Social relationship difficulties in autism and reactive attachment disorder: Improving diagnostic validity through structured assessment

Davidson, Claire; O’Hare, Anne; Mactaggart, Fiona; Green, Jonathan; Young, David; Gillberg, Christopher; Minnis, Helen

doi:10.1016/j.ridd.2015.01.007

Cited by 61 publications

(89 citation statements)

References 42 publications

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“…The presence of developmental delays or co-occurring diagnoses, such as ADHD, in addition to ASD symptoms may add complexity to the diagnostic assessment process. Another important consideration is exposure to trauma and attachment disorder; a history suggestive of these problems should prompt the assessor to consider the overlap in presentation between attachment disorders and ASD and seek out expertise as needed 203204205. Given these complexities, cognitive and language assessments and consideration of comorbid emotional behavioral disorders are recommended for all patients with ASD.…”

Section: Additional Elements Of Asd Assessmentmentioning

confidence: 99%

Autism spectrum disorder: advances in diagnosis and evaluation

Zwaigenbaum

Penner

2018

BMJ

192

137

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Autism spectrum disorder (ASD) has a variety of causes, and its clinical expression is generally associated with substantial disability throughout the lifespan. Recent advances have led to earlier diagnosis, and deep phenotyping efforts focused on high risk infants have helped advance the characterization of early behavioral trajectories. Moreover, biomarkers that measure early structural and functional connectivity, visual orienting, and other biological processes have shown promise in detecting the risk of autism spectrum disorder even before the emergence of overt behavioral symptoms. Despite these advances, the mean age of diagnosis is still 4-5 years. Because of the broad consistency in published guidelines, parameters for high quality comprehensive assessments are available; however, such models are resource intensive and high demand can result in greatly increased waiting times. This review describes advances in detecting early behavioral and biological markers, current options and controversies in screening for the disorder, and best practice in its diagnostic evaluation including emerging data on innovative service models.

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Section: Additional Elements Of Asd Assessmentmentioning

confidence: 99%

Autism spectrum disorder: advances in diagnosis and evaluation

Zwaigenbaum

Penner

2018

BMJ

192

137

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“…In previously institution‐reared children, DSEB was associated not only with inattention/hyperactivity and conduct problems, but also with autism‐like behavior and problems in peer interaction (Rutter et al., ). Clinically, the differentiation between DSED and Autism Spectrum Disorder (ASD) is of interest given that both disorders entail problematic social behaviors (Davidson et al., ). It was shown that while symptoms of DSED and ASD co‐occurred in some children, manifestation of DSEB was independent from symptoms of ASD in children with mild intellectual disability, who were referred for psychiatric evaluation (Giltaij, Sterkenburg, & Schuengel, ).…”

Section: Introductionmentioning

confidence: 99%

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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“…However, there is good evidence that the assessment of neurodevelopmental and/or psychiatric disorders, including autism, is very challenging in the context of multiple and overlapping co-morbidities amongst children in care, which can arise from a range of interrelated factors including prenatal influences, early trauma and disrupted attachment (DeJong, 2010). The social difficulties that lie at the core of an autism spectrum diagnosis (American Psychiatric Association, 2013) can be misclassified in some cases where there is a history of attachment problems and related behavioural and cognitive difficulties (Davidson et al, 2015). Although differential and co-occuring diagnoses between reactive attachment disorder and/or disinhibited social engagement (for example) and autism is possible Autism spectrum diagnoses of looked-after children 101 (Mayes et al, 2016), there is also acknowledgement that sometimes the subtle nature of differences is very difficult to detect with current assessment measures (Davidson et al, 2015).…”

Section: Introductionmentioning

confidence: 99%

“…The social difficulties that lie at the core of an autism spectrum diagnosis (American Psychiatric Association, 2013) can be misclassified in some cases where there is a history of attachment problems and related behavioural and cognitive difficulties (Davidson et al, 2015). Although differential and co-occuring diagnoses between reactive attachment disorder and/or disinhibited social engagement (for example) and autism is possible Autism spectrum diagnoses of looked-after children 101 (Mayes et al, 2016), there is also acknowledgement that sometimes the subtle nature of differences is very difficult to detect with current assessment measures (Davidson et al, 2015).…”

Section: Introductionmentioning

confidence: 99%

Awareness within local authorities in England of autism spectrum diagnoses of looked‐after children

Parsons

McCullen²,

Emery

et al. 2018

British Educational Res J

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Educational outcomes for looked‐after children on the autism spectrum are significantly poorer than for autistic children not being looked‐after by their local authority (those ‘in care’), and poorer than for most other groups of children with special educational needs who are looked‐after in England. Such poor outcomes have led to calls for specific attention to be paid to the needs of autistic looked‐after children within the care of local authorities. There is also evidence that the numbers of autistic children being looked‐after by local authorities could be under‐represented in official figures. This study sought to find the current numbers of autistic looked‐after children formally recorded across local authorities in England, and whether their needs are given special attention via strategic planning and oversight, using freedom of information (FoI) requests sent to all local authorities in England. From the 147 (97%) local authorities who responded, approximately 3% of looked‐after children in England are recorded as having an autism spectrum diagnosis, although this is still very likely to be an underestimation. The majority of local authorities do not routinely monitor or report on the diagnostic status of autistic looked‐after children at a strategic level. Implications for research and practice are discussed.

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Social relationship difficulties in autism and reactive attachment disorder: Improving diagnostic validity through structured assessment

Cited by 61 publications

References 42 publications

Autism spectrum disorder: advances in diagnosis and evaluation

Autism spectrum disorder: advances in diagnosis and evaluation

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

Awareness within local authorities in England of autism spectrum diagnoses of looked‐after children

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