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Betcher HK, Bommersbach TJ, Perossa BA, Larrabee B, Croarkin PE, Romanowicz M, Vande Voort JL, McKean AJ. Adult Outcomes of Children With Reactive Attachment Disorder in a Non-Institutionalized Sample. J Clin Psychiatry 2023; 84:23m14994. [PMID: 37870368 DOI: 10.4088/jcp.23m14994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2023]
Abstract
Objective: Research on reactive attachment disorder (RAD) has focused on institutionalized samples, and long-term outcomes have not been described. This study examines the natural history of RAD into adulthood in a US community sample. Methods: The electronic medical record of a tertiary care center was reviewed for individuals who received an ICD-9 or ICD-10 diagnosis of RAD between 3-12 years old and were ≥ 18 years old at the start of the study; data were collected between February and June 2018. Children with RAD (n = 49) were identified and psychiatric, social, and medical outcomes were collected in childhood and adulthood. A subset of the RAD cohort with comorbid attention-deficit/hyperactivity disorder (ADHD) based on ICD codes (n = 34) was compared with age-matched controls with ADHD and without attachment disorders (n = 102). Results: Children with RAD had high rates of adult psychiatric diagnoses (73.5%), substance use (42.9%), suicide attempts (28.6%), and psychiatric hospitalizations (71.4%). They also demonstrated poor psychosocial outcomes, including low high school (34.7%) and college (2.0%) graduation, high unemployment (26.5%), state-funded health insurance (65.3%), and legal issues (34.7%). Compared to children with ADHD alone, children with RAD and ADHD had higher rates of comorbid adult psychiatric diagnoses (OR 3.0, P = .02), suicide attempts (OR 7.5, P < .01), and hospitalizations (OR 6.4, P < .01). Conclusions: This study describes the natural history of RAD into adulthood in a non-institutionalized sample. The findings suggest that children with RAD have a high burden of psychiatric comorbidities and reduced psychosocial functioning into adulthood that extend beyond the impairment associated with ADHD, a common comorbidity in RAD. These findings highlight the continuous impact of early attachment difficulties on the developmental trajectory of children.
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Affiliation(s)
- Hannah K Betcher
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota
| | | | | | | | - Paul E Croarkin
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota
| | | | | | - Alastair J McKean
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota
- Corresponding Author: Alastair McKean, MD, Mayo Clinic, 200 1st Street SW, Rochester, MN 55902
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Román M, Palacios J, Minnis H. Changes in Attachment Disorder symptoms in children internationally adopted and in residential care. Child Abuse Negl 2022; 130:105308. [PMID: 34544592 DOI: 10.1016/j.chiabu.2021.105308] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/23/2021] [Revised: 07/27/2021] [Accepted: 09/01/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND A high incidence of Reactive Attachment Disorder (RAD) and Disinhibited Social Engagement Disorder (DSED) has been reported for children with experiences of trauma and other forms of adversity. OBJECTIVE The present study aims to explore symptoms of RAD and DSED in children in two protection alternatives (international adoption and residential care) after experiences of early adversity. PARTICIPANTS AND SETTING The participants were 146 children: 40 children adopted into Spanish families from Russia, 49 children in residential care in Spanish institutions (40.8% in long-term foster centers) and 57 community comparison children. METHODS The Relationship Problems Questionnaire was used to explore both RAD and DSED. All adoptive parents and institutional caregivers retrospectively reported the problems at time of placement (Wave 0), as well as the symptoms observed at the time of the study, with children aged 4-8 years old (Wave 1). At this stage, the assessment of the community comparison group was added. RESULTS Adopted and children in residential care presented high levels of RAD and DSED symptoms at placement. For adoptees, previous experiences of abuse and neglect were marginally associated with the initial presence of RAD symptoms and a significant recovery was observed after an average of three years in their families, with a certain level of longitudinal continuity between initial and later assessments. In children currently placed in long-term residential centers in Spain, DSED symptoms worsened from W0 to W1. CONCLUSIONS Adoption appears to be an effective intervention that promotes recovery of RAD and DSED symptomatology after early adversity, whereas institutionalization causes negative effects.
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Affiliation(s)
- Maite Román
- Departamento de Psicología Evolutiva y de la Educación, Universidad de Sevilla, Spain.
| | - Jesús Palacios
- Departamento de Psicología Evolutiva y de la Educación, Universidad de Sevilla, Spain
| | - Helen Minnis
- Institute of Health and Wellbeing, University of Glasgow, Scotland, United Kingdom of Great Britain and Northern Ireland
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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 Negl 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] [What about the content of this article? (0)] [Affiliation(s)] [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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Waschbusch DA, Mayes SD, Calhoun SL, Baweja R. Response to Allen (2018): Points of agreement and disagreement on reactive attachment disorder. Res Dev Disabil 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] [What about the content of this article? (0)] [Affiliation(s)] [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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Vasileva M, Petermann F. Attachment, Development, and Mental Health in Abused and Neglected Preschool Children in Foster Care: A Meta-Analysis. Trauma Violence Abuse 2018; 19:443-458. [PMID: 27663993 DOI: 10.1177/1524838016669503] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
A proper preparation for foster parents to care for abused and neglected children includes effective training and initial diagnostics in order to plan individual treatment. Hence, a basic knowledge about the main psychosocial and developmental problems associated with abuse and neglect and their prevalence in foster children is needed. For this purpose, a systematical literature review and a series of meta-analyses were conducted. A total of 25 studies reporting data on development ( n = 4,033), mental health ( n = 726), and attachment ( n = 255) of foster children in preschool age met the inclusion criteria. The meta-analyses indicated prevalence rates of approximately 40% for developmental, mental health problems, and insecure attachment. Rates of disorganized attachment were estimated to 22%. These findings outline the necessity of an initial trauma-oriented diagnostics and trainings for foster parents that address foster children's development, mental health, and disorganized attachment.
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Affiliation(s)
- Mira Vasileva
- 1 Center for Clinical Psychology and Rehabilitation, University of Bremen, Bremen, Germany
| | - Franz Petermann
- 1 Center for Clinical Psychology and Rehabilitation, University of Bremen, Bremen, Germany
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Katsurada E, Tanimukai M, Akazawa J. A study of associations among attachment patterns, maltreatment, and behavior problem in institutionalized children in Japan. Child Abuse Negl 2017; 70:274-282. [PMID: 28654777 DOI: 10.1016/j.chiabu.2017.06.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/10/2016] [Revised: 06/12/2017] [Accepted: 06/16/2017] [Indexed: 06/07/2023]
Abstract
The present study investigates the relationships among children's history of maltreatment, attachment patterns, and behavior problems in Japanese institutionalized children. Twenty-nine children (12 boys and 17 girls) from three different institutions in the Kinki area (Western part of Japan) participated in this study. Their average age was 6. 41-years (ranging from 4 to 10). Thirteen of the children (44.8%) had history of maltreatment before they were institutionalized. Children's attachment was assessed by the Attachment Doll Play Assessment (George & Solomon, 1990, 1996, 2000). The child's main caregiver answered the Child Behavior Checklist (CBCL; Archenbach, 1991) to identify children's behavior problems. Results indicated a significant relationship between maltreatment history and attachment pattern. The relationship between attachment pattern and behavior problem was also confirmed. Implications and limitations of this study were discussed.
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Affiliation(s)
- Emiko Katsurada
- Kwansei Gakuin University, Department of Psychology, School of Humanities, 1-155 Uegahara Ichiban-cho, Nishinomiya 662-8501, Japan.
| | - Mitsue Tanimukai
- Kansai University of Welfare Sciences, Department of Social Welfare, 3-11-1 Asahigaoka, Kashihara city, Osaka 582-0026, Japan.
| | - Junko Akazawa
- Fukuyama University, Department of Humanities, Gakuen-cho 1banchi Sanzou, Fukuyama city 729-0292, Japan.
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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. Res Dev Disabil 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] [What about the content of this article? (0)] [Affiliation(s)] [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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8
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Moran K, McDonald J, Jackson A, Turnbull S, Minnis H. A study of Attachment Disorders in young offenders attending specialist services. Child Abuse Negl 2017; 65:77-87. [PMID: 28126657 DOI: 10.1016/j.chiabu.2017.01.009] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/14/2015] [Revised: 12/29/2016] [Accepted: 01/11/2017] [Indexed: 06/06/2023]
Abstract
Attachment disorders, specifically Reactive Attachment Disorder (RAD) and Disinhibited Social Engagement Disorder (DSED) are disorders associated with neglect and abuse in which people have significant difficulties relating to others. This study aims to explore Attachment Disorder symptoms and diagnoses in young offenders and factors that may be associated with them such as mental health problems. A cross-sectional design was used with 29 young people who were known to Intensive Services, aged 12-17 (M=16.2, SD=1.3), 29 carers and 20 teachers. They completed measures investigating symptoms of Attachment Disorders and psychopathology. Eighty-six percent of the young people had experienced some form of maltreatment and the rates of an actual or borderline Attachment Disorder was 52%. A positive correlation between Attachment Disorder symptoms and other mental health problems (as rated by carer-report Strengths and Difficulties Questionnaire Total Difficulties Score), accounting for 36% of the variance was found, with a large effect size (rs=0.60). Attachment Disorder symptoms were associated with hyperactivity and peer relationship problems.
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Affiliation(s)
- Kate Moran
- Adverse Childhood Experiences Centre, Mental Health and Wellbeing, University of Glasgow, Gartnavel Royal Hospital, 1055 Great Western Road, Glasgow, Scotland G12 0XH, United Kingdom.
| | - Jennifer McDonald
- Forensic Child and Adolescent Mental Health, Ferguson Smith Centre, Dalnair Street, Glasgow, Scotland G3 8SJ, United Kingdom.
| | - Alison Jackson
- Adverse Childhood Experiences Centre, Mental Health and Wellbeing, University of Glasgow, Gartnavel Royal Hospital, 1055 Great Western Road, Glasgow, Scotland G12 0XH, United Kingdom.
| | - Sue Turnbull
- Adverse Childhood Experiences Centre, Mental Health and Wellbeing, University of Glasgow, Gartnavel Royal Hospital, 1055 Great Western Road, Glasgow, Scotland G12 0XH, United Kingdom.
| | - Helen Minnis
- Adverse Childhood Experiences Centre, Mental Health and Wellbeing, University of Glasgow, Gartnavel Royal Hospital, 1055 Great Western Road, Glasgow, Scotland G12 0XH, United Kingdom.
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Topal E, Catal F, Soylu N, Ozcan OO, Celiksoy MH, Babayiğit A, Erge D, Karakoç HTE, Sancak R. Psychiatric disorders and symptoms severity in pre-school children with cow's milk allergy. Allergol Immunopathol (Madr) 2016; 44:445-9. [PMID: 27240441 DOI: 10.1016/j.aller.2016.03.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2015] [Revised: 02/15/2016] [Accepted: 03/01/2016] [Indexed: 11/17/2022]
Abstract
BACKGROUND Psychiatric disorders are seen frequently in atopic diseases. The present study aims to evaluate the frequency of psychiatric disorders and the severity of psychiatric symptoms in pre-school children with cow's milk allergy. METHODS The parents of the pre-school children with cow's milk allergy were interviewed in person and asked to fill out the Early Childhood Inventory-4 form. RESULTS The cow's milk allergy group included 40 children (27 male, 13 female) with mean age, 44.5±14.7 months, and the control group included 41 children (25 male, 16 female) with mean age, 47.6±15.2 months. It was established that 65% of the group with cow's milk allergy received at least one psychiatric diagnosis, while 36.6% of the control group received at least one psychiatric diagnosis, with a statistically significant difference (p=0.02). Within the psychiatric disorders, attention deficit hyperactivity disorders (odds ratio: 4.9, 95% CI: 1.472-16.856, p=0.006), oppositional defiant disorder (odds ratio: 5.6, 95% CI: 1.139-28.128, p=0.026), and attachment disorder (odds ratio: 4.8, 95% CI: 1.747-13.506, p=0.004) were found significantly higher compared with the healthy control group. When the groups were compared in terms of psychiatric symptom severity scores, calculated by using the Early Childhood Inventory-4 form, attention deficit hyperactivity disorders severity (p=0.006) and oppositional defiant disorder severity (p=0.037) were found to be higher in the cow's milk allergy group. CONCLUSION Psychiatric disorders are frequent and severe in pre-school children with cow's milk allergy.
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Affiliation(s)
- E Topal
- Department of Pediatric Allergy and Immunology, Inonu University Turgut Ozal Medical Center, Malatya, Turkey.
| | - F Catal
- Department of Pediatric Allergy and Immunology, Inonu University Turgut Ozal Medical Center, Malatya, Turkey
| | - N Soylu
- Department of Child and Adolescent Psychiatry, Inonu University Turgut Ozal Medical Center, Malatya, Turkey
| | - O O Ozcan
- Department of Child and Adolescent Psychiatry, Inonu University Turgut Ozal Medical Center, Malatya, Turkey
| | - M H Celiksoy
- Department of Pediatric Allergy and Immunology, Ondokuz Mayıs University Faculty of Medicine, Samsun, Turkey
| | - A Babayiğit
- Department of Pediatric Allergy and Immunology, Kanuni Sultan Süleyman Training and Research Hospital, Istanbul, Turkey
| | - D Erge
- Department of Pediatric Allergy and Immunology, Adnan Menderes University Faculty of Medicine, Aydın, Turkey
| | - H T E Karakoç
- Department of Pediatric Allergy and Immunology, Inonu University Turgut Ozal Medical Center, Malatya, Turkey
| | - R Sancak
- Department of Pediatric Allergy and Immunology, Ondokuz Mayıs University Faculty of Medicine, Samsun, Turkey
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10
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Vervoort E, De Schipper JC, Bosmans G, Verschueren K. Screening symptoms of reactive attachment disorder: evidence for measurement invariance and convergent validity. Int J Methods Psychiatr Res 2013; 22:256-65. [PMID: 24022942 PMCID: PMC6878561 DOI: 10.1002/mpr.1395] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2012] [Revised: 11/14/2012] [Accepted: 12/12/2012] [Indexed: 11/07/2022] Open
Abstract
The Relationship Problems Questionnaire (RPQ) was developed to screen symptoms of the inhibited and disinhibited subtype of reactive attachment disorder (RAD). This study further examines the psychometric properties of the RPQ in children with severe emotional and behavioural problems by testing its measurement invariance across informants and its convergent validity. Parents and teachers of 152 children [mean age (Mage) = 7.92] from 20 schools for special education filled out the RPQ and the Strengths and Difficulties Questionnaire (SDQ). During a home visit in a subsample of 77 children the Disturbances of Attachment Interview (DAI) was administered to the caregiver and the child was observed using an observational schedule for RAD. Exploratory and confirmatory factor analyses revealed the expected two-factor structure for both parent and teacher RPQ. Configural and metric invariance, but no scalar invariance, were obtained across informants. Both RPQ-subscales had acceptable to good internal consistencies and correlated as expected with similar DAI-subscales. Furthermore, the disinhibited RPQ-scale related with observations of the child's approach to a stranger. Finally, significant associations were found between the RPQ and the SDQ. Overall, the RPQ has good psychometric qualities as a multi-informant instrument for RAD-symptoms in children with severe emotional and behavioural problems.
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Affiliation(s)
- Eleonora Vervoort
- Research Unit School Psychology and Child and Adolescent DevelopmentKU LeuvenBelgium
| | | | - Guy Bosmans
- Research Unit Parenting and Special EducationKU LeuvenBelgium
| | - Karine Verschueren
- Research Unit School Psychology and Child and Adolescent DevelopmentKU LeuvenBelgium
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Pritchett R, Pritchett J, Marshall E, Davidson C, Minnis H. Reactive attachment disorder in the general population: a hidden ESSENCE disorder. ScientificWorldJournal 2013; 2013:818157. [PMID: 23710150 PMCID: PMC3654285 DOI: 10.1155/2013/818157] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2013] [Accepted: 03/27/2013] [Indexed: 01/08/2023] Open
Abstract
Reactive attachment disorder (RAD) is a severe disorder of social functioning. Previous research has shown that children with RAD may have poor cognitive and language abilities; however, findings mainly come from biased, institutionalised samples. This paper describes the characteristics of all children who were given a suspected or likely diagnosis of reactive attachment disorder in an epidemiological study of approximately 1,600 children investigating the prevalence of RAD in the general population. We found that children with RAD are more likely to have multiple comorbidities with other disorders, lower IQs than population norms, more disorganised attachment, more problem behaviours, and poorer social skills than would be found in the general population and therefore have a complex presentation than can be described as ESSENCE. We discuss the clinical and educational implications.
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Affiliation(s)
- Rachel Pritchett
- Academic Unit of Mental Health & Wellbeing, University of Glasgow, Caledonia House, Royal Hospital for Sick Children, Glasgow G3 8SJ, UK.
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12
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Abstract
We examined whether hostile dominant interpersonal problems (HDIP), antisocial features, and borderline features mediated the relationship between attachment (anxiety or avoidance) and intimate partner violence (IPV) with a sample of 132 male partner abusers. We conducted two path analyses with avoidant attachment as the predictor in one model and anxious attachment as the predictor in a second model. In both models, HDIP, antisocial features, and borderline features were the mediators with IPV as the criterion. For both models, the attachment variable had statistically significant path values to the mediating variables. However, neither antisocial nor borderline features had statistically significant path values from the mediating variable to the criterion variable (IPV). Only HDIP had a statistically significant path value from the mediating variable to the criterion variable in both models. However, only the avoidant model produced a statistically significant specific indirect effect indicating that HDIP clearly mediated the relationship between attachment and IPV. Results suggest that partner abusive men with predominantly avoidant and, to a lesser degree, anxious attachment may be at increased risk for addressing conflicts in a coercive, controlling, and vengeful manner that is manifested in physical aggression toward a partner. Further, interpersonal constructs may be better measures of psychopathology and provide more relevant clinical targets than personality constructs with male partner abusers.
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Affiliation(s)
- David M Lawson
- Department of Human Services, Stephen F. Austin State University, Nacogdoches, TX 75962-3019, USA.
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13
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Kočovská E, Puckering C, Follan M, Smillie M, Gorski C, Barnes J, Wilson P, Young D, Lidstone E, Pritchett R, Hockaday H, Minnis H. Neurodevelopmental problems in maltreated children referred with indiscriminate friendliness. Res Dev Disabil 2012; 33:1560-1565. [PMID: 22522215 DOI: 10.1016/j.ridd.2012.02.016] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/17/2012] [Accepted: 02/20/2012] [Indexed: 05/31/2023]
Abstract
We aimed to explore the extent of neurodevelopmental difficulties in severely maltreated adopted children. We recruited 34 adopted children, referred with symptoms of indiscriminate friendliness and a history of severe maltreatment in their early childhood and 32 typically developing comparison children without such a history, living in biological families. All 66 children, aged 5-12 years, underwent a detailed neuropsychiatric assessment. The overwhelming majority of the adopted/indiscriminately friendly group had a range of psychiatric diagnoses, including Attention Deficit Hyperactivity Disorder (ADHD), Post-Traumatic Stress Disorder (PTSD) and Reactive Attachment Disorder (RAD) and one third exhibited the disorganised pattern of attachment. The mean IQ was 15 points lower than the comparison group and the majority of the adopted group had suspected language disorder and/or delay. Our findings show that school-aged adopted children with a history of severe maltreatment can have very complex and sometimes disabling neuropsychiatric problems.
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Affiliation(s)
- Eva Kočovská
- Institute of Health and Wellbeing, College of Medical, Veterinary, and Life Sciences, University of Glasgow, Caledonia House, Royal Hospital for Sick Children, Yorkhill, Glasgow G3 8SJ, UK
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14
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Follan M, Anderson S, Huline-Dickens S, Lidstone E, Young D, Brown G, Minnis H. Discrimination between attention deficit hyperactivity disorder and reactive attachment disorder in school aged children. Res Dev Disabil 2011; 32:520-526. [PMID: 21257287 DOI: 10.1016/j.ridd.2010.12.031] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/13/2010] [Accepted: 12/21/2010] [Indexed: 05/30/2023]
Abstract
We aimed to determine whether it is possible to discriminate between children with attention deficit hyperactivity disorder (ADHD) and children with reactive attachment disorder (RAD) using standardized assessment tools for RAD. The study involved 107 children: 38 with a diagnosis of RAD and 30 with ADHD were recruited through community child and adolescent mental health services (CAMHS) and specialist ADHD clinics. In addition, 39 typically developing children were recruited through family practice. Clinicians were trained to use a standardized assessment package for RAD using a DVD with brief follow-up support. Discriminant function analysis was used to identify the items in the standardized assessment package that best discriminated between children with ADHD and children with RAD. Clinicians' ratings of RAD symptoms were reliable, particularly when focusing on eight core DSM-IV symptoms of RAD. Certain parent-report symptoms were highly discriminatory between children with ADHD and children with RAD. These symptoms included "cuddliness with strangers" and "comfort-seeking with strangers". A semi-structured interview with parents, observation of the child in the waiting room and teacher report of RAD symptoms aided diagnostic discrimination between the groups. Clinical diagnosis of RAD can be made reliably by clinicians, especially when focusing on eight core RAD symptoms. Clear discrimination can be made between children with RAD and children with ADHD.
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Affiliation(s)
- Michael Follan
- NHS Greater Glasgow and Clyde, Specialist Childrens Services, Templeton Business Centre, Templeton Street, Glasgow G40 4ED, United Kingdom.
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15
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Abstract
BACKGROUND A significant gap in the literature on risk factors for psychopathy is the relative lack of research on parental bonding.MethodThis study examines the cross-sectional relationship between maternal and paternal bonding, childhood physical abuse and psychopathic personality at age 28 years in a community sample of 333 males and females. It also assesses prospectively whether children separated from their parents in the first 3 years of life are more likely to have a psychopathic-like personality 25 years later. RESULTS Hierarchical regression analyses indicated that: (1) poor parental bonding (lack of maternal care and low paternal overprotection) and childhood physical abuse were both associated with a psychopathic personality; (2) parental bonding was significantly associated with psychopathic personality after taking into account sex, social adversity, ethnicity and abuse; (3) those separated from parents in the first 3 years of life were particularly characterized by low parental bonding and a psychopathic personality in adulthood; and (4) the deviant behavior factor of psychopathy was more related to lack of maternal care whereas the emotional detachment factor was related to both lack of maternal care and paternal overprotection. CONCLUSIONS Findings draw attention to the importance of different components of early bonding in relation to adult psychopathy, and may have potential implications for early intervention and prevention of psychopathy.
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Affiliation(s)
- Y Gao
- Department of Criminology, University of Pennsylvania, Philadelphia, PA 19104-6286, USA.
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16
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Abstract
The current study investigated the relationships between internalizing and externalizing (I-E) behaviors and family variables, including both parenting stress and quality of attachment relations, in children aged 8-12 with high-functioning autism spectrum disorder (ASD) or with typical development. Compared to the group with typical development, children with ASD exhibited significantly greater levels of psychopathology as assessed by the Child Behavior Checklist [Achenbach, 1991], and parents of children with ASD exhibited higher parenting stress as assessed by the Parenting Stress Index [Abidin, 1995]. In a hierarchical multiple regression analysis, parenting stress emerged as the most important predictor of children's I-E problems. Results are discussed in light of the two groups' similar relationships between parenting stress and child psychopathology.
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17
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Shaffer A, Huston L, Egeland B. Identification of child maltreatment using prospective and self-report methodologies: a comparison of maltreatment incidence and relation to later psychopathology. Child Abuse Negl 2008; 32:682-92. [PMID: 18638626 PMCID: PMC2581900 DOI: 10.1016/j.chiabu.2007.09.010] [Citation(s) in RCA: 147] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/03/2004] [Revised: 09/04/2007] [Accepted: 09/17/2007] [Indexed: 05/05/2023]
Abstract
OBJECTIVES One of the greatest methodological problems in the study of childhood maltreatment is the discrepancy in methods by which cases of child maltreatment are identified. The current study compared incidents of maltreatment identified prospectively, retrospectively, or through a combination of both methods. METHOD Within a cohort of 170 participants followed from birth to age 19, incidents of maltreatment which occurred prior to age 17.5 were identified via prospective case review and interviewer ratings of retrospective self-reports. Multi-informant measures of behavior problems were obtained at age 16, and diagnostic assessments of psychopathology were completed at age 17.5. RESULTS While the maximal number of maltreatment cases was identified by using a combination of all available identification methods, the prospective method was the single most comprehensive method for identifying the most cases of childhood physical abuse, sexual abuse, and neglect. Those who were identified as maltreated by a combination of both prospective and self-report methods experienced the greatest number of incidences of maltreatment (i.e., 49% of this group experienced more than one type of maltreatment) and displayed the most emotional and behavioral problems in late adolescence (i.e., 74% met diagnostic criteria for a clinical disorder). CONCLUSIONS This study emphasizes the variability in the incidence rates of maltreatment and the psychological outcomes that result from utilizing different methods of identification. The most severe cases of maltreatment are likely to be identified by both prospective and retrospective methods; however, cases that are identified solely through retrospective self-report may have unique relations to psychopathology in late adolescence. PRACTICE IMPLICATIONS Reliance on a single method to identify childhood maltreatment incidents often overlooks many cases. Comparing both prospective case reviews and retrospective self-reports in late adolescence, the most severe cases of multiple incidents of abuse were most likely to be identified by both methodologies. The less severe maltreatment incidents were more likely to be missed, either by prospective methods or, more frequently, by self-report methods. Practitioners must be continually sensitive to possible abuse histories among their clients, seeking out information from multiple sources whenever feasible. Additionally, the potential effects of abuse disclosure on pre-existing or developing psychopathology should be considered.
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Affiliation(s)
- Anne Shaffer
- Institute of Child Development, University of Minnesota, 51 East River Road, Minneapolis, MN 55455, USA
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18
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Abstract
Exploratory analyses of sexual behavior problems (SBP) were conducted within a larger epidemiological study of 347 preadolescent children in foster and kinship care. SBP was estimated from carergiver-reported scores on the Assessment Checklist for Children. The study simultaneously examined a large number of discrete and cumulative influences on the development of children at high risk for SBP. Most children with SBP had corresponding psychopathology, most notably conduct problems, inattention, and interpersonal behavior problems suggestive of attachment disturbances. Several correlates identified in previous studies were not associated with SBP. High concordance of SBP was found among 52 sibling dyads. Independent predictors of SBP were older age at entry into care, female gender, placement instability, and contact sexual abuse. The findings emphasize the significance of cumulative risk among children exposed to multiple adversities. The findings generated several hypothesized mechanisms involving attachment disturbances.
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Guedeney A, Foucault C, Bougen E, Larroque B, Mentré F. Screening for risk factors of relational withdrawal behaviour in infants aged 14-18 months. Eur Psychiatry 2007; 23:150-5. [PMID: 17904336 DOI: 10.1016/j.eurpsy.2007.07.008] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2007] [Revised: 07/19/2007] [Accepted: 07/23/2007] [Indexed: 10/22/2022] Open
Abstract
OBJECTIVES The objectives of this study were (1) to evaluate the prevalence of relational withdrawal behaviour in infants aged 14-18 months attending a public health centre in Paris, (2) to check some identified risk factors for relational withdrawal behaviour in this population. METHODS A cross-sectional study was conducted in infants aged 14-18 months attending a child health screening centre during the year 2005. RESULTS A total of 640 children were included in the study. Thirteen percent of the 640 infants (n=83, 95% CI [10.4%; 15.6%]) had an ADBB score at 5 and over 5 on the ADBB. There was a clear relationship between withdrawal behavior and having psychological difficulties as reported by parents, and between withdrawal and developmental delay. Withdrawal was also significantly associated with being a boy, with living in risk conditions (e.g. child being in joint custody, or with living in a foster family), with being adopted, or with being a twin. More withdrawn infants were taken care of at home. CONCLUSION Sustained relational withdrawal behaviour was linked with developmental disorders and psychopathology and not with SES, ethnical origin or rank of birth. The scale could be used in screening early psychopathology in infants aged 2-24 months of age.
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Affiliation(s)
- Antoine Guedeney
- Department of Child and Adolescent Psychiatry, hôpital Bichat-Claude Bernard APHP Paris F 75018, France.
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20
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Abstract
The relevance of attachment theory and research for practice has become increasingly clear. The authors describe a series of studies with 3 aims: (a) to validate measures of attachment for use by clinicians with adolescents and adults, (b) to examine the relation between attachment and personality pathology, and (c) to ascertain whether factor analysis can recover dimensions of attachment reflecting both interpersonal and narrative style. In 3 studies, experienced clinicians provided psychometric data using 1 of 4 attachment questionnaires (2 adolescent and 2 adult samples). Attachment dimensions predicted both personality pathology and developmental experiences in predictable ways. Factor analysis identified 4 dimensions that replicated across adolescent and adult samples on the basis of a combination of interpersonal and narrative indicators: secure, dismissing, preoccupied, and incoherent/disorganized.
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Affiliation(s)
- Drew Westen
- Department of Psychiatry and Behavioral Science, Emory University, Atlanta, GA 30322, USA.
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21
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Crawford TN, Shaver PR, Cohen P, Pilkonis PA, Gillath O, Kasen S. Self-reported attachment, interpersonal aggression, and personality disorder in a prospective community sample of adolescents and adults. J Pers Disord 2006; 20:331-51. [PMID: 16901258 DOI: 10.1521/pedi.2006.20.4.331] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Anxious and avoidant attachment were assessed in the Children in the Community (CIC) Study during adolescence and adulthood using self-report scales developed for this prospective study. The convergent and discriminant validity of the new CIC attachment scales were evaluated and their stability was assessed across a 17-year interval. Attachment scales predicted DSM-IV personality disorders in theoretically coherent and clinically meaningful ways, especially when supplemented with a separate measure of interpersonal aggression. Cluster B and C personality disorder symptoms were associated with elevated anxious attachment. Avoidant attachment was positively associated with Cluster A symptoms and inversely associated with Cluster B and C symptoms. Interpersonal aggression was higher in Cluster B symptoms and lower in Cluster C symptoms, thus differentiating between these symptom clusters.
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Affiliation(s)
- Thomas N Crawford
- Columbia University and New York State Psychiatric Institute, NY, USA.
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22
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Tasca GA, Kowal J, Balfour L, Ritchie K, Virley B, Bissada H. An attachment insecurity model of negative affect among women seeking treatment for an eating disorder. Eat Behav 2006; 7:252-7. [PMID: 16843228 DOI: 10.1016/j.eatbeh.2005.09.004] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2005] [Revised: 09/02/2005] [Accepted: 09/22/2005] [Indexed: 12/26/2022]
Abstract
The purpose of this study was to propose and test a model of attachment insecurity in a clinical sample of 268 eating disordered women. Structural relationships among attachment insecurity, BMI, perceived pressure to diet, body dissatisfaction, restrained eating, and negative affect were assessed. A heterogeneous sample of treatment seeking women with a diagnosed eating disorder completed psychometric tests prior to receiving treatment. The data were analysed using structural equation modeling. Fit indices indicated that the hypothesized model fit adequately to the data. Although cross-sectional in nature, the data suggested that attachment insecurity may lead to negative affect. As well, attachment insecurity may lead to body dissatisfaction, which in turn may lead to restrained eating among women with eating disorders. Attachment insecurity could be a possible vulnerability factor for the development of eating disorder symptoms among women.
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van Ijzendoorn MH, Schuengel C, Bakermans-Kranenburg MJ. Disorganized attachment in early childhood: meta-analysis of precursors, concomitants, and sequelae. Dev Psychopathol 2006; 11:225-49. [PMID: 16506532 DOI: 10.1017/s0954579499002035] [Citation(s) in RCA: 745] [Impact Index Per Article: 41.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
During the past 10 years nearly 80 studies on disorganized attachment involving more than 6,000 infant-parent dyads have been carried out. The current series of meta-analyses have established the reliability and discriminant validity of disorganized infant attachment. Although disorganized attachment behavior is necessarily difficult to observe and often subtle, many researchers have managed to become reliable coders. Furthermore, disorganized attachment shows modest short- and long-term stability, in particular in middle class environments, and it is not just a concomitant of constitutional, temperamental, or physical child problems. The predictive validity of disorganized attachment is established in terms of problematic stress management, the elevated risk of externalizing problem behavior, and even the tendency of disorganized infants to show dissociative behavior later in life. In normal, middle class families, about 15% of the infants develop disorganized attachment behavior. In other social contexts and in clinical groups this percentage may become twice or even three times higher (e.g., in the case of maltreatment). Although the importance of disorganized attachment for developmental psychopathology is evident, the search for the mechanisms leading to disorganization has just started. Frightening parental behavior may play an important role but it does not seem to be the only causal factor involved in the emergence of disorganized attachment.
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Affiliation(s)
- M H van Ijzendoorn
- Center for Child and Family Studies, Leiden University, The Netherlands.
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24
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Abrams KY, Rifkin A, Hesse E. Examining the role of parental frightened/frightening subtypes in predicting disorganized attachment within a brief observational procedure. Dev Psychopathol 2006; 18:345-61. [PMID: 16600058 DOI: 10.1017/s0954579406060184] [Citation(s) in RCA: 71] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Following Main and Hesse's hypothesis, several investigators have affirmed that frightened/frightening (FR) as well as particular atypical maternal behaviors are associated with infant disorganized and adult unresolved attachment. Here, for the first time, FR behavior was observed in (a) middle-class father-infant (n = 25) and independent mother-infant dyads (n = 50) and (b) a brief laboratory play session. In addition, relations between disorganization, unresolved attachment, and the six FR system subscales were explored. Paternal and maternal overall FR behavior was related to infant disorganization (n = 75, phi = .61, p < .001), and for a subsample where Adult Attachment Interviews were available (n = 32), to unresolved adult attachment (phi = .59, p < .001). At the subscale level, disorganized-FR behaviors were related to infant disorganization, but only for mother-infant dyads. Across the whole sample, both dissociative-FR and threatening-FR subscales were associated with infant disorganization. The dissociative-FR subscale emerged as the central predictor of infant disorganization and was the only subscale significantly related to unresolved attachment. The appearance of FR behavior in this 18-min play procedure suggests that FR probably occurs more frequently than previously suspected. The possible role of dissociative processes in unresolved adult attachment, disorganized attachment, and FR parental behavior is discussed.
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Affiliation(s)
- Kelley Yost Abrams
- Department of Psychology, University of California, Berkeley, CA 94720, USA
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25
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Wearden AJ, Lamberton N, Crook N, Walsh V. Adult attachment, alexithymia, and symptom reporting: an extension to the four category model of attachment. J Psychosom Res 2005; 58:279-88. [PMID: 15865953 DOI: 10.1016/j.jpsychores.2004.09.010] [Citation(s) in RCA: 95] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2004] [Accepted: 09/07/2004] [Indexed: 12/15/2022]
Abstract
OBJECTIVE A previous study using a three-category attachment model found that avoidant attachment was associated with increased symptom reporting, and that this relationship was largely mediated by negative affectivity and alexithymia. The present study aimed to advance on these findings by using a four-category model of attachment to determine which aspect of avoidant attachment (fearful or dismissing) is related to symptom reporting, and via which mediating variables. METHOD One hundred and forty-two male and female undergraduates, aged 17-44, completed questionnaire measures of attachment style, alexithymia, self-esteem, positive and negative affectivity, and symptom reporting. RESULTS Fearful and preoccupied attachment styles, negative affectivity, and alexithymia were all significantly associated with increased symptom reporting, while the dismissing attachment style was not. Regression analyses showed that the relationship between fearful attachment and symptom reporting was partly, but not fully, mediated by alexithymia and negative affectivity, while that between preoccupied attachment and symptom reporting was mediated mainly by negative affectivity. Low self-esteem was associated with symptom reporting only via its association with negative affectivity. CONCLUSIONS Fearful and preoccupied attachment styles are both associated with symptom reporting via a negative model of the self and increased negative affectivity, but alexithymia is an additional predictor of symptom reporting in individuals with fearful attachment. This difference is thought to be linked to the model of others developed in early interactions with caregivers.
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Affiliation(s)
- Alison J Wearden
- School of Psychological Sciences, University of Manchester, Oxford Road, Manchester, M139PL, UK.
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26
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Abstract
OBJECTIVE To determine the frequency and effects of exposure to adverse events in pediatric bipolar disorder. METHOD Charts of youths with bipolar disorder were retrospectively reviewed. RESULTS Thirty-five of 66 (53%) had experienced maltreatment. Most (90.9%) had divorced or separated parents and 31.8% were adopted or in foster care. Exposure to adverse events was associated with delay of diagnosis (p = .010), psychiatric hospitalization (p = .035), residential treatment (p = .003) and a decreased response to treatment (p = .006). CONCLUSIONS Exposure to adverse events may be common among pediatric bipolar patients and have a negative impact on prognosis.
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Affiliation(s)
- William R Marchand
- University of Utah, 50 North Medical Drive, Salt Lake City, Utah 84132, USA.
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27
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Johann M, Laufkötter R, Lange K, Wodarz N. [Attachment styles in German alcoholics with or without attention-deficit hyperactivity disorder (ADHD)]. Psychiatr Prax 2004; 31 Suppl 1:S105-7. [PMID: 15570520 DOI: 10.1055/s-2004-828447] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
INTRODUCTION Attachment theory yields empirical constructs for development of human self, personality and cognition. Insecure attachment strategies were associated with various psychiatric disorders. METHOD We investigated distribution of attachment styles in 368 adult alcoholics of German descent with or without persistent symptoms of attention-deficit hyperactivity disorder (ADHD) and in 402 healthy individuals. RESULT Insecure attachment styles were significantly overrepresented compared to healthy controls. The subgroup of alcoholics with ADHD showed significantly more frequent enmeshed (74.1 %), the subgroup of alcoholics without persistent ADH-associated symptoms showed more frequent dismissing (35 %) attachment strategies. CONCLUSION In our sample, insecure attachment styles are associated with alcoholism. The subgroup of alcoholics with persistent ADHD shows a specific attachment behavior that could contribute to different therapy response or to early onset or severity of alcoholism.
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Affiliation(s)
- Monika Johann
- Klinik und Poliklinik für Psychiatrie und Psychotherapie der Universität Regensburg am Bezirksklinikum.
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28
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Abstract
Repetitive, intrafamilial abuse and neglect leads to a complex array of deficiencies and symptoms that reflect both the traumatic effects of maltreatment on children as well as the effects of their failing to develop a coherent pattern of attachment behaviours toward their caregivers. This article will attempt to describe principles of a psychological treatment for maltreated children and young people who have been placed in foster care and adoptive homes. This treatment, based on attachment theory, provides dyadic interventions that aim to be transforming and integrative. The co-regulation of affect and the co-construction of meaning are central to the treatment process, just as they are central features in attachment security.
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29
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Zeanah CH, Scheeringa M, Boris NW, Heller SS, Smyke AT, Trapani J. Reactive attachment disorder in maltreated toddlers. Child Abuse Negl 2004; 28:877-888. [PMID: 15350771 DOI: 10.1016/j.chiabu.2004.01.010] [Citation(s) in RCA: 92] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/25/2002] [Revised: 12/19/2003] [Accepted: 01/16/2004] [Indexed: 05/24/2023]
Abstract
OBJECTIVE To determine if Reactive Attachment Disorder (RAD) can be reliably identified in maltreated toddlers in foster care, if the two types of RAD are independent, and to estimate the prevalence of RAD in these maltreated toddlers. METHODS Clinicians treating 94 maltreated toddlers in foster care were interviewed regarding signs of attachment disorder at intake in an intervention program. RESULTS Using categorical and continuous measures, both types of RAD can be reliably identified in maltreated toddlers. Both continuous scores and categorical diagnoses indicated that a substantial minority of maltreated young children do exhibit signs of attachment disorders sufficient to meet criteria in DSM-IV and ICD-10. The two types were moderately convergent and at times co-occurred in the same child. Prevalence of RAD in this high-risk sample was 38-40%. Indiscriminate/disinhibited RAD was identified in children with and without an attachment figure. Within this maltreated group, toddlers whose mothers had a history of psychiatric disturbance were more likely to be diagnosed with attachment disorders. CONCLUSIONS RAD may be reliably identified in maltreated toddlers. Emotionally withdrawn/inhibited and indiscriminate/disinhibited types of RAD are not entirely independent.
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Affiliation(s)
- Charles H Zeanah
- Institute of Infant and Early Childhood Mental Health, Tulane University Health Sciences Center, 1440 Canal Street TB-52, New Orleans, LA 70112, USA
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30
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Haugaard JJ, Hazan C. Recognizing and treating uncommon behavioral and emotional disorders in children and adolescents who have been severely maltreated: reactive attachment disorder. Child Maltreat 2004; 9:154-160. [PMID: 15104884 DOI: 10.1177/1077559504264316] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
This article explores reactive attachment disorder, a disorder that has been linked to severe and chronic maltreatment. The fundamental concepts of attachment theory are reviewed briefly, and the two types of behaviors associated with reactive attachment disorder in children and adolescents are discussed. Treatment strategies are explored, including the controversial holding or rebirthing strategies.
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31
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Abstract
The authors compared behavioral and personality characteristics of children with reactive attachment disorder (RAD) with non-RAD children. Participants included parents of children with RAD (n = 21), parents of non-RAD children (n = 21), and some of the children (n = 20). The parents completed questionnaires regarding behavioral and personality characteristics of their children. Parents were also given the option of asking their children to participate in the study by completing self-report measures. Several significant findings were obtained. Children with RAD scored lower on empathy but higher on self-monitoring than non-RAD children. These differences were especially pronounced based on parent ratings and suggest that children with RAD may systematically report their personality traits in overly positive ways. Their scores also indicated considerably more behavioral problems than scores of the control children. Previous research has been generally qualitative in nature. The current research represents some of the first quantitative, empirical work documenting specific behaviors associated with the diagnosis of RAD. The findings of this study have implications for better understanding and dealing with reactive attachment disorder.
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32
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Abstract
The purpose of this study was to establish benchmark data to assist in identifying factors associated with mental health service needs and level of care for children living in a rural state. Clinical and psycho-social needs and strengths were assessed using retrospective chart review for all children and adolescents (n=150) with symptoms or a diagnosis of reactive attachment disorder who presented to a comprehensive treatment facility between January 1997 and December 1999. Logistic regression was used to predict factors associated with inpatient admission (n=15) vs. community-based care (n=135). Significant individual contributors to the prediction of inpatient care were more limited clinical/psycho-social strengths, history of inpatient use and history of sexual abuse. Although 80 percent of children admitted to inpatient care had a history of hospitalization, two-thirds had no history of receiving community-based services and presented to current treatment with a two-year or longer history of symptoms. Approximately two-thirds of children admitted to inpatient care had a history of sexual abuse; however, one-third of these children had no history of mental health service use and presented to current treatment with a two-year or longer history of symptoms. Findings raise concerns about current efforts in public health education, community awareness and health prevention and early intervention programs for children with mental/behavioral health challenges and children and families at risk for abuse and/or neglect living in rural areas.
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Affiliation(s)
- R L Anderson
- Health Management and Policy, College of Public Health, University of Iowa, Iowa City 52242, USA.
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