Abstract
BackgroundPrevious DSM-versions recognized an inhibited and a disinhibited subtype of the Reactive Attachment Disorder (RAD). The current DSM-5 distinguishes two different disorders, instead of two subtypes of RAD. This study examined whether a split-up of the subtypes is valid.MethodIn 126 foster children, attachment disorder symptoms were assessed with the Disturbances of Attachment Interview. Forms of pathogenic care were identified based on dossier analyses. Associations between symptoms of attachment disorder with internalizing and externalizing problems (Child Behavior Checklist and Teacher Report Form) were examined.ResultsOmnibus tests showed no significant association between type of symptoms and type of pathogenic care. Exploratory analyses did reveal an univariate association between disinhibited symptoms and history of physical abuse. Disinhibited symptoms were associated with more internalizing and externalizing problems (d’s < 0.50).ConclusionThe distinction of inhibited and disinhibited subtypes of RAD seems valid regarding their emotional and behavioral correlations. Whereas inhibited symptoms lack a correlation, disinhibited symptoms seem to have an externalizing and internalizing correlation.Trial registrationNTR1747
Highlights
Previous DSM-versions recognized an inhibited and a disinhibited subtype of the Reactive Attachment Disorder (RAD)
Exploratory analyses did reveal an univariate association between disinhibited symptoms and history of physical abuse
For disinhibited symptoms results revealed a trend towards higher percentages in treatment foster care (TFC), compared to regular foster care (RFC) (χ2 = 3.23, p = .07)
Summary
Low quality of care in relation to symptoms of inhibited, disinhibited and mixed attachment Multiple testing revealed no significant associations between the four symptoms of attachment categories with indicators of low quality of care. Performing separate analyses wherein the without symptoms group was the reference category indicated no significant associations between specific indicators of low Quality of care and inhibited or mixed symptoms (see Table 3). Associated psychopathology of symptoms of inhibited, disinhibited and mixed attachment Multivariate statistics showed that the four categories differed in severity in the overall domain of psychopathology reported by parents and teacher’s, F (18, 267) = 2.15, p = .005. Additional analyses revealed that problems in children with mixed symptoms were significantly more severe compared to children with disinhibited symptoms solely, F (12, 178) = 3.00, p = .001. Compared to the RFC and total sample, parent’s report of internalizing, externalizing and total problems in the TFC sample were not linked to inhibited or disinhibited symptoms
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