Development and Examination of the Reactive Attachment Disorder and Disinhibited Social Engagement Disorder Assessment Interview.

Stine Lehmann,Sebastien Monette,David Young,Helen Minnis,Kyrre Breivik,Helen Egger,Claire Davidson

doi:10.1177/1073191118797422

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.

Highlights

The construct of attachment disorder links early maltreatment to later psychopathology (Goldfarb, 1945a, 1945b; Tizard & Rees, 1975)
This study is the first to modify a well-established assessment tool for reactive attachment disorder (RAD) and disinhibited social engagement disorder (DSED) to correspond to the new Diagnostic and Statistical Manual (DSM)-5 criteria and evaluate its construct validity for youth in foster care
The factor representing DSED encompasses all of the nine items measuring DSED behavior according to the DSM-5 criteria

Summary

Introduction

The construct of attachment disorder links early maltreatment to later psychopathology (Goldfarb, 1945a, 1945b; Tizard & Rees, 1975). In DSM-IV, attachment disorder was assumed to be one disorder with two subtypes: disinhibited reactive attachment disorder ([RAD]; socially indiscriminate behavior) and inhibited RAD (lack of comfort seeking and withdrawal; Zeanah & Gleason, 2015). These were assumed to share the etiology of exposure to physical and social neglect and abuse and an absence of adequate caregiving during childhood (DSM-IV; American Psychiatric Association, 1994). RAD refers to the cluster of inhibited symptoms only Both RAD and DSED are categorized under the chapter “Trauma- and Stressor-Related Disorders” in DSM-5 and are still considered associated with severe pathogenic care

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