Reactive Attachment Disorder in the General Population: A Hidden ESSENCE Disorder

Pritchett, Rachel; Pritchett, Jennifer; Marshall, Emma; Davidson, Claire; Minnis, Helen

doi:10.1155/2013/818157

Cited by 38 publications

(37 citation statements)

References 21 publications

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“…Results of the current study did show that children with persisting DSEB, as well as children with de novo DSEB, had a higher prevalence of ADHD than children without DSEB. This is consistent with evidence for comorbidity of DSED and ADHD (Gleason et al., ; Pritchett et al., ). However, there is also a possibility that parent‐reported DSEB was miss‐classified in some of the children with ADHD, because ADHD/ODD was not associated with the observational measures for DSEB.…”

Section: Discussionsupporting

confidence: 90%

“…Regarding clinical implications, DSEB could be overshadowed by comorbid ADHD symptoms and lead to selective treatment of ADHD symptoms in children without focus on parent‐child relation and social interaction, as has been discussed by Pritchett et al. (). On the other hand, a lack of understanding of etiology of DSEB in clinically referred children asks for cautious interpretation of DSEB in home‐reared children.…”

Section: Discussionmentioning

confidence: 99%

“…This leaves open the possibility that DSED may be comorbid with ADHD. DSED and ADHD showed comorbidity in post‐institutionalized children and in general population children (Gleason et al., ; Pritchett, Pritchett, Marshall, Davidson, & Minnis, ). In previous studies, DSED symptoms were phenotypically distinguished from ADHD and conduct problems, supporting the clinical relevance of DSEB (Gleason et al., ; Minnis et al., ).…”

Section: Introductionmentioning

confidence: 99%

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Course of disinhibited social engagement behavior in clinically referred home‐reared preschool children

Scheper

Groot

Vries

et al. 2018

Child Psychology Psychiatry

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Background Evidence supporting clinical relevance and persistence of disinhibited social engagement behavior (DSEB) pertains mostly to children reared in institutions and foster care. This study examined the course of DSEB in clinically referred home‐reared children from early into middle childhood, and associations with neglect/emotional maltreatment, effortful control, Attention Deficit/Hyperactivity Disorder, Oppositional Defiant Disorder, and Autism Spectrum Disorder. Methods Disinhibited social engagement behavior was examined in 124 children (82% boys, M = 4.06 years, SD = 0.89), referred for treatment of emotional and behavioral problems, by use of the Disturbances of Attachment Interview (DAI) with biological parents. Neglect and emotional maltreatment were assessed from case records and effortful control by use of the Child Behavior Questionnaire. At follow‐up, on average 4 years later, DSEB was examined by use of DAI as well as two observational ratings: the Stranger at the Door procedure (SatD) and a structured home observation of stranger approach. Psychiatric disorders were assessed by means of the Kiddie‐Schedule for Affective Disorders and Schizophrenia. Results Persistence of parent‐reported DSEB was found in 57% (n = 27) of the children with DSEB at baseline (n = 47). Parent‐reported DSEB at follow‐up was significantly related to DSEB observed in the SatD (rpb = .31, p = .001) and to observed stranger approach (rs = .41, p < .001), but only stranger approach was associated with baseline DSEB. The course of DSEB was not related to neglect/emotional maltreatment, nor to the level of effortful control. There was no association between DSEB and Autism Spectrum Disorder, but course of DSEB was associated with Attention Deficit/Hyperactivity Disorder/Oppositional Defiant Disorder at follow‐up (χ2 = 13.08, p = .004). Conclusions Although explanations for the onset and course of DSEB in home‐reared children remain elusive, findings suggest that DSEB is part of a complex of clinically significant problem behaviors in referred home‐reared preschool children.

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Section: Discussionsupporting

confidence: 90%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Course of disinhibited social engagement behavior in clinically referred home‐reared preschool children

Scheper

Groot

Vries

et al. 2018

Child Psychology Psychiatry

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“…Consultation with experts on the advisory panel recommend that this model parameter be provisionally explored using recent research. 237 This research finds that the prevalence of RAD in the general population to be 1.4%. (This paper was published in 2013 after the cut-off point for our systematic review.…”

Section: Prevalence Of Severe Attachment Problemmentioning

confidence: 87%

Clinical effectiveness and cost-effectiveness of parenting interventions for children with severe attachment problems: a systematic review and meta-analysis

Wright

Barry

Hughes

et al. 2015

Health Technol Assess

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Background and objectivesServices have variable practices for identifying and providing interventions for ‘severe attachment problems’ (disorganised attachment patterns and attachment disorders). Several government reports have highlighted the need for better parenting interventions in at-risk groups. This report was commissioned to evaluate the clinical effectiveness and cost-effectiveness of parenting interventions for children with severe attachment problems (the main review). One supplementary review explored the evaluation of assessment tools and a second reviewed 10-year outcome data to better inform health economic aspects of the main review.Data sourcesA total of 29 electronic databases were searched with additional mechanisms for identifying a wide pool of references using the Cochrane methodology. Examples of databases searched include PsycINFO (1806 to January week 1, 2012), MEDLINE and MEDLINE In-Process & Other Non-Indexed Citations (1946 to December week 4, 2011) and EMBASE (1974 to week 1, 2012). Searches were carried out between 6 and 12 January 2012.Review methodsPapers identified were screened and data were extracted by two independent reviewers, with disagreements arbitrated by a third independent reviewer. Quality assessment tools were used, including quality assessment of diagnostic accuracy studies – version 2 and the Cochrane risk of bias tool. Meta-analysis of randomised controlled trials (RCTs) of parenting interventions was undertaken. A health economics analysis was conducted.ResultsThe initial search returned 10,167 citations. This yielded 29 RCTs in the main review of parenting interventions to improve attachment patterns, and one involving children with reactive attachment disorder. A meta-analysis of eight studies seeking to improve outcome in at-risk populations showed statistically significant improvement in disorganised attachment. The interventions saw less disorganised attachment at outcome than the control (odds ratio 0.47, 95% confidence interval 0.34 to 0.65;p < 0.00001). Much of this focused around interventions improving maternal sensitivity, with or without video feedback. In our first supplementary review, 35 papers evaluated an attachment assessment tool demonstrating validity or psychometric data. Only five reported test–retest data. Twenty-six studies reported inter-rater reliability, with 24 reporting a level of 0.7 or above. Cronbach’s alphas were reported in 12 studies for the comparative tests (11 with α > 0.7) and four studies for the reference tests (four with α > 0.7). Three carried out concurrent validity comparing the Strange Situation Procedure (SSP) with another assessment tool. These had good sensitivity but poor specificity. The Disturbances of Attachment Interview had good sensitivity and specificity with the research diagnostic criteria (RDC) for attachment disorders. In our supplementary review of 10-year outcomes in cohorts using a baseline reference standard, two studies were found with disorganised attachment at baseline, with one finding raised psychopathology in adolescence. Budget impact analysis of costs was estimated because a decision model could not be justifiably populated. This, alongside other findings, informed research priorities.LimitationsThere are relatively few UK-based clinical trials. A 10-year follow-up, while necessary for our health economists for long-term sequelae, yielded a limited number of papers.ConclusionsMaternal sensitivity interventions show good outcomes in at-risk populations, but require further research with complex children. The SSP and RDC for attachment disorders remain the reference standards for identification until more concurrent and predictive validity research is conducted. A birth cohort with sequential attachment measures and outcomes across different domains is recommended with further, methodologically sound randomised controlled intervention trials. The main area identified for future work was a need for good-quality RCTs in at-risk groups such as those entering foster care or adoption.Study registrationThis study is registered as PROSPERO CRD42011001395.FundingThe National Institute for Health Research Health Technology Assessment programme.

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“…Inhibited RAD is thought to be very rare beyond the specific context of maltreatment [14] but we have recently shown that the disinhibited form is far from being rare and has a prevalence of around 1.4% in a deprived population [15]—similar to or even higher than the population prevalence of ASD [16]. We have also found that children with RAD often have complex neurodevelopmental problems [17] and that, even after living for several years in loving adoptive families, these children can still have problems that are a major burden for themselves, their families, and their peers [18]. …”

Section: What Are the Maltreatment-associated Psychiatric Problems?mentioning

confidence: 99%

Maltreatment‐Associated Psychiatric Problems: An Example of Environmentally Triggered ESSENCE?

Minnis

2013

The Scientific World Journal

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This paper presents a new concept—maltreatment associated psychiatric problems (MAPP)—a syndrome of overlapping complex neurodevelopmental problems in children who have experienced abuse or neglect in early life. Children with MAPP are a hidden population in the community and, in clinical settings, their problems can seem overwhelming. Individual disorders associated with maltreatment are discussed as well as the overlap between these disorders and their shared environmental and genetic predisposing factors. Because of the complex and overlapping nature of MAPP, with symptoms emerging in early life, I argue that it should be considered an example of ESSENCE. Children presenting with likely MAPP should receive a comprehensive assessment, probing for symptoms of all of the ESSENCE disorders and leading to the use of evidence-based treatments where these are available.

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Reactive Attachment Disorder in the General Population: A Hidden ESSENCE Disorder

Cited by 38 publications

References 21 publications

Course of disinhibited social engagement behavior in clinically referred home‐reared preschool children

Course of disinhibited social engagement behavior in clinically referred home‐reared preschool children

Clinical effectiveness and cost-effectiveness of parenting interventions for children with severe attachment problems: a systematic review and meta-analysis

Maltreatment‐Associated Psychiatric Problems: An Example of Environmentally Triggered ESSENCE?

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