Autism and reactive attachment/disinhibited social engagement disorders: Co-occurrence and differentiation

Abstract

DSM-5 ( Diagnostic and Statistical Manual of Mental Disorders, 5th edition) Reactive Attachment Disorder (RAD) and Disinhibited Social Engagement Disorder (DSED) are rare disorders sharing social difficulties with autism. The DSM-5 and ICD-10 (International Classification of Diseases, 10th revsion) state that RAD/DSED should not be diagnosed in children with autism. The purpose of our study is to determine whether children can meet criteria for both autism and RAD/DSED and to identify specific symptoms discriminating the disorders. Subjects were 486 children with autism and no RAD/DSED and 20 with RAD/DSED, 4-17 years of age. In total, 13 children with RAD/DSED met criteria for autism. Using the Checklist for Autism Spectrum Disorder (CASD), there was no overlap in total scores between the RAD/DSED with autism group (score range = 15-27) versus the RAD/DSED without autism group (range = 7-10 ). The autism with and without RAD/DSED groups did not differ in CASD scores. Nine of the CASD autism symptoms were found only in the autism with and without RAD/DSED groups. Our study demonstrates that children can meet criteria for both autism and RAD/DSED and that the disorders are easily differentiated by the presence of specific autism symptoms. Autism is a neurogenetic disorder, and RAD/DSED results from severe social-emotional maltreatment. Given the different etiologies, there is no reason why a child cannot have both disorders.

Validity of reactive attachment disorder and disinhibited social engagement disorder in adolescence

“…Finding a high covariance between RAD and ASD is reflective of this. Nonetheless, the model differential test indicated that RAD and ASD are best conceptualized as different disorders, supporting previous findings that RAD and ASD are indeed differentiable [12,51].…”

Attachment Disorder and Early Media Exposure: Neurobehavioral symptoms mimicking autism spectrum disorder

“…Conversely, if a child is allowed physical play with his/ her parents and forms parent!child attachment, the child does not need to watch television. Children with no opportunity to develop an attachment relationship, as if like our patient, are at increased risk of a variety of social and behavioral problems, including an autistic-like pattern (9). Our patient's CARS score, which is a useful guide to the severity of ASD, improved after he was forbidden to watch videos.…”

Management of a Child with Reactive Attachment Disorder in the Dental Clinical Setting: A Case Report

“…RAD usually begins before the age of 5 years and persists over time (10-12). It results from a lack of basic emotional attachment and/or pathogenic care conditions, particularly during the first years of childhood (12,13). The disorder has also been strongly associated with early maltreatment and affects deprivation by the primary caregiver, typically through abuse, neglect, and abandonment (4,7,14).…”

“…Allen (15) mentions that RAD is currently considered essentially "the absence of a preferred attachment to anyone". A diagnostic requirement for this disorder is social neglect, which is the absence of adequate caregiving during childhood (13). In RAD children, psychological depression leads to increased levels of cortisol, inefficiencies in the functioning of serotonin and other neurotransmitters and reduced growth-hormone production (12,16).…”