Abstract
Objective: A comprehensive approach is needed for diagnosing disordered attachment behavior due to the multifaceted nature of attachment. Differences between various indicators can pose a challenge for deciding on the proper diagnosis. This study assessed the convergence between clinical interview assessment and observation-based clinical diagnosis, and their linkages with inadequate care. Method: Participating children (N = 55) had intelligence quotients (IQs) between 50 and 85 and were referred for psychiatric consultation. Data were obtained by structured review of medical records, the Disturbances of Attachment Interview (DAI), and the Clinical Observation of Attachment (COA) procedure. Results: Of the 18 children identified using the DAI with Diagnostic and Statistical Manual of Mental Disorders–Fifth Edition (DSM-5) diagnosis of reactive attachment disorder (RAD) and/or disinhibited social engagement disorder (DSED), only 7 received a clinical DSM-5 diagnosis of RAD and/or DSED. Observed maladaptive attachment behavior in the COA was strongly associated with DAI scores and with clinical diagnosis of DSM-5 RAD and/or DSED. There was a significantly higher prevalence of extremes of insufficient care in children who were classified with RAD by DAI or DSM-5 and/or with DSED by DSM-5 compared to those with no attachment disorder. Conclusions: Using structured observation and record assessment leads to more conservative identification of RAD or DSED than using the DAI.
| Original language | English |
|---|---|
| Pages (from-to) | 603-619 |
| Number of pages | 17 |
| Journal | Clinical Child Psychology and Psychiatry |
| Volume | 22 |
| Issue number | 4 |
| DOIs | |
| Publication status | Published - 1 Oct 2017 |
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Keywords
- assessment
- Attachment
- disinhibited social engagement disorder (DSED)
- low average intellectual functioning
- reactive attachment disorder (RAD)
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Convergence between observations and interviews in clinical diagnosis of reactive attachment disorder and disinhibited social engagement disorder. / Giltaij, Hans Peter; Sterkenburg, Paula Sophia; Schuengel, Carlo.
In: Clinical Child Psychology and Psychiatry, Vol. 22, No. 4, 01.10.2017, p. 603-619.Research output: Contribution to Journal › Article › Academic › peer-review
TY - JOUR
T1 - Convergence between observations and interviews in clinical diagnosis of reactive attachment disorder and disinhibited social engagement disorder
AU - Giltaij, Hans Peter
AU - Sterkenburg, Paula Sophia
AU - Schuengel, Carlo
PY - 2017/10/1
Y1 - 2017/10/1
N2 - Objective: A comprehensive approach is needed for diagnosing disordered attachment behavior due to the multifaceted nature of attachment. Differences between various indicators can pose a challenge for deciding on the proper diagnosis. This study assessed the convergence between clinical interview assessment and observation-based clinical diagnosis, and their linkages with inadequate care. Method: Participating children (N = 55) had intelligence quotients (IQs) between 50 and 85 and were referred for psychiatric consultation. Data were obtained by structured review of medical records, the Disturbances of Attachment Interview (DAI), and the Clinical Observation of Attachment (COA) procedure. Results: Of the 18 children identified using the DAI with Diagnostic and Statistical Manual of Mental Disorders–Fifth Edition (DSM-5) diagnosis of reactive attachment disorder (RAD) and/or disinhibited social engagement disorder (DSED), only 7 received a clinical DSM-5 diagnosis of RAD and/or DSED. Observed maladaptive attachment behavior in the COA was strongly associated with DAI scores and with clinical diagnosis of DSM-5 RAD and/or DSED. There was a significantly higher prevalence of extremes of insufficient care in children who were classified with RAD by DAI or DSM-5 and/or with DSED by DSM-5 compared to those with no attachment disorder. Conclusions: Using structured observation and record assessment leads to more conservative identification of RAD or DSED than using the DAI.
AB - Objective: A comprehensive approach is needed for diagnosing disordered attachment behavior due to the multifaceted nature of attachment. Differences between various indicators can pose a challenge for deciding on the proper diagnosis. This study assessed the convergence between clinical interview assessment and observation-based clinical diagnosis, and their linkages with inadequate care. Method: Participating children (N = 55) had intelligence quotients (IQs) between 50 and 85 and were referred for psychiatric consultation. Data were obtained by structured review of medical records, the Disturbances of Attachment Interview (DAI), and the Clinical Observation of Attachment (COA) procedure. Results: Of the 18 children identified using the DAI with Diagnostic and Statistical Manual of Mental Disorders–Fifth Edition (DSM-5) diagnosis of reactive attachment disorder (RAD) and/or disinhibited social engagement disorder (DSED), only 7 received a clinical DSM-5 diagnosis of RAD and/or DSED. Observed maladaptive attachment behavior in the COA was strongly associated with DAI scores and with clinical diagnosis of DSM-5 RAD and/or DSED. There was a significantly higher prevalence of extremes of insufficient care in children who were classified with RAD by DAI or DSM-5 and/or with DSED by DSM-5 compared to those with no attachment disorder. Conclusions: Using structured observation and record assessment leads to more conservative identification of RAD or DSED than using the DAI.
KW - assessment
KW - Attachment
KW - disinhibited social engagement disorder (DSED)
KW - low average intellectual functioning
KW - reactive attachment disorder (RAD)
UR - http://www.scopus.com/inward/record.url?scp=85031411307&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85031411307&partnerID=8YFLogxK
U2 - 10.1177/1359104517709049
DO - 10.1177/1359104517709049
M3 - Article
VL - 22
SP - 603
EP - 619
JO - Clinical Child Psychology and Psychiatry
JF - Clinical Child Psychology and Psychiatry
SN - 1359-1045
IS - 4
ER -