional unpredictability) and (2) DSED scale (two subscales: Interactions with unfamiliar adults, Social disinhibition). All scales showed excellent internal consistency, test-retest reliability, convergent validity, and known-group validity. CONCLUSIONS Results support the reliability and validity of the ETRADQ.
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Affiliation(s)
- Sebastien Monette
- Université du Québec à Montréal, Montréal, Québec, Canada.,CIUSSS Centre-Sud-de-l'île-de-Montréal, Montréal, Québec, Canada
| | - Chantal Cyr
- Université du Québec à Montréal, Montréal, Québec, Canada.,CIUSSS Centre-Sud-de-l'île-de-Montréal, Montréal, Québec, Canada
| | - Miguel M Terradas
- CIUSSS Centre-Sud-de-l'île-de-Montréal, Montréal, Québec, Canada.,Université de Sherbrooke, Montreal, Québec, Canada
| | - Sophie Couture
- CIUSSS Centre-Sud-de-l'île-de-Montréal, Montréal, Québec, Canada.,Université de Montréal, Montreal, Québec, Canada
| | | | - Stine Lehmann
- Norce Norwegian Research Centre, Bergen, Hordaland, Norway.,University of Bergen, Bergen, Hordaland, Norway
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Seim AR, Jozefiak T, Wichstrøm L, Kayed NS. Validity of reactive attachment disorder and disinhibited social engagement disorder in adolescence. Eur Child Adolesc Psychiatry 2020; 29:1465-1476. [PMID: 31832788 PMCID: PMC7501108 DOI: 10.1007/s00787-019-01456-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/04/2019] [Indexed: 10/26/2022]
Abstract
Although reactive attachment disorder (RAD) and disinhibited social engagement disorder (DSED) are acknowledged as valid disorders in young children, controversy remains regarding their validity in adolescence. An unresolved question is whether symptoms of RAD and DSED are better conceptualized as other psychiatric disorders at this age. All adolescents (N = 381; 67% consent; 12-20 years old) living in residential youth care in Norway were interviewed to determine the symptoms and diagnosis of RAD/DSED and other common psychiatric disorders using the Child and Adolescent Psychiatric Assessment (CAPA). The construct validity of RAD and DSED, including structural and discriminant validity, was investigated using confirmatory factor analysis and latent profile analysis. Two-factor models distinguishing between symptoms of RAD and DSED and differentiating these symptoms from the symptoms of other psychiatric disorders revealed better fit than one-factor models. Symptoms of RAD and DSED defined two distinct latent groups in a profile analysis. The prevalence of RAD was 9% (95% CI 6-11%), and the prevalence of DSED was 8% (95% CI 5-11%). RAD and DSED are two distinct latent factors not accounted for by other common psychiatric disorders in adolescence. RAD and DSED are not uncommon among adolescents in residential youth care and therefore warrant easy access to qualified health care and prevention in high-risk groups.
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Affiliation(s)
- Astrid R Seim
- Division of Mental Healthcare, Department of Children and Youth, St. Olavs Hospital, Trondheim, Norway.
- Department of Mental Health, Faculty of Medicine and Health Sciences, NTNU Norwegian University of Science and Technology, Trondheim, Norway.
| | - Thomas Jozefiak
- Department of Mental Health, Faculty of Medicine and Health Sciences, NTNU Norwegian University of Science and Technology, Trondheim, Norway
| | | | - Nanna S Kayed
- Department of Mental Health, Faculty of Medicine and Health Sciences, NTNU Norwegian University of Science and Technology, Trondheim, Norway
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11
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Lehmann S, Breivik K, Monette S, Minnis H. Potentially traumatic events in foster youth, and association with DSM-5 trauma- and stressor related symptoms. CHILD ABUSE & NEGLECT 2020; 101:104374. [PMID: 31982843 DOI: 10.1016/j.chiabu.2020.104374] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Revised: 01/02/2020] [Accepted: 01/13/2020] [Indexed: 05/25/2023]
Abstract
BACKGROUND In DSM 5, three disorders are related to trauma and/or maltreatment: Post-traumatic Stress Disorder (PTSD), Reactive Attachment Disorder (RAD) and Disinhibited Social Engagement Disorder (DSED) but how these disorders relate to each other and to traumatic events is unknown. OBJECTIVE We examined 1. Prevalence of Potentially Traumatic Events (PTEs) and poly-victimization for youths in foster care. 2. Associations between single/multiple PTEs and PTSD, DSED, and the two symptom-clusters that constitute RAD: Failure to seek/accept comfort (RAD A), and Low social-emotional responsiveness/ emotion dysregulation (RAD B). PARTICIPANTS, SETTING AND METHODS Foster youth 11-17 years (N = 303) in Norway completed The Child and Adolescent Trauma Screen. Foster parents completed the RAD and DSED Assessment interview. RESULTS Foster youth reported experiencing, on average, 3.44 PTEs each (range 0-15, SD 3.33), and 52.9 % reported PTSD symptoms at or above clinical cut off. The PTE sum score was associated with the latent factors PTSD (r = .66, p < 0.001), RAD cluster B symptoms (Low social-emotional responsiveness / emotion dysregulation, r = .28, p < 0.001) and DSED (r = .11, p = 0.046), but not with RAD cluster A symptoms (Failure to seek/accept comfort). CONCLUSIONS These findings raise new questions about the nature, mechanisms and timing of development of RAD and DSED. Maltreatment assessment needs to encompass a wide range of PTEs, and consider poly-victimization.
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Affiliation(s)
- Stine Lehmann
- Regional Centre for Child and Youth Mental Health and Child Welfare -West, NORCE Norwegian Research Centre, Bergen, Norway; Department of Health Promotion and Development, Faculty of Psychology, The University of Bergen, Norway.
| | - Kyrre Breivik
- Regional Centre for Child and Youth Mental Health and Child Welfare -West, NORCE Norwegian Research Centre, Bergen, Norway
| | - Sebastien Monette
- Department of Psychology, Université Du Québec à Montréal (UQAM), Canada
| | - Helen Minnis
- Adverse Childhood Experiences Clinical and Research Centre, Institute of Health and Wellbeing, University of Glasgow, Glasgow, Scotland, United Kingdom
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12
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Liu Y, Tan TX, Li D, Xu Y. Development and Evaluation of the Disinhibited Social Engagement Scale (DSES): a Tool for Assessment and Guide for Counseling Practice. INTERNATIONAL JOURNAL FOR THE ADVANCEMENT OF COUNSELLING 2019. [DOI: 10.1007/s10447-019-09389-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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13
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Schröder M, Fux E, Lüdtke J, Izat Y, Bolten M, Schmid M. German Version of the Relationship Problems Questionnaire: Effective Screening for Attachment Disorder. Psychopathology 2019; 52:334-345. [PMID: 31865355 DOI: 10.1159/000504675] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Accepted: 11/10/2019] [Indexed: 12/16/2022]
Abstract
INTRODUCTION Attachment disorder (AD), including reactive AD and disinhibited social engagement disorder, is a prevalent, yet underdiagnosed disorder in severely maltreated children. Because the condition is associated with significant psychiatric morbidity over the entire lifespan, a valid and economic screening tool to identify children with clinical symptoms of AD is needed to avoid unspecific or ineffective treatment. The present study aimed to assess the effectiveness and efficiency of the German version of the Relationship Problems Questionnaire (RPQ). METHODS With a total of 135 children (mean age = 7.17 years, SD = 1.40, 63% male) from both general (34 children) and high-risk populations (69 in- and outpatients, 32 foster children), we investigated the sensitivity and specificity of the RPQ. AD was diagnosed using a standardized clinical interview (K-DIPS). 35 out of 135 children fulfilled the criteria for AD. RESULTS The RPQ identified 74% of the children who fulfilled the criteria for AD in the standardized clinical interview. The optimal cut-off score of the RPQ for identifying AD was 4.5 with a moderate sensitivity of 0.74 and specificity of 0.68. CONCLUSIONS The German version of the RPQ proved useful as a diagnostic indicator of clinical symptoms of AD. The tool is economic and suitable for the screening of AD in the general population as well as high-risk populations. We recommend the use of the RPQ in clinical and research settings, adding multi-method approaches after a positive screening.
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Affiliation(s)
- Martin Schröder
- Child and Adolescent Research Department (UPKKJ), Psychiatric University Hospitals Basel (UPK), University of Basel, Basel, Switzerland, .,Institute of Social Work and Social Pedagogy, Faculty of Education, University of Lüneburg, Lüneburg, Germany,
| | - Elodie Fux
- Child and Adolescent Research Department (UPKKJ), Psychiatric University Hospitals Basel (UPK), University of Basel, Basel, Switzerland
| | - Janine Lüdtke
- Child and Adolescent Research Department (UPKKJ), Psychiatric University Hospitals Basel (UPK), University of Basel, Basel, Switzerland
| | - Yonca Izat
- Vivantes Clinic Friedrichshain, Child and Adolescent Psychiatry Berlin, Berlin, Germany
| | - Margarete Bolten
- Child and Adolescent Research Department (UPKKJ), Psychiatric University Hospitals Basel (UPK), University of Basel, Basel, Switzerland
| | - Marc Schmid
- Child and Adolescent Research Department (UPKKJ), Psychiatric University Hospitals Basel (UPK), University of Basel, Basel, Switzerland
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