A review of the scientific literature showed few valid tools for assessing reactive attachment disorder (RAD) and disinhibited social engagement disorder (DSED), two diagnostic entities traditionally grouped under “attachment disorders.” The Early TRAuma-related Disorders Questionnaire (ETRADQ), a caregiver report, was developed to assess attachment disorders in school-age children based on the Diagnostic and Statistical Manual of Mental Disorders–Fifth edition criteria. This study sought to validate this instrument.
Method:
Caregivers of school-age children from the community (n = 578) and caregivers of at-risk children adopted or in out-of-home care (n = 245) completed a sociodemographic questionnaire, the ETRADQ, the Relationship Problem Questionnaire, the RADA (RAD and DSED Assessment) interview, and the Barkley Functional Impairment Scale for Children and Adolescents.
Results:
Confirmatory factor analysis of the ETRADQ items supported the expected organization of the measure, that is, two second-order factors and five subfactors: (1) RAD scale (three subscales: Low selective attachment, Low social and emotional responsiveness, Emotional unpredictability) and (2) DSED scale (two subscales: Interactions with unfamiliar adults, Social disinhibition). All scales showed excellent internal consistency, test–retest reliability, convergent validity, and known-group validity.
Conclusions:
Results support the reliability and validity of the ETRADQ.
AllenB. (2018). Misperceptions of reactive attachment disorder persist: Poor methods and unsupported conclusions. Research in Developmental Disabilities, 77(June), 24-29. https://doi.org/10.1016/j.ridd.2018.03.012
2.
American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders (4th ed.). Author.
3.
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Author.
4.
AtkinsonL. (2019). Reactive attachment disorder and attachment theory from infancy to adolescence: Review, integration, and expansion. Attachment & Human Development, 21(2), 205-217. https://doi.org/10.1080/14616734.2018.1499214
5.
BarkleyR. A. (2012). Barkley Functional Impairment Scale for children and adolescents. Guildford Press.
6.
BlunchN. J. (2013). Introduction to structural equation modelling using SPSS and Amos. Sage.
7.
BorisN. W.ZeanahC. H.LarrieuJ. A.ScheeringaM. S.HellerS. (1998). Attachment disorders in infancy and early childhood: A preliminary investigation of diagnostic criteria. American Journal of Psychiatry, 155(2), 295-297. https://doi.org/10.1176/ajp.155.2.295
8.
BruceM.YoungD.TurnbullS.RooksbyM.ChadwickG.OatesC.NelsonR.Young-SouthwardG.HaigC.MinnisH. (2019). Reactive attachment disorder in maltreated young children in foster care. Attachment & Human Development, 21(2), 152-169. https://doi.org/10.1080/14616734.2018.1499211
9.
ByrneB. M.StewartS. M. (2006). Teacher’s Corner: The MACS approach to testing for multigroup invariance of a second-order Structure: A walk through the process. Structural Equation Modeling: A Multidisciplinary Journal, 13(2), 287–32. https://doi.org/10.1207/s15328007sem1302_7
10.
CadmanT.DiamondP. R.FearonP. (2018). Reassessing the validity of the Attachment Q-Sort: An updated meta-analysis. Infant and Child Development, 27(1), e2034. https://doi.org/10.1002/icd.2034
11.
ChenF. F.SousaK. H.WestS. G. (2005). Teacher’s corner: testing measurement invariance of second-order factor models. Structural Equation Modeling: A Multidisciplinary Journal, 12(3), 471–492. https://doi.org/10.1207/s15328007sem1203_7
12.
CorvalR.BelskyJ.BaptistaJ.MesquitaA.SoaresI. (2019). Development and validation of an observational measure of symptoms of reactive attachment disorder. Attachment & Human Development, 21(2), 111-131. https://doi.org/10.1080/14616734.2018.1499209
13.
DavidsonC.O’HareA.MactaggartF.GreenJ.YoungD.GillbergC.MinnisH. (2015). Social relationship difficulties in autism and reactive attachment disorder: Improving diagnostic validity through structured assessment. Research in Developmental Disabilities, 40(May), 63-72. https://doi.org/10.1016/j.ridd.2015.01.007
Dobrova-KrolN. A.Bakermans-KranenburgM. J.van IjzendoornM. H.JufferF. (2010). The importance of quality of care: Effects of perinatal HIV infection and early institutional rearing on preschoolers’ attachment and indiscriminate friendliness. Journal of Child Psychology and Psychiatry, 51(12), 1368-1376. https://doi.org/10.1111/j.1469-7610.2010.02243.x
16.
EndersC. K. (2001). A primer on maximum likelihood algorithms available for use with missing data. Structural Equation Modeling, 8(1), 128-141. https://doi.org/10.1207/S15328007SEM0801_7
17.
GleasonM. M.FoxN. A.DruryS. S.SmykeA. T.NelsonC. A.ZeanahC. H. (2014). Indiscriminate behaviors in previously institutionalized young children. Pediatrics, 133(3), e657-e665. https://doi.org/10.1542/peds.2013-0212
18.
HallS. E. K.GeherG. (2003). Behavioral and personality characteristics of children with reactive attachment disorder. Journal of Psychology, 137(2), 145-162. https://doi.org/10.1080/00223980309600605
19.
HansonR. F.SprattE. G. (2000). Reactive attachment disorder: What we know about the disorder and implication for treatment. Child Maltreatment, 5(2), 137–145.
20.
HuL.BentlerP. M. (1999). Cutoff criteria for fit indexes in covariance structure analysis: Conventional criteria versus new alternatives. Structural Equation Modeling: A Multidisciplinary Journal, 6(1), 1-55. https://doi.org/10.1080/10705519909540118
21.
JacksonD. L.GillaspyJ. A.Purc-StephensonR. (2009). Reporting practices in confirmatory factor analysis: An overview and some recommendations. Psychological Methods, 14(1), 6-23. https://doi.org/10.1037/a0014694
JonkmanC. S.OostermanM.SchuengelC.BolleE. A.BoerF.LindauerR. J. (2014). Disturbances in attachment: Inhibited and disinhibited symptoms in foster children. Child and Adolescent Psychiatry and Mental Health, 8, Article 21. https://doi.org/10.1186/1753-2000-8-21
24.
KayC.GreenJ. (2013). Reactive attachment disorder following early maltreatment: Systematic evidence beyond the institution. Journal of Abnormal Child Psychology, 41(4), 571-581. https://doi.org/10.1007/s10802-012-9705-9
25.
KayC.GreenJ.SharmaK. (2016). Disinhibited attachment disorder in UK adopted children during middle childhood: Prevalence, validity and possible developmental origin. Journal of Abnormal Child Psychology, 44(7), 1375-1386. https://doi.org/10.1007/s10802-016-0131-2
26.
KazdinA. E. (1998). Research design in clinical psychology (3rd ed.). Allyn & Bacon.
27.
Kliewer-NeumannJ. D.ZimmermannJ.BovenschenI.GablerS.LangK.SpanglerG.NowackiK. (2018). Assessment of attachment disorder symptoms in foster children: Comparing diagnostic assessment tools. Child and Adolescent Psychiatry and Mental Health, 12, Article 43. https://doi.org/10.1186/s13034-018-0250-3
28.
KočovskáE.PuckeringC.FollanM.SmillieM.GorskiC.BarnesJ.WilsonP.YoungD.LidstoneE.PritchettR.HockdayH.MinnisH. (2012). Neurodevelopmental problems in maltreated children referred with indiscriminate friendliness. Research in Developmental Disabilities, 33(5), 1560-1565. https://doi.org/10.1016/j.ridd.2012.02.016
29.
LalandeC.CyrC.Dubois-ComtoisK.LosierV.PaquetteD.EmeryJ. (2014). Les comportements d’attachement indiscriminé chez les enfants de mères adolescentes: Étiologie et facteurs de risque [Indiscriminate attachment behavior among infants of adolescent mothers: Etiology and risk factors.]. Canadian Journal of Behavioural Science/Revue canadienne des sciences du comportement, 46(2), 73-83. https://doi.org/10.1037/a0027426
30.
LawlerJ. M.KossK. J.DoyleC. M.GunnarM. R. (2016). The course of early disinhibited social engagement among post-institutionalized adopted children. Journal of Child Psychology and Psychiatry, 57(10), 1126–1134. https://doi.org/10.1111/jcpp.12606
31.
LehmannS.BreivikK.HeiervangE. R.HavikT.HavikO. E. (2016). Reactive attachment disorder and disinhibited social engagement disorder in school-aged foster children: A confirmatory approach to dimensional measures. Journal of Abnormal Child Psychology, 44(3), 445-457. https://doi.org/10.1007/s10802-015-0045-4
32.
LehmannS.HavikO. E.HavikT.HeiervangE. R. (2013). Mental disorders in foster children: A study of prevalence, comorbidity and risk factors. Child and Adolescent Psychiatry and Mental Health, 7, Article 39. https://doi.org/10.1186/1753-2000-7-39
33.
LehmannS.MonetteS.EggerH.BreivikK.YoungD.DavidsonC.MinnisH. (2018). Development and examination of the reactive attachment disorder and disinhibited social engagement disorder assessment interview. Assessment, 27(4), 749-765. https://doi.org/10.1177/1073191118797422
34.
McLaughlinA.EspieC.MinnisH. (2010). Development of a brief waiting room observation for behaviours typical of reactive attachment disorder. Child and Adolescent Mental Health, 15(2), 73-79. https://doi.org/10.1111/j.1475-3588.2009.00549.x
35.
MinnisH.GreenJ.O’ConnorT. G.LiewA.GlaserD.TaylorE.FollanM.YoungD.BarnesJ.GilbergC.PelosiA.ArthurJ.BurstonA.SadiqF. A. (2009). An exploratory study of the association between reactive attachment disorder and attachment narratives in early school-age children. Journal of Child Psychology and Psychiatry, 50(8), 931-942. https://doi.org/10.1111/j.1469-7610.2009.02075.x
36.
MinnisH.MacmillanS.PritchettR.YoungD.WallaceB.ButcherJ.SimF.BaynhamK.DavidsonC.GillbergC. (2013). Prevalence of reactive attachment disorder in a deprived population. British Journal of Psychiatry, 202(5), 342-346. https://doi.org/10.1192/bjp.bp.112.114074
37.
MinnisH.Rabe-HeskethS.WolkindS. (2002). Development of a brief, clinically relevant, scale for measuring attachment disorders. International Journal of Methods in Psychiatric Research, 11(2), 90-98. https://doi.org/10.1002/mpr.127
38.
MüllerJ. M.FurnissT. (2013). Correction of distortions in distressed mothers’ ratings of their preschool children’s psychopathology. Psychiatry Research, 210(1), 294-301. https://doi.org/10.1016/j.psychres.2013.03.025
OostermanM.SchuengelC. (2008). Attachment in foster children associated with caregivers’ sensitivity and behavioral problems. Infant Mental Health Journal, 29(6), 609-623. https://doi.org/10.1002/imhj.20198
42.
PearsK. C.BruceJ.FisherP. A.KimH. K. (2010). Indiscriminate friendliness in maltreated foster children. Child Maltreatment, 15(1), 64-75. https://doi.org/10.1177/1077559509337891
43.
PutnickD. L.BornsteinM. H. (2016). Measurement invariance conventions and reporting: The state of the art and future directions for psychological research. Developmental Review, 41(September), 71-90. https://doi.org/10.1016/j.dr.2016.06.004
44.
RandolphE. M. (2000). Manual for the Randolph Attachment Disorder Questionnaire (3rd ed.). Attachment Center Press.
45.
RingootA. P.van der EndeJ.JansenP. W.MeaselleJ. R.BastenM.SoP.JaddoeV. W. V.HofmanA.VerhulstF. C.TiemeierH. (2015). Why mothers and young children agree or disagree in their reports of the child’s problem behavior. Child Psychiatry & Human Development, 46(6), 913-927. https://doi.org/10.1007/s10578-014-0531-x
SeimA. R.JozefiakT.WichstrømL.KayedN. S. (2019). Validity of reactive attachment disorder and disinhibited social engagement disorder in adolescence. European Child & Adolescent Psychiatry. https://doi.org/10.1007/s00787-019-01456-9
48.
SmykeA. T.DumitrescuA.ZeanahC. H. (2002). Attachment disturbances in young children. I: The continuum of caretaking casualty. Journal of the American Academy of Child & Adolescent Psychiatry, 41(8), 972-982. https://doi.org/10.1097/00004583-200208000-00016
49.
Sonuga-BarkeE. J. S.KennedyM.KumstaR.KnightsN.GolmD.RutterM.MaughanB.SchlotzW.KreppnerJ. (2017). Child-to-adult neurodevelopmental and mental health trajectories after early life deprivation: The young adult follow-up of the longitudinal English and Romanian Adoptees study. Lancet, 389(10078), 1539-1548. https://doi.org/10.1016/S0140-6736(17)30045-4
50.
van IjzendoornM. H.VereijkenC. M. J. L.Bakermans-KranenburgM. J.Riksen-WalravenJ. M. (2004). Assessing attachment security with the Attachment Q Sort: Meta-analytic evidence for the validity of the observer AQS. Child Development, 75(4), 1188-1213. https://doi.org/10.1111/j.1467-8624.2004.00733.x
51.
VervoortE.De SchipperJ.BosmansG.VerschuerenK. (2013). Screening symptoms of reactive attachment disorder: Evidence for measurement invariance and convergent validity. International Journal of Methods in Psychiatric Research, 22(3), 256-265. https://doi.org/10.1002/mpr.1395
52.
WestS. G.TaylorA. B.WuW. (2012). Model fit and model selection in structural equation modeling. In HoyleR. H. (Ed.), Handbook of structural equation modeling (pp. 209-231). Guilford Press.
53.
WoolgarM.BaldockE. (2015). Attachment disorders versus more common problems in looked after and adopted children: Comparing community and expert assessments. Child and Adolescent Mental Health, 20(1), 34-40. https://doi.org/10.1111/camh.12052
54.
World Health Organization. (1992). ICD-10 classification of mental and behavioural disorders: Clinical descriptions and diagnostic guidelines. Author.
55.
ZeanahC. H.ChesherT.BorisN. W.WalterH. J.BuksteinO. G.BellonciC.BensonR. C.BussingR.ChrismanA.HamiltonJ.HayekM.KeableH.RockhillC.SiegelM.StockS. (2016). Practice parameter for the assessment and treatment of children and adolescents with reactive attachment disorder and disinhibited social engagement disorder. Journal of the American Academy of Child & Adolescent Psychiatry, 55(11), 990-1003. https://doi.org/10.1016/j.jaac.2016.08.004
56.
ZeanahC. H.GleasonM. M. (2015). Annual research review: Attachment disorders in early childhood—clinical presentation, causes, correlates, and treatment. Journal of Child Psychology and Psychiatry, 56(3), 207-222. https://doi.org/10.1111/jcpp.12347
57.
ZeanahC. H.HumphreysK. L.FoxN. A.NelsonC. A. (2017). Alternatives for abandoned children: Insights from the Bucharest Early Intervention Project. Current Opinion in Psychology, 15(June), 182-188. https://doi.org/10.1016/j.copsyc.2017.02.024
ZimmermannP.IwanskiA. (2019). Attachment disorder behavior in early and middle childhood: Associations with children’s self-concept and observed signs of negative internal working models. Attachment & Human Development, 21(2), 170-189. https://doi.org/10.1080/14616734.2018.1499212
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