Search

Background: \ud 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.\ud \ud Objective: \ud 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.\ud \ud Participants and setting: \ud 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.\ud \ud Methods: \ud 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.\ud \ud Results: \ud 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.\ud \ud Conclusions: \ud Adoption appears to be an effective intervention that promotes recovery of RAD and DSED symptomatology after early adversity, whereas institutionalization causes negative effects.

The links between Reactive Attachment Disorder (RAD) and temperament received relatively little research attention, in spite of their clinical and social relevance. Children with RAD sustain disproportionate burdens of early adversity related to their caregiving environment. However, there seem to be important individual differences in susceptibility to adversity, since only a small number of children show signs of RAD. Based on the work of Zeanah and Fox, this review aims to bring new insights to this relevant clinical issue in light of recent research. A differential susceptibility hypothesis will be considered as a promising and innovative approach toward a further understanding of the links between temperament and RAD., This research was conducted at Psychology Research Centre (UID/PSI/01662/2013), University of Minho, and supported in part by the Fundacao para a Ciencia e Tecnologia through national funds, under grant PTDC/PSI-PCL/101506/2008, PTDC/PSI-PCL/116897/2010 and grant SFRH/BD/87495/2012, and co-financed by the European Regional Development Fund (FEDER) through COMPETE2020 under the PT2020 Partnership Agreement (POCI01-0145-FEDER-007653).

Reactive attachment disorder (RAD) is a severe social functioning disorder associated with early childhood maltreatment where the child displays emotionally withdrawn/inhibited behaviors toward caregivers. Brain regions develop at different rates and regions undergoing rapid change may be particularly vulnerable during these times to stressors or adverse experiences. The aim of this study was to investigate the effect of type and timing of childhood adversities on structural alterations in regional gray matter (GM) volume in maltreated children with RAD. High-resolution magnetic resonance imaging datasets were obtained for children and adolescents with RAD (n = 21; mean age = 12.76 years) and typically developing (TD) control subjects (n = 22; mean age = 12.95 years). Structural images were analyzed using a whole-brain voxel-based morphometry approach and the type and timing of maltreatment, which may be more strongly associated with structural alterations, was assessed using random forest regression with conditional inference trees. Our findings revealed that there is a potential sensitive period between 5 and 7 years of age for GM volume reduction of the left primary visual cortex (BA17) due to maltreatment. We also found that the number of types of maltreatment had the most significant effect on GM volume reduction and that the second most significant variable was exposure to neglect. The present study provides the first evidence showing that type and timing of maltreatment have an important role in inducing structural abnormalities in children and adolescents with RAD., Highlights • We studied the effect of maltreatment type and timing on brain structure in RAD. • There was a sensitive period for GM volume reduction in the visual cortex. • The clinical symptoms of RAD showed the same sensitive period. • The number of types of maltreatment had significant effects on GM volume reduction. • Neglect was common and could be acting as a basis for the effects of maltreatment.

Objective: A comprehensive approach is needed for diagnosing disordered attachment behavior due to the multifaceted nature of attachment. Differences between various indicators can pose a challenge for deciding on the proper diagnosis. This study assessed the convergence between clinical interview assessment and observation-based clinical diagnosis, and their linkages with inadequate care. Method: Participating children (N = 55) had intelligence quotients (IQs) between 50 and 85 and were referred for psychiatric consultation. Data were obtained by structured review of medical records, the Disturbances of Attachment Interview (DAI), and the Clinical Observation of Attachment (COA) procedure. Results: Of the 18 children identified using the DAI with Diagnostic and Statistical Manual of Mental Disorders–Fifth Edition (DSM-5) diagnosis of reactive attachment disorder (RAD) and/or disinhibited social engagement disorder (DSED), only 7 received a clinical DSM-5 diagnosis of RAD and/or DSED. Observed maladaptive attachment behavior in the COA was strongly associated with DAI scores and with clinical diagnosis of DSM-5 RAD and/or DSED. There was a significantly higher prevalence of extremes of insufficient care in children who were classified with RAD by DAI or DSM-5 and/or with DSED by DSM-5 compared to those with no attachment disorder. Conclusions: Using structured observation and record assessment leads to more conservative identification of RAD or DSED than using the DAI.

Introduction: Currently, attachment quality and attachment disorder exist in parallel, but the mutual association is still insufficiently clarified. For policy makers and clinical experts, it can be difficult to differentiate between these constructs, but the distinction is crucial to develop mental-health services and effective treatment concepts.We aimed to investigate the association between attachment representations (AR) and attachment disorders (AD), including Reactive Attachment Disorder (RAD) and Disinhibited Social Engagement Disorder (DSED) in children aged between 5 and 9. Methods: A total of 135 children aged between 5 and 9 years (M = 7.17 years, SD = 1.40, 63% male) and their primary caregivers participated in the study. Children were interviewed with the story stem method to assess AR, and the primary caregiver completed diagnostic interviews and questionnaires on mental disorders, AD, emotional and behavioral problems, and intelligence and development. Results: The prevalence of AR in children with AD was 28.6% for the ‘secure’ form of AR, 17.1% for the ‘insecure-avoidant’ form, 25.7% for the ‘insecure-ambivalent’ form, and 28.6% for the ‘disorganized’ form. Prevalences of the various AR forms did not differ statistically significantly, indicating that AR is conceptionally distinct from AD. Children with disorganized attachment scored significantly lower on language and intelligence skills than children with secure attachment. AD was significantly associated with a higher number of comorbidities, emotional and behavioral problems, and lower language skills. Conclusions: Longitudinal studies using standardized assessment instruments are needed to systematically provide comparable and reliable empirical findings to improve current understanding of AR and AD as well as their etiological models. Keywords: Attachment theory, Attachment representations (AR), Reactive attachment disorder (RAD), Story stem method, Research Domain Criteria (RDoC)

Background Standardized methods for assessing attachment disorders are scarce but needed for research and practice. Methods In the current study, several assessments for attachment disorder symptoms are used within a German sample of foster children after being exposed to neglect and maltreatment in their biological families. The symptoms were assessed with four established assessment methods based on both parents’ report and behavioral observation: The Rating for Infant Stranger Engagement, the Stranger at the Door, the Disturbances of Attachment Interview and the Reactive Attachment Disorder Questionnaire. Results The foster care sample showed symptoms of both the inhibited and the disinhibited attachment disorder. The degree of symptoms is comparable to previous findings. The results of the different tools investigating the disinhibited type of attachment disorder are correlated to each other, but do not overlap. Conclusions Although all approaches are based on the clinical criteria of the DSM-IV, the assessments do not coincide. Each tool provides a different point of view on the symptoms, so a multi methodical approach for assessing attachment disorder symptoms should be implemented. Furthermore, the inhibited and the disinhibited symptoms represent separate categories, as reflected in the DSM-5, requiring separate assessment.