Reactive Attachment Disorder Research Articles

A modified video-feedback intervention for carers of foster children aged 6 years and under with reactive attachment disorder: a feasibility study and pilot RCT.

Looked-after children are at risk of suboptimal attachment patterns and reactive attachment disorder. However, access to interventions varies widely and there are no evidence-based interventions for this disorder. (1) To adapt an existing video-feedback intervention to meet the specific needs of foster children in the UK with reactive attachment symptoms, (2) to conduct a case series to road-test the treatment manual and study procedures, (3) to conduct a scoping study of the key hurdles in a pilot trial and (4) to conduct a pilot randomised controlled trial of the adapted intervention to determine the feasibility of a future full-scale trial. This was a mixed-methods study. The adapted treatment manual was developed with expert input and tested on a small case series. Qualitative interviews with key stakeholders were used in the scoping study in preparation for the trial and later with foster carers who received the new intervention. The final stage was a feasibility and pilot randomised controlled trial of the new intervention, compared with usual care. Researchers assessing the outcomes were blinded to group assignment. The study was set in outpatient child and adolescent mental health services and partner social services departments. Sites included urban and rural/semirural areas. Participants were foster carers with children aged ≤ 6 years presenting with difficulties in the domain of reactive attachment disorder. Key stakeholders included children's services managers and mental health service practitioners in the scoping study. Foster carers who received the modified intervention participated in qualitative interviews. The video-feedback intervention to promote positive parenting and sensitive discipline is an extensively evaluated and effective treatment approach. This intervention was modified (based on the adapted version for foster care in the Netherlands) to suit the needs of young children with reactive attachment symptoms in foster care in the UK and was delivered to improve the sensitive responding of foster carers, foster carer-child relationships and child outcomes. The modified intervention was delivered in-home by trained mental health professionals over a period of 4-6 months. The main outcome was reactive attachment symptom scores on the Disturbances of Attachment Interview. A series of minor changes to the intervention programme were introduced, which focused on improving its suitability for the UK foster care context. Challenges in recruitment meant that, despite numerous modifications to the protocol and the inclusion of additional sites, only 30 families (target, n = 40) were recruited to the randomised controlled trial (15 allocated to each group). However, most other trial parameters were deemed feasible and acceptable, particularly the high levels of data and treatment completeness. All randomised families were available for baseline analyses, but two in the treatment arm were not available for post-treatment analyses. The revised intervention was positively received by practitioners and foster carers. Only three-quarters of the target sample size was recruited. Furthermore, the sites' own exclusion of potential participants and the low return rates of screening questionnaires raise the possibility of non-randomness of non-responses. A larger-scale trial may be feasible, but only if recruitment barriers can be overcome. Dedicated resources to support recruitment within local authorities and wider inclusion criteria are recommended. Central resourcing of intervention capacity to supplement NHS staff is also recommended. This trial is registered as ISRCTN18374094. This project was funded by the National Institute for Health and Care Research ( NIHR ) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 26, No. 35. See the NIHR Journals Library website for further project information.

Attachment behaviour in autism versus attachment disorders

SUMMARYDifferentiating between autism spectrum disorder and attachment disorders such as reactive attachment disorder (RAD) and disinhibited social engagement disorder (DSED) can be difficult. We comment on Davidson et al's article on this problem, note the dearth of validated assessment tools for RAD and DSED, and point to the utility of the Early Trauma-Related Disorders Questionnaire.

Children in foster care with symptoms of reactive attachment disorder: feasibility randomised controlled trial of a modified video-feedback parenting intervention.

Looked-after children are at risk of suboptimal attachment patterns and reactive attachment disorder (RAD). However, access to interventions varies widely, and there are no evidence-based interventions for RAD. To modify an existing parenting intervention for children with RAD in the UK foster care setting, and test the feasibility of conducting a randomised controlled trial (RCT) of the modified intervention. The intervention was modified with expert input and tested on a case series. A feasibility and pilot RCT compared the new intervention with usual care. Foster carers and children in their care aged ≤6 years were recruited across nine local authorities, with 1:1 allocation and blind post-treatment assessments. The modified intervention was delivered in-home by trained mental health professionals over 4-6 months. Children were assessed for RAD symptoms, attachment quality and emotional/behavioural difficulties, and foster carers were assessed for sensitivity and stress. Minimal changes to the intervention programme were necessary, and focused on improving its suitability for the UK foster care context. Recruitment was challenging, and remained below target despite modifications to the protocol and the inclusion of additional sites. Thirty families were recruited to the RCT; 15 were allocated to each group. Most other feasibility outcomes were favourable, particularly high numbers of data and treatment completeness. The revised intervention was positively received by practitioners and foster carers. A large-scale trial may be feasible, but only if recruitment barriers can be overcome. Dedicated resources to support recruitment within local authorities and wider inclusion criteria are recommended.

The Potential and Effects of Equine-Assisted Activities in a Day Care Center for Children and Adolescents with Developmental Disorders

This study examined whether equine-assisted therapy is effective for treating developmental disorders. Equine-assisted activities (not including horseback riding) were performed once a week for 10 months at a Japanese daycare center. Social maturity and self-esteem were assessed every two months. The participants were six children with attention deficit hyperactivity disorder (ADHD), three with autism spectrum disorder, three with anxiety disorder, and one each with obsessive-compulsive disorder, reactive attachment disorder, and somatic symptom disorder. The equine-assisted activities improved self-esteem in all participants. Improvements in occupation in those who continued for 10 months and self-direction in those with ADHD were observed.

Perinatal Depression

Key Points Perinatal mood and anxiety disorders affect 15% to 20% of mothers from conception to 1 year postpartum and 4% to 25% of fathers.Infants of affected mothers are at risk for impaired social interaction, delays in language and cognitive development, failure to thrive, reactive attachment disorder of infancy, early discontinuation of breastfeeding, and neglect and abuse; longer-term adverse effects can be seen in the child’s learning, memory, behavioral, and emotional adaptation.Formal screening for perinatal depression at infant preventive visits, consistent with the peaks of occurrence, is recommended by Bright Futures, 4th Edition; US Preventive Services Taskforce (2016); and Centers for Medicare & Medicaid Services (2016).Caregivers with a positive screen result and/or symptoms of depression should be triaged for a psychiatric or social emergency and their infants should be screened and followed for potential social-emotional problems.Management is 2-generational.For the parents, demystification, brief interventions to promote the mother-infant relationship and encourage social connections, and referral for evidence-based therapy (individual or couple), emergency medical services, or hospitalizationFor the child, regular monitoring of social-emotional development and Early Intervention Part C servicesFor the mother-infant dyad, evidence-based therapy by a pediatric mental health specialist with expertise in treating infants and young children (0–5 years of age).

The expected and the unexpected in recovery and development after abuse and neglect: The role of early foster carer commitment on young children's symptoms of attachment disorders and mental health problems over time

BackgroundWhilst we know that foster care is better than institutional care for abused and neglected children, we know less about the specific qualities of foster care that are important for their development and recovery from maltreatment effects. ObjectiveThis is the first study to investigate the effects of foster carer commitment on symptoms of Attachment Disorders (AD) and mental health problems in young children post-maltreatment. Participants & setting144 children, age 0–5, recently accommodated into foster care as part of an ongoing Randomised Controlled Trial. MethodsChildren were assessed using the Disturbances of Attachment Interview and the Strengths and Difficulties Questionnaire, then followed up 15 months and 2.5 years thereafter. Commitment of the foster carer was measured by ‘This Is My Baby’ interview. Multiple regression was used to analyse the data. ResultsHigher initial foster carer commitment, measured shortly after entry to care, was associated with a reduction in Reactive Attachment Disorder symptoms 15 months after placement, with a modest (non-significant) association persisting 2.5 years later. Initial commitment was not associated with symptoms of Disinhibited Social Engagement Disorder at any follow-up time point, nor with symptoms of mental health problems at 15 months. However, higher initial commitment was unexpectedly associated with higher mental health symptom scores at 2.5 years post-accommodation. ConclusionsThis study highlights the complex and non-linear development of children in committed foster care, underscoring the need to examine multiple time-points and to consider symptoms of Attachment Disorders separately from those of other mental health problems.

Autism and attachment disorders – how do we tell the difference?

SUMMARYClinicians assessing children with autism are sometimes faced with a dilemma, especially if there is a definite or suspected history of abuse or neglect: is this autism or attachment disorder? This is important because the attachment disorders (reactive attachment disorder and disinhibited social engagement disorder) are thought to be caused by abuse or neglect, whereas autism is not. We discuss the Coventry Grid, a clinical tool aiming to aid differentiation between autism and attachment disorders. We examine the small body of empirical studies focusing on this differential diagnosis and find that the Coventry Grid can be regarded as an evidence-based tool. We also discuss preliminary findings regarding a relatively unstructured observational method involving two assessors who engage the child in jokes and playful social dilemmas, which might help clinicians elicit the information required to complete the Coventry Grid.

Effectiveness of Theraplay on Reactive Attachment Disorder in Children Aged 8-12 Years

Aim: The aim of this study was to determine the effectiveness of attachment-based play therapy method (Thera-play) on reactive attachment disorder in children aged 8 to 12 years. Method: The research method was quasi-experimental with pre-test, post-test and follow-up design. The statistical population included all children aged 8 to 12 years in Tehran who had expressed interest in the call through cyberspace. From the mentioned community, 32 children were selected and divided into two groups of experiments and controls. The intervention was presented as a weekly attachment-centered play therapy (Thera-play) (Peacock, 2020). Participants completed the Attachment Disorder Questionnaire (Randolph, 2000) before the beginning and after the sessions and repeated the post-test three months later. Data were analyzed by SPSS software using two-factor ANOVA statistical method. Results: The results of data analysis confirmed the significant effect of attachment-centered play therapy (Thera-play) on the symptoms of reactive attachment disorder (antisocial behaviors, impulsivity and coercion) (P<0.05). Conclusion: According to the results obtained in this study, the use of attachment-based play therapy approach (Thera-play) can be used as effective treatments in reducing the symptoms of reactive attachment disorder appropriate to the child's condition.

Socioemotional profiles of autism spectrum disorders, attention deficit hyperactivity disorder, and disinhibited and reactive attachment disorders: a symptom comparison and network approach.

Children with autism spectrum disorders (ASDs), attention deficit hyperactivity disorder (ADHD) and disinhibited and reactive attachment disorders (RAD/DAD) often experience socioemotional problems. Elucidating a clear picture of these profiles is essential. Strengths and Difficulties Questionnaires (SDQs) were analysed from cohort of children with ASD (n = 1430), ADHD (n = 1193), and RAD/DAD (n = 39). Kruskal-Wallis Tests and network analytic techniques were used to investigate symptom profiles. Children with ASD experienced more emotional problems, peer problems and fewer prosocial behaviours. Children with ADHD and RAD/DAD had higher levels of hyperactivity and conduct problems. Overall, ASD and ADHD networks were highly correlated (rs = 0.82), and we did not observe a statistically significant difference in terms of global Strength.

Changes in Attachment Disorder symptoms in children internationally adopted and in residential care

BackgroundA 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. ObjectiveThe 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 settingThe 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. MethodsThe 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. ResultsAdopted 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. ConclusionsAdoption appears to be an effective intervention that promotes recovery of RAD and DSED symptomatology after early adversity, whereas institutionalization causes negative effects.

A-86 Reactive Attachment Disorder in Adulthood: A Neuropsychological Perspective

Abstract Objective The sequelae of poor attachment and trauma on psychological and social functioning is well documented, however, this complex relationship applied to a neuropsychological profile is less understood. The current case uses a neuropsychological assessment to further understand the brain-behavior relationship in a case of poor maternal attachment, multiple traumas, psychiatric comorbidities, and poor social adaptation. Method Patient is a 22-year-old, right-handed, Eastern European woman with fetal alcohol and infant toxic mold exposure, failure to thrive, maternal neglect, adoption and relocation to the United States (age four), posttraumatic stress disorder (PTSD; multiple reported sexual traumas and bullying victimization), and depression. Referred for a neuropsychological evaluation for longstanding inattention, learning difficulties, being socially and emotionally withdrawn, and suspected Autism Spectrum Disorder (ASD). Results Data revealed average intellectual ability, dyscalculia, Attention Deficit Hyperactivity Disorder (ADHD), PTSD, and depression. A self-report measure of ASD revealed a strong perception of ASD, characterized by inability to read verbal cues or other’s emotions, and poor communication and self-expression, however, this diagnosis was not supported by formal assessment and behavioral observations; instead, it was determined a diagnosis of Reactive Attachment Disorder (RAD). Conclusions This case provides an example of the complex interplay of poor maternal–infant bonding coupled by adolescent trauma on adult attachment style and compromised social interactions. More specifically, the case addresses the poly-etiologic and neuropsychological impact of an insecure attachment style and trauma on self-perceptions of social and emotional withdrawal commonly seen in ASD. The case further stresses the overlapping presentations RAD, ADHD, learning disabilities, and psychiatric comorbidities.

Lessons Learned Through a Failed Effort to Remediate Reactive Attachment Disorder (RAD) In a Pre-adolescent Via Binaural Sound and A Surrogate Mother Experience

Lessons Learned Through a Failed Effort to Remediate Reactive Attachment Disorder (RAD) In a Pre-adolescent Via Binaural Sound and A Surrogate Mother Experience

Trauma-Informed Care in Child Health Systems.

Trauma-Informed Care in Child Health Systems.

Self-esteem in adolescents with reactive attachment disorder or disinhibited social engagement disorder

BackgroundLow self-esteem predicts negative outcomes and mediates the association between childhood adversity and mental health problems in adolescence. Reactive attachment disorder (RAD) and disinhibited social engagement disorder (DSED) are presumably caused by early insufficient care, but their association with self-esteem is unknown. ObjectiveInvestigate global and domain-specific self-esteem in adolescents with RAD or DSED. Participants and settingAll adolescents living in Norwegian residential youth care (RYC) (N = 306; age 12–20) were compared with a sample from the general Norwegian adolescent population (N = 10,480; age 12–20). MethodsSelf-esteem for scholastic competence (SC), social acceptance (SA), athletic competence (AC), physical appearance (PA), romantic appeal (RA), close friendship (CF), and self-worth (SW) was investigated using the revised version of the Self-Perception Profile for Adolescents. ResultsCompared to the general population, adolescents with RAD diagnosis had lower SC (mean difference, MD = −0.30, p = .020) and higher CF (MD = 0.25, p = .021), whereas adolescents with DSED diagnosis had lower SC (MD = −0.42, p = .005), SA (MD = −0.40, p = .015), AC (MD = −0.22, p = .038), PA (MD = −0.33, p = .048), and SW (MD = −0.37, p = .013). Compared to adolescents in RYC without RAD/DSED diagnoses, adolescents with DSED diagnoses had lower SA (MD = −0.42, p = .012) and SW (MD = −0.32, p = .037). More RAD symptoms were associated with lower SA (B = −0.051, p = .013), AC (B = −0.048, p = .028), RA (B = −0.053, p = .007), and CF (B = −0.052, p = .005). More DSED symptoms were associated with lower SC (B = −0.125, p = .038). ConclusionBoth global and domain-specific self-esteem in adolescents with RAD or DSED should be assessed; developmental support and treatment plans should be adjusted accordingly.

The effect of phosphatidylserine administration on cognition and symptoms of reactive attachment disorder ‐ a randomized, double‐blind, placebo‐controlled clinical trial in adolescents

BACKGROUND Reactive Attachment Disorder (RAD) occurs in 1% of the general population and is caused by a disregard for a child's emotional or physical needs, or a repeated change in caregivers. Children with RAD display persistent social and emotional disturbances resulting in underperforming at school. Phosphatidylserine (PS) is a naturally occurring phospholipid that is most concentrated in the brain and has unique regulatory and structural functions. Supplementation with PS beneficially influences numerous neurotransmitter systems such as acetylcholine, dopamine, serotonin and norepinephrine. PS improves the cognitive response to physical or mental stress, and has been shown to improve memory and cognition in healthy individuals. In addition, PS has previously been shown to improve symptoms of attention-deficit hyperactivity disorder (ADHD) and short-term auditory memory in children with ADHD. HYPOTHESIS We hypothesized that PS supplementation results in favorable changes in cognition and RAD symptoms in adolescents. METHODS Thirty male and female adolescents (PS: n=14 (11 male, 3 female), 17.7±3.3 years; PLA n=16 (13 male, 3 female), 19.4±2.4 years) from Showa Gakuen school (Tokyo, Japan) ingested 200mg of PS (LIPAMINE-PS, Healthy Navi Co., Ltd., Japan) in form of a cocoa flavored chewable tablet or a matching placebo for two months in a randomized, double-blind, parallel design in accordance with the Basic Principles of the Declaration of Helsinki. Main outcome measures included: (i) RAD symptoms based on DSM-IV-TR; (ii) cognitive tests to evaluate memory, attention and concentration: short-term auditory memory (Digit Spin Forward), working memory (Digit Span Backward), attention and working memory (Serial Subtraction Test: Serial Sevens), visual-motor integration skills (Beery-Buktenica Developmental Test), processing speed, mental flexibility and language skills. Subjects were randomized into groups based on their baseline working memory scores. Statistical analysis was performed using STATCEL 2 (Oms-Publishing, Saitama, Japan). A p-value of <0.05 was considered statistically significant. RESULTS PS administration resulted in a statistically significant decrease in RAD symptoms (-65%) and an increases in sort-term auditory memory (+26%), working memory (+30%), calculus performance (+48%), Visual-Motor Integration (+32%), and processing speed (+32%), p<0.01, as well as language skills (+28%, p<0.05), compared to baseline, while the placebo group showed an improvement in processing speed (+24%, p<0.05). CONCLUSIONS PS supplementation can be an important nutritional strategy to improve RAD symptoms and cognition in adolescents.

International Adoption: A Review and Update.

1. Judith Kim Eckerle, MD*,† 2. Megan Marie Bresnahan, OTR/L† 3. Maria Kroupina, PhD, LP*,† 4. Dana Ernest Johnson, MD, PhD*,† 5. Cynthia Ruth Howard, MD, MPHTM*,† 1. *Department of Pediatrics, University of Minnesota, Minneapolis, MN 2. †MHealth Fairview University of Minnesota Masonic Children’s Hospital, Minneapolis, MN * Abbreviations: Ab : : antibody ACE : : adverse childhood experience CDC : : Centers for Disease Control and Prevention CXR : : chest radiography IA : : international adoptee TB : : tuberculosis 1. Key information for accurate assessment of the preadoption referral. 2. Determining immunization status and planning catch-up strategy. 3. Updated screening protocol for and treatment of latent tuberculosis infection. 4. Evaluation of developmental delays in the context of international adoption. 5. Screening for risk factors indicating the need for referral to child mental health and developmental specialists. After completing this article, readers should be able to: 1. Review the basic components of an adoption referral file and know when to consult an international adoption medicine expert. 2. Perform the initial medical assessment of a newly arrived international adoptee, including evaluation of the efficacy of previous immunizations and planning of catch-up immunization based on new recommendations. 3. Screen for tuberculosis and treat latent tuberculosis infection based on recent Centers for Disease Control and Prevention (CDC) guidelines. 4. Understand the multiple areas of a developmental baseline of adopted children and assess for catch-up needs. 5. Identify the child with multiple risk factors and/or parental or family stressors who needs a referral to an adoption-competent mental health specialist. Although interest in intercountry adoption continues to be high, the numbers of international adoptions have changed dramatically since the peak in 2004 when 45,483 international adoptees (IAs) were placed in families worldwide. By 2017, the number dropped 79% to 9,387. In the United …

Child maltreatment, attachment and psychopathology: A case report

IntroductionThe exposure to child maltreatment increases the lifetime risk for many psychopathological symptoms: depression, anxiety disorders, bipolar disorder, schizophrenia, post-traumatic stress disorder, personality disorder and dissociation. Besides, adopted children, especially those with a history of institutional living before adoption, are at greater risk for a range of developmental, behavioral and attachment concerns. The case report is of a 17-year-old male, with reactive attachment disorder (RAD). He suffered child maltreatment in his family of origin before the international adoption.ObjectivesThe aim of this study is to present a case-report illustrating the relationship between chil maltreatment, adopted children and the reactive attachment disorder.MethodsA bibliographic search was performed about reactive attachment disorder. Information regarding the clinical case was obtained by consulting the patient’s file.ResultsA 17-years-old male who was adopted at age of 9 from Spain. According to reports from the orphanage, the patient suffered severe maltreatment by his family of origin, with scars on his back. The patient presents impulse control disorder, with verbal and physical heteroaggressiveness in situations of frustration, hunger and sleep. He stopped attending the institute at the age of 12, with marked isolation and reversal of the sleep-wake cycle. His treatment plan are partial hospitalization, psychotherapy and pharmacotherapy.ConclusionsBoth child maltreatment and adoption are risk factors for the presence of psychopathology during the lifetime. Especially during the pre-adoption process and the first years after adoption, both the family and the child should be able to use specialized Mental Health services.DisclosureNo significant relationships.

РЕАКТИВНИЙ РОЗЛАД ПРИВ’ЯЗАНОСТІ ЯК ДЕРМІНАНТА ВІКТИМНОЇ ПОВЕДІНКИ НЕПОВНОЛІТНІХ

The article is devoted to the consideration of the correlation between reactive attachment disorder and victim behavior of a minor. The author considers the main types of such a disorder and, depending on them, differentiates the type of victim of a criminal offense. It is noted that the lack of close emotional connection with the mother leads to a simplification of the worldview and destructive changes in the set of moral values. A child who is brought up in harsh conditions and placed in a certain framework gradually begins to feel discomfort, due to the inability to understand their place and role in family life, a value for their own parents. Such a situation can have two probable scenarios of further development: the first – the child will shut himself in and consider himself unworthy of the environment, friendship, love and recognition; second, the child will seek a spiritual replacement for parental love, and therefore will become vulnerable to people who will show affection and interest. It is pointed out that the formation in the mind of a juvenile victim of a criminal offense of the correct reaction to the wrongful influence and the generation of an adequate conditioned reflex to its negative consequences can be achieved by visualizing and gradually consolidating certain guidelines that form the algorithm necessary to avoid victimization. It turns out that the main reason for the victimization of such children is the emphasized protective compensation, which is aimed at overcoming the psychological trauma caused by dissatisfaction with the relationship with the mother. Adolescents who suffer from this type of disorder subconsciously seek to become victims, their behavior encouraging illegal influence. It is concluded that reactive attachment disorder can be considered an independent and full-fledged determinant of victim behavior of a minor. Disorders of reactive attachment can negatively affect several areas of adolescent life: emotional and volitional; intellectual; psychological. To date, the victim behavior of adolescents suffering from RAD is infantile (regressive), stimulating (fictitious-provoking) or situational. The reasons for victimization of such adolescents are their conformity, as well as transformational processes in the mind, caused by the wrong approach of parents to interact with their own children.

Mental health and use of health care services in opioid-exposed school-aged children compared to foster children

Given the concerns raised regarding the effects of prenatal exposure to methadone and buprenorphine on the developmental outcomes of the children, this study assessed mental health and use of services in a national sample of school-aged children (N = 78) born to women enrolled in opioid maintenance treatment during pregnancy, compared with a group of foster children (N = 140). The majority of the opioid-exposed children lived with their birth parent(s) at the time of assessment (N = 62), while 16 lived in foster homes. Caregivers completed the Strengths and Difficulties Questionnaire (SDQ) and the Reactive Attachment Disorder scale. Teachers completed the SDQ. Three kinds of services were included in measuring service use: school-based education services, child mental health services, and hospital-based habilitation services. The main finding of the study is that children prenatally exposed to methadone or buprenorphine living with their family of origin had significantly better mental health status than their foster-placed counterparts and that of the comparison group of foster children. In addition, the exposed children living at home had less child welfare involvement, and only half of them were using any of the three services measured. The odds for using services increased significantly in accordance with increasing mental health problems, independent of group affiliation, indicating a need-based access to services. In line with other studies, we found that the odds for using one or more services was 2.3 times greater for boys than for girls. Our results contribute to a more-nuanced understanding of the developmental outcomes of prenatal exposure to methadone and buprenorphine, and factors associated with increased service use in groups of at-risk children.

Predictors of Mental Health Diagnoses Among Youth in Psychiatric Residential Care: A Retrospective Case Record Analysis

In this study the relation between familial risk factors and maltreatment types and mental health diagnoses among youth in residential care were examined. Using data from a larger study, six separate hierarchical logistic regression models were specified using family risk factors and maltreatment type to predict risk for attention deficit hyperactivity disorder (ADHD), conduct disorder, generalized anxiety disorder, post-traumatic stress disorder (PTSD), reactive attachment disorder, and major depressive disorder. The results show that, for this population, demographic characteristics are more predictive of diagnoses compared to family risk factors and maltreatment. Specifically, age and gender significantly predicted four out of the six diagnoses. Maltreatment types were associated with two diagnoses, ADHD and PTSD. Findings from this study suggest residential treatment programs should include person-centered treatment plans considering demographics and maltreatment experiences.