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

Abstract

SUMMARY Clinicians 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.

‘They are always in the top of our mind’: Designated Teachers' views on supporting care experienced children in England

“…None of the DTs interviewed supported any CEC with a formal diagnosis of autism, and one stated that, prior to her involvement in the research, she and her colleagues had never considered them as a distinct group of learners. Diagnostic dilemmas regarding autism and attachment disorders are common, and professionals can find it challenging to differentiate between them (Davidson et al, 2022; Pickles et al, 2023). Consequently, some children's needs may be misattributed and therefore not supported in the most appropriate way.…”

“…Consequently, some children's needs may be misattributed and therefore not supported in the most appropriate way. It is important that professionals and researchers recognise autistic CEC as a distinct population (Green et al, 2016) yet there is a paucity of empirical research in this area (Davidson et al, 2022), suggesting that further exploration is needed to understand what is happening on the ground to impact on children's poor outcomes (O'Higgins et al, 2021). With regards to addressing issues of potential misdiagnosis, the Coventry Grid is a clinical tool designed to aid clinicians in distinguishing between attachment disorders and autism (Moran, 2010, 2021) and there is scope for future research on the potential usefulness of this tool for educational professionals in non‐clinical settings.…”

The prevalence of autism spectrum disorder traits and diagnosis in adults and young people with personality disorders: A systematic review

“…Further characterisation of the behavioural-cognitive phenotypes and distinguishing factors between conditions may clarify these nosological uncertainties. For instance, factor analysis has begun to clarify shared and condition-specific aspects of ASD and schizotypal personality (Ford et al, 2017) and the Coventry Grid aims to distinguish ASD from attachment difficulties (implicated in BPD), although it is yet to be validated (Davidson et al, 2022). Research into the aetiology of social cognition and mentalisation difficulties may prove fruitful, given the area may represent a shared neuropsychological feature of both ASD and PDs despite stemming from different research traditions (Gur and Gur, 2016; Herpertz and Bertsch, 2014; Hessels et al, 2016).…”

Neurodevelopmental disorders including intellectual disability: a clinical tool kit for mental health professionals

“…The article by Davidson and colleagues (2022) reflecting on the use of available clinical tools to help differentiate between autism and attachment disorder is complemented by a commentary by Biswas & Beardsworth (2022).…”