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Attachment disorders diagnosed by community practitioners: a replication and extension.

Brian Allen^1,2, Carlo Schuengel³

¹Center for the Protection of Children, Penn State Children's Hospital, Hershey, PA, USA.

Child and Adolescent Mental Health

|April 15, 2020

Summary

Reactive Attachment Disorder (RAD) is often misdiagnosed in community settings, with conduct problems frequently leading to inaccurate RAD diagnoses in children. This study confirms that RAD criteria are often misapplied in clinical practice.

Keywords:

Reactive attachment disorder attachment clinical decision-making disinhibited social engagement disorder parent-child relationship

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Area of Science:

Child and Adolescent Psychiatry
Developmental Psychology
Clinical Psychology

Background:

Reactive Attachment Disorder (RAD) is a debated diagnosis, with concerns about its overdiagnosis in community settings.
Previous research suggests conduct problems may be incorrectly used to diagnose RAD.

Purpose of the Study:

To replicate and extend findings on the potential overdiagnosis of RAD.
To investigate the accuracy of RAD diagnoses in community settings.

Main Methods:

Reviewed clinical assessment data from 100 maltreated foster and adopted children (ages 3-17) admitted to a specialty clinic.
Utilized semi-structured interviews for RAD and disinhibited social engagement disorder (DSED) symptoms.
Employed caregiver-report questionnaires for emotional and conduct problems, and parent-child relationship quality.

Main Results:

Of 39 children with a history of RAD, DSED, or 'attachment disorder', only 3 met criteria for DSED; none met criteria for RAD (DSM-5).
Children diagnosed with RAD by community clinicians were significantly more likely to exhibit conduct problems and be adopted.
No cases met DSM-5 diagnostic criteria for RAD in the specialty clinic setting.

Conclusions:

Findings support previous research suggesting RAD is frequently misdiagnosed in community practice.
Diagnostic criteria for RAD appear to be inaccurately applied in general community settings.
Poor dissemination or implementation of updated diagnostic criteria and empirical data may contribute to misdiagnosis.