Narrative responses as an aid to understanding the presentation of maltreated children who meet criteria for autistic spectrum disorder and reactive attachment disorder: A case series study

Abstract

This paper offers research case studies of four severely maltreated children who had received a diagnosis of autistic spectrum disorder. A range of measures were employed to explore the children's psychological and emotional functioning, including Theory of Mind assessment (Sally-Anne Test), attachment measures (Story Stems Assessment Profile and Relationship Problems Questionnaire), along with measures to assess general psychological and emotional well-being. Contrary to the diagnosis, the children did not reveal a theory of mind deficit. However, they did indicate a profile of difficulties in mentalisation on the Story Stems. The findings are discussed in terms of the extent to which mentalisation and theory of mind are influenced by situational factors, especially the anxiety evoked by the Story Stem attachment scenarios. Clinical implications regarding mentalisation as a state vs. trait phenomenon are discussed.

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

“…In our study, 65% of the referred children with RAD/DSED met criteria for autism, which did not differ significantly from our diagnostic clinic autism base rate. The co-occurrence of autism and RAD/DSED using standardized autism diagnostic instruments has been reported in other research as well (McCullough et al, 2014; Pritchett et al, 2013; Sadiq et al, 2012).…”

“…However, the authors noted, “there are insufficient data to date that have addressed whether RAD and pervasive developmental disorder can co-occur” (p. 11) and “there are no obvious reasons why a child could not be co-morbid for both autism spectrum disorder and RAD” (p. 29). In fact, research indicates that some children diagnosed with RAD also score in the autism range on standardized autism assessment measures (McCullough, Stedmon, & Dallos, 2014; Pritchett, Pritchett, Marshall, Davidson, & Minnis, 2013; Sadiq et al, 2012).…”

Increased Risk for Substance Use-Related Problems in Autism Spectrum Disorders: A Population-Based Cohort Study

“…For example, exposure to alcohol during pregnancy may lead to fetal alcohol spectrum disorder and autistic-like symptoms within the course of this condition (Stevens et al 2013). In addition, severely neglected children of parents addicted to psychoactive substance may present symptoms of reactive attachment disorder which, particularly when accompanied with autistic-like symptoms, may increase the probability of receiving an ASD diagnosis (McCullough et al 2013). …”

John Bowlby and contemporary issues of clinical diagnosis

“…This is perhaps one factor that has led to excessive use of an unspecified “attachment disorder” diagnosis even when the diagnostic criteria for RAD are not met (Woolgar & Baldock, 2015). This overuse has been particularly prevalent among children who have been maltreated (McCullough et al, 2014) or adopted (DeJong et al, 2016; Woolgar & Scott, 2014). In fact, RAD is exceptionally rare, even in disadvantaged samples of young children (Zeanah & Smyke, 2009), and disinhibited attachment is distinctly uncommon in children who have not been exposed to profound and pervasive institutional deprivation (Rutter, 2009).…”