Validity of reactive attachment disorder and disinhibited social engagement disorder in adolescence
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ORIGINAL CONTRIBUTION
Validity of reactive attachment disorder and disinhibited social engagement disorder in adolescence Astrid R. Seim1,2 · Thomas Jozefiak2 · Lars Wichstrøm3 · Nanna S. Kayed2 Accepted: 4 December 2019 © The Author(s) 2019
Abstract Although reactive attachment disorder (RAD) and disinhibited social engagement disorder (DSED) are acknowledged as valid disorders in young children, controversy remains regarding their validity in adolescence. An unresolved question is whether symptoms of RAD and DSED are better conceptualized as other psychiatric disorders at this age. All adolescents (N = 381; 67% consent; 12–20 years old) living in residential youth care in Norway were interviewed to determine the symptoms and diagnosis of RAD/DSED and other common psychiatric disorders using the Child and Adolescent Psychiatric Assessment (CAPA). The construct validity of RAD and DSED, including structural and discriminant validity, was investigated using confirmatory factor analysis and latent profile analysis. Two-factor models distinguishing between symptoms of RAD and DSED and differentiating these symptoms from the symptoms of other psychiatric disorders revealed better fit than one-factor models. Symptoms of RAD and DSED defined two distinct latent groups in a profile analysis. The prevalence of RAD was 9% (95% CI 6–11%), and the prevalence of DSED was 8% (95% CI 5–11%). RAD and DSED are two distinct latent factors not accounted for by other common psychiatric disorders in adolescence. RAD and DSED are not uncommon among adolescents in residential youth care and therefore warrant easy access to qualified health care and prevention in high-risk groups. Keywords Adolescence · Reactive attachment disorder · Disinhibited social engagement disorder · Mental health · Residential youth care · Validity
Introduction Reactive attachment disorder (RAD) and disinhibited social engagement disorder (DSED) are socially disabling disorders caused by insufficient care, such as social neglect, deprivation or limited opportunity to form stable and selective attachments to caregivers [1]. Although research on these disorders has increased considerably in Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00787-019-01456-9) contains supplementary material, which is available to authorized users. * Astrid R. Seim [email protected] 1
Division of Mental Healthcare, Department of Children and Youth, St. Olavs Hospital, Trondheim, Norway
2
Department of Mental Health, Faculty of Medicine and Health Sciences, NTNU Norwegian University of Science and Technology, Trondheim, Norway
3
Department of Psychology, NTNU, Trondheim, Norway
recent years [2, 3], RAD and DSED remain among the least studied and most poorly understood psychiatric disorders in the Diagnostic and Statistical Manual of Mental Disorders (DSM) [4]. Further, most existing research examines young children, and the question of whether RAD and DSED diagnoses should be reserved for the youngest or w
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