Autism and attachment disorder symptoms in the general population: Prevalence, overlap, and burden

Abstract

Background: Co-occurring trauma-related and neurodevelopmental problems are common in maltreated children. In population research and clinical practice, these tend to be considered separately. Overlapping health problems, that is, “multi-morbidity,” in adulthood is associated with increased service burden and costs, but this has not been investigated in childhood. Methods: Using well-validated parent-report questionnaires, we examined the overlap between symptoms of the neurodevelopmental disorder autism (autism spectrum disorder, ASD) and symptoms of the trauma- and stressor-related disorders (reactive attachment disorder [RAD] and disinhibited social engagement disorder [DSED]) in a representative general population sample of over 3,300 children aged 5–6 years of age. We investigated sociodemographic factors, service burden, and costs in association with these problems when considered separately and when co-occurring. Results: Nearly 2% of this population had symptoms suggestive of both ASD and RAD/DSED. High symptom scores for ASD were associated with male gender, (younger) age of mother at birth, and being in a single-parent family, while high symptom scores for RAD/DSED were associated with (younger) age of mother at birth, being in a single-parent family, and the number of accidents reported. Service use costs per likely case of both ASD and RAD/DSED in the preschool years were increased by £348.62 (95% confidence interval 121.04–391.11)—nearly double the costs of ASD alone. Conclusions: There is considerable overlap between symptoms of ASD and RAD/DSED in the general population, indicating that multi-morbidity is already present in childhood and is associated with increased service use and costs even in the preschool years.

Evidence for measurement of overlap between Autism Spectrum Disorder and Attachment Disorder

“…The level of overlap in clinical diagnosis being about half that observed when using screening tools (5% versus 10% of the sample receiving a joint classification). The level of joint classification for pupils with learning difficulties was marginally higher (4% versus 2%) than that noted in a community sample by Minnis et al (2020).…”

“…The current data give strength to the argument that overlap between ASD and AD can exist (Mayes et al, 2017;Minnis et al, 2020;Sadiq et al, 2012), and is clearly evident in a group of individuals with learning disability. Thus, the evidence of an association between behavioural presentation of ASD and the behavioural presentation of AD is one that is increasingly difficult to contest (Denis et al, 2009;Moran, 2010).…”

“…It also assessed the degree of overlap when screening-tools are used to assess these disorders and whether any easily identifiable behaviour problems might discriminate between the two disorders. The current results indicated that there was a degree of overlap between the two disorders both when clinical diagnoses and psychometric methods were employed (Mayes et al, 2017;Minnis et al, 2020).…”

“…Despite the clear theoretical demarcation, in practice it can be challenging to determine whether a child has AD or ASD (Golding, 2006;Sadiq et al, 2012), and several reports have suggested that there is no reason to exclude the presence of both (Mayes et al, 2017;Minnis et al, 2020). Levels of overlap in terms of occurrence are currently unclear and may depend on how a classification is made.…”

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

“…RAD and DAD are often considered together under the umbrella of attachment difficulties in other studies (e.g. Davidson et al, 2015;Mayes et al, 2017;Minnis et al, 2020). We also judged that combining the two conditions would safeguard against the possibility of small cell sizes and risk of patient deanonymisation.…”