Reactive Attachment Disorder and Disinhibited Social Engagement Disorder in School-Aged Foster Children--A Confirmatory Approach to Dimensional Measures.

Stine Lehmann,Odd E. Havik,Kyrre Breivik,Einar R. Heiervang,Toril Havik

doi:10.1007/s10802-015-0045-4

Abstract

This study aimed to investigate the factor structure and external correlates of the constructs Reactive Attachment Disorder (RAD) and Disinhibited Social Engagement Disorder (DSED) from the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). The following were addressed: First, do our data support the DSM-5 conceptualization of RAD/DSED as two separate constructs? Second, are RAD and DSED distinct from other well-established dimensions of child psychopathology? Third, what are the external correlates of RAD/DSED in this sample? The study sample included 122 foster children aged 6–10 years. Foster parents completed the Strengths and Difficulties Questionnaire (SDQ), and the RAD/DSED-scale from the Developmental and Well-Being Assessment. Child protection caseworkers completed a questionnaire regarding exposure to maltreatment and placement history. Confirmatory factor analysis (CFA) of the RAD/DSED items identified a good fit for a model with a two-factor structure, which is congruent with the DSM-5 definition of RAD and DSED. A new CFA model, which included the RAD and DSED factors together with the four problem factors of the SDQ (emotional, conduct, hyperactivity-inattention, and peer problems), also demonstrated a good fit with our data. RAD and DSED were associated with the SDQ Impact scale and help seeking behavior. This was partly explained by the SDQ externalizing and peer problem subscales. Our findings lend support for the DSM-5 conceptualization of RAD and DSED as separate dimensions of child psychopathology. Thus, the assessment of RAD and DSED provides information beyond other mental health problems.

Highlights

IntroductionNorway 5 Uni Research, Regional Centre for Child and Youth Mental Health and Child Welfare, Bergen, Norway included the Reactive Attachment Disorder (RAD) and Disinhibited Social Engagement Disorder (DSED) factors together with the four problem factors of the Strengths and Difficulties Questionnaire (SDQ) (emotional, conduct, hyperactivity-inattention, and peer problems), demonstrated a good fit with our data
Oslo, Norway 5 Uni Research, Regional Centre for Child and Youth Mental Health and Child Welfare, Bergen, Norway included the Reactive Attachment Disorder (RAD) and Disinhibited Social Engagement Disorder (DSED) factors together with the four problem factors of the Strengths and Difficulties Questionnaire (SDQ), demonstrated a good fit with our data
We address three questions related to the understanding of attachment disorders: First, is there statistical support for the conceptualization of attachment disorders as two separate dimensions as described by the DSM-5, among school-aged foster children without institutional rearing? Second, are the dimensions of RAD and DSED distinguishable from other established dimensions of more common child psychopathology? Third, what are the correlates of RAD and DSED among characteristics of the placement history, exposure to risk factors in the biological family, functional impairment, and help-seeking behavior?

Summary

Introduction

Norway 5 Uni Research, Regional Centre for Child and Youth Mental Health and Child Welfare, Bergen, Norway included the RAD and DSED factors together with the four problem factors of the SDQ (emotional, conduct, hyperactivity-inattention, and peer problems), demonstrated a good fit with our data. Attachment disorder is defined in terms of markedly disturbed and developmentally inappropriate social relatedness in most social contexts which begins before the age of 5 years, persists over time, and it is assumed to originate from very depriving and pathogenic care conditions (Rutter et al 2009) Both the International Classification of Diseases (ICD-10; World Health Organization 1992) and the Diagnostic and Statistical Manual of Mental Disorders (DSM-5, American Psychiatric Association 2013) organize the symptoms of attachment disorder into two different but related disorders: an inhibited type termed Reactive Attachment Disorder (RAD) in both the ICD-10 and the DSM-5; and a disinhibited type termed Disinhibited Attachment Disorder (DAD) in the ICD-10 and Disinhibited Social Engagement Disorder (DSED) in the DSM-5. Children with the inhibited pattern appear to lack selective attachments and exhibit disinterest in interaction with adults, but they are responsive to enhanced caregiving These considerations led to the current revision in the DSM-5 that classified the two patterns as separate disorders – RAD and DSED

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