Reactive attachment/disinhibited social engagement disorders: Callous-unemotional traits and comorbid disorders

DSM-5 Reactive Attachment Disorder (RAD) and Disinhibited Social Engagement Disorder (DSED) are rare, understudied, and controversial disorders.

Comorbidity in children diagnosed with RAD or DSED was compared with comorbidity in ADHD and autism to determine if RAD/DSED comorbidity differed from that for the two most common disorders in child psychiatric clinics. Samples included 4-17-year-olds, 20 with RAD and/or DSED, 933 with autism, and 895 with ADHD. Children with RAD/DSED were removed from their neglectful environments at a mean of 4 years and were a mean 10 years when studied. Mothers rated the children on the Pediatric Behavior Scale assessing oppositional behavior, conduct problems, ADHD, anxiety, depression, and other symptoms.

Five of the 20 children with RAD/DSED had DSED without RAD, 15 had RAD with DSED, and none had RAD without DSED. All children with RAD had callous-unemotional traits (CU) and 73% had conduct disorder (CD). No children with DSED-no RAD had CU or CD. Children with RAD+DSED were considerably more impaired than children with DSED-no RAD, autism, and ADHD.

Findings are consistent with other studies indicating high CD/CU comorbidity in RAD and extreme rarity of RAD without DSED, findings which are not noted in the DSM-5.