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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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Pasalich DS, Aquilina B, Hassall A, Goulter N, Xyrakis N, Khoo A. Childhood Experiences of Alternative Care and Callousness/Unemotionality: A Conceptual Model, Scoping Review, and Research Agenda. Clin Child Fam Psychol Rev 2023; 26:789-804. [PMID: 37436541 PMCID: PMC10465668 DOI: 10.1007/s10567-023-00445-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/02/2023] [Indexed: 07/13/2023]
Abstract
Individuals with experiences of alternative care (AC; i.e., out-of-home care and institutional care) are at high risk for various mental health and relational problems stemming from exposure to serious attachment disruptions, loss, and complex trauma. Yet, despite the interpersonal context of their significant adversities, surprisingly there is scant research explicitly focusing on callousness/unemotionality (e.g., lack of guilt, callous disregard for others) in this population. This paper provides the first conceptual model for, and systematic scoping review of, callousness/unemotionality in children and young people with experiences of AC. In a comprehensive search of nine databases, 22 articles involving samples of participants in AC or with histories of AC, were identified for inclusion. The pattern of findings revealed that callous-unemotional and psychopathic traits are elevated in children and young people with AC experiences, and positively associated with AC. Moreover, results showed associations between these traits and various psychosocial correlates, most consistently with externalizing and internalizing problems and attachment-related problems. Only two intervention studies were located, one of which found benefits of training and supporting foster caregivers for reducing callous-unemotional traits. These findings are discussed with respect to gaps in the literature, future research directions, and trauma-informed practice to assess and treat callousness/unemotionality in children and young people with experiences of AC.
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Affiliation(s)
- Dave S Pasalich
- School of Medicine and Psychology, Australian National University, Building 39, Science Rd, ACT 2601, Canberra, Australia.
| | - Benjamin Aquilina
- School of Medicine and Psychology, Australian National University, Building 39, Science Rd, ACT 2601, Canberra, Australia
| | - Alison Hassall
- School of Medicine and Psychology, Australian National University, Building 39, Science Rd, ACT 2601, Canberra, Australia
| | - Natalie Goulter
- School of Psychology, Newcastle University, Newcastle upon Tyne, UK
| | - Nakiya Xyrakis
- School of Medicine and Psychology, Australian National University, Building 39, Science Rd, ACT 2601, Canberra, Australia
| | - Anderson Khoo
- School of Medicine and Psychology, Australian National University, Building 39, Science Rd, ACT 2601, Canberra, Australia
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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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Lehmann S, Monette S, Egger H, Breivik K, Young D, Davidson C, Minnis H. Development and Examination of the Reactive Attachment Disorder and Disinhibited Social Engagement Disorder Assessment Interview. Assessment 2020; 27:749-765. [PMID: 30175603 PMCID: PMC7227130 DOI: 10.1177/1073191118797422] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The fifth edition of the Diagnostic and Statistical Manual (DSM) categorizes reactive attachment disorder (RAD) and disinhibited social engagement disorder (DSED) as two separate disorders, and their criteria are revised. For DSED, the core symptoms focus on abnormal social disinhibition, and symptoms regarding lack of selective attachment have been removed. The core symptoms of RAD are the absence of attachment behaviors and emotional dysregulation. In this study, an international team of researchers modified the Child and Adolescent Psychiatric Assessment for RAD to update it from DSM-IV to DSM-5 criteria for RAD and DSED. We renamed the interview the reactive attachment disorder and disinhibited social engagement disorder assessment (RADA). Foster parents of 320 young people aged 11 to 17 years completed the RADA online. Confirmatory factor analysis of RADA items identified good fit for a three-factor model, with one factor comprising DSED items (indiscriminate behaviors with strangers) and two factors comprising RAD items (RAD1: failure to seek/accept comfort, and RAD2: withdrawal/hypervigilance). The three factors showed differential associations with clinical symptoms of emotional and social impairment. Time in foster care was not associated with scores on RAD1, RAD2, or DSED. Higher age was associated with lower scores on DSED, and higher scores on RAD1.
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Affiliation(s)
- Stine Lehmann
- Regional Centre for Child and Youth Mental Health and Child Welfare -West, Uni Research Health, Bergen, Norway
| | - Sebastien Monette
- Department of Psychology, Université du Québec à Montréal (UQAM), Quebec, Canada
| | - Helen Egger
- Department of Child and Adolescent Psychiatry, New York University School of Medicine, NY, USA
| | - Kyrre Breivik
- Regional Centre for Child and Youth Mental Health and Child Welfare -West, Uni Research Health, Bergen, Norway
| | - David Young
- Department of Mathematics and Statistics, University of Strathclyde, NHS, Greater Glasgow and Clyde, Glasgow, Scotland, UK
| | - Claire Davidson
- Adverse Childhood Experiences Clinical and Research Centre, Institute of Health and Wellbeing, University of Glasgow, Glasgow, Scotland, UK
| | - Helen Minnis
- Adverse Childhood Experiences Clinical and Research Centre, Institute of Health and Wellbeing, University of Glasgow, Glasgow, Scotland, UK
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Jung M, Takiguchi S, Hamamura S, Mizuno Y, Kosaka H, Tomoda A. Thalamic Volume Is Related to Increased Anterior Thalamic Radiations in Children with Reactive Attachment Disorder. Cereb Cortex 2020; 30:4238-4245. [PMID: 32147718 DOI: 10.1093/cercor/bhaa051] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Reactive attachment disorder (RAD) is associated with childhood maltreatment and affects approximately 1% of the general population. Recent data suggest that childhood maltreatment is associated with brain alterations in white and gray matter. However, the neural mechanisms of RAD-related brain alterations remain unknown. Herein, we evaluated the white matter pathways and gray matter volumes in 31 and 41 age-matched children with RAD and typical development (TD), respectively, by analyzing T1- and diffusion-weighted images. An increased fractional anisotropy (FA) and axial diffusivity in the anterior thalamic radiations (ATR) and an increased volume in the bilateral pallidum and right thalamus were observed in children with RAD compared with those with TD. Moreover, the volume of the thalamus was associated with increased ATR FA in children with RAD. Our study confirmed the existence of atypical neurodevelopment processes in the thalamus, pallidum, and ATR in children with RAD and highlighted an interdependent relationship between the alterations in the thalamus and ATR. These findings may help to improve our understanding of the comprehensive neural mechanisms of RAD.
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Affiliation(s)
- Minyoung Jung
- Department of Neuropsychiatry, University of Fukui, Eiheiji, Fukui 910-1193, Japan.,Biomedical Imaging Research Center, University of Fukui, Eiheiji, Fukui 910-1193, Japan.,Research Center for Child Mental Development, University of Fukui, Eiheiji, Fukui 910-1193, Japan
| | - Shinichiro Takiguchi
- Research Center for Child Mental Development, University of Fukui, Eiheiji, Fukui 910-1193, Japan.,Department of Child and Adolescent Psychological Medicine, University of Fukui Hospital, Eiheiji, Fukui 910-1193, Japan
| | - Shoko Hamamura
- Research Center for Child Mental Development, University of Fukui, Eiheiji, Fukui 910-1193, Japan.,Department of Child and Adolescent Psychological Medicine, University of Fukui Hospital, Eiheiji, Fukui 910-1193, Japan
| | - Yoshifumi Mizuno
- Research Center for Child Mental Development, University of Fukui, Eiheiji, Fukui 910-1193, Japan.,Department of Psychiatry & Behavioral Sciences, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Hirotaka Kosaka
- Department of Neuropsychiatry, University of Fukui, Eiheiji, Fukui 910-1193, Japan.,Research Center for Child Mental Development, University of Fukui, Eiheiji, Fukui 910-1193, Japan.,Department of Child and Adolescent Psychological Medicine, University of Fukui Hospital, Eiheiji, Fukui 910-1193, Japan
| | - Akemi Tomoda
- Research Center for Child Mental Development, University of Fukui, Eiheiji, Fukui 910-1193, Japan.,Department of Child and Adolescent Psychological Medicine, University of Fukui Hospital, Eiheiji, Fukui 910-1193, Japan
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Schröder M, Lüdtke J, Fux E, Izat Y, Bolten M, Gloger-Tippelt G, Suess GJ, Schmid M. Attachment disorder and attachment theory - Two sides of one medal or two different coins? Compr Psychiatry 2019; 95:152139. [PMID: 31706154 DOI: 10.1016/j.comppsych.2019.152139] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2019] [Revised: 10/10/2019] [Accepted: 10/14/2019] [Indexed: 01/04/2023] Open
Abstract
INTRODUCTION Currently, attachment quality and attachment disorder exist in parallel, but the mutual association is still insufficiently clarified. For policy makers and clinical experts, it can be difficult to differentiate between these constructs, but the distinction is crucial to develop mental-health services and effective treatment concepts. We aimed to investigate the association between attachment representations (AR) and attachment disorders (AD), including Reactive Attachment Disorder (RAD) and Disinhibited Social Engagement Disorder (DSED) in children aged between 5 and 9. METHODS A total of 135 children aged between 5 and 9 years (M=7.17 years, SD=1.40, 63% male) and their primary caregivers participated in the study. Children were interviewed with the story stem method to assess AR, and the primary caregiver completed diagnostic interviews and questionnaires on mental disorders, AD, emotional and behavioral problems, and intelligence and development. RESULTS The prevalence of AR in children with AD was 28.6% for the 'secure' form of AR, 17.1% for the 'insecure-avoidant' form, 25.7% for the 'insecure-ambivalent' form, and 28.6% for the 'disorganized' form. Prevalences of the various AR forms did not differ statistically significantly, indicating that AR is conceptionally distinct from AD. Children with disorganized attachment scored significantly lower on language and intelligence skills than children with secure attachment. AD was significantly associated with a higher number of comorbidities, emotional and behavioral problems, and lower language skills. CONCLUSIONS Longitudinal studies using standardized assessment instruments are needed to systematically provide comparable and reliable empirical findings to improve current understanding of AR and AD as well as their etiological models.
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Affiliation(s)
- Martin Schröder
- Psychiatric University Clinics (UPK), Department of Child and Adolescent Psychiatry (UPKKJ), University of Basel, Research Department, Schanzenstrasse 13, 4056, Basel, Switzerland; University of Lüneburg, Faculty of Education, Institute of Social work and Social Education, Universitätsallee 1, 21339, Lüneburg, Germany.
| | - Janine Lüdtke
- Psychiatric University Clinics (UPK), Department of Child and Adolescent Psychiatry (UPKKJ), University of Basel, Research Department, Schanzenstrasse 13, 4056, Basel, Switzerland
| | - Elodie Fux
- Psychiatric University Clinics (UPK), Department of Child and Adolescent Psychiatry (UPKKJ), University of Basel, Research Department, Schanzenstrasse 13, 4056, Basel, Switzerland
| | - Yonca Izat
- Vivantes Clinic Friedrichshain, Child and Adolescent Psychiatry Berlin, Child and Adolescent Psychiatry, Psychotherapy, Psychosomatic, Zadekstrasse 53, 12351, Berlin, Germany
| | - Margarete Bolten
- Psychiatric University Clinics (UPK), Department of Child and Adolescent Psychiatry (UPKKJ), University of Basel, Research Department, Schanzenstrasse 13, 4056, Basel, Switzerland
| | | | - Gerhard J Suess
- Hamburg University of Applied Sciences, Faculty Business & Social Sciences, Department Social Work, Alexanderstraße 1, 20099, Hamburg, Germany
| | - Marc Schmid
- Psychiatric University Clinics (UPK), Department of Child and Adolescent Psychiatry (UPKKJ), University of Basel, Research Department, Schanzenstrasse 13, 4056, Basel, Switzerland
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Waschbusch DA, Mayes SD, Calhoun SL, Baweja R. Response to Allen (2018): Points of agreement and disagreement on reactive attachment disorder. RESEARCH IN DEVELOPMENTAL DISABILITIES 2018; 83:190-193. [PMID: 30248581 DOI: 10.1016/j.ridd.2018.09.002] [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: 06/01/2018] [Accepted: 09/12/2018] [Indexed: 06/08/2023]
Abstract
Reactive attachment disorder (RAD) is a very rare, understudied, and controversial disorder. Research in Developmental Disabilities (RIDD) recently published our research study, "Reactive attachment/disinhibited social engagement disorders: Callous-unemotional traits and comorbidity" (Mayes, Waschbusch, Calhoun, Breaux, & Baweja, 2017) investigating comorbidity in children with RAD and demonstrating a high prevalence of conduct disorder and callous-unemotional traits, consistent with previous research. Allen (2018) responded with a paper published in RIDD criticizing our study and offering his points of view. In our response to Allen, which follows, we discuss areas where we agree with Allen, as well as areas of disagreement, all presented within the context of scientific research. A point we assume we all agree on is the importance of continued empirical research to advance our knowledge and understanding of RAD.
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Affiliation(s)
| | - Susan D Mayes
- Department of Psychiatry, Penn State College of Medicine, Hershey, PA, USA
| | - Susan L Calhoun
- 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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Allen B. Misperceptions of reactive attachment disorder persist: Poor methods and unsupported conclusions. RESEARCH IN DEVELOPMENTAL DISABILITIES 2018; 77:24-29. [PMID: 29626664 DOI: 10.1016/j.ridd.2018.03.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/28/2017] [Revised: 09/02/2017] [Accepted: 03/26/2018] [Indexed: 06/08/2023]
Abstract
Reactive Attachment Disorder (RAD) is an often discussed, but misunderstood, diagnostic presentation. A growing body of well-designed prospective studies is providing a wealth of information about the condition; however, misconceptions of RAD abound in both clinical and research arenas. As such, it can be difficult for reviewers to critically evaluate papers pertaining to RAD that are submitted to academic journals and even more difficult for practicing clinicians operating under the time constraints of community-based practice. Papers continue to appear that promote RAD as a form of conduct disorder (CD) or callous/unemotional (CU) presentation among maltreated children, although this conceptualization is directly at odds with the diagnostic criteria found in the DSM-5 and ICD-10 as well as a significant body of well-conducted research. Studies attempting to promote this understanding of RAD typically suffer from significant and multiple methodological flaws. This paper reviews these concerns and provides 5 questions that must be sufficiently answered when evaluating a paper purportedly examining RAD. A recently published paper promoting the CD/CU-conceptualization of RAD is critiqued as an exemplar of applying these 5 questions.
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Affiliation(s)
- Brian Allen
- Penn State Children's Hospital, Hershey, PA, USA; Penn State College of Medicine, Hershey, PA, USA.
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