Department of Psychiatry and Behavioral Sciences, Tulane University School of Medicine, 1440 Canal Street, New Orleans, LA 70112, USA.
J Am Acad Child Adolesc Psychiatry. 2011 Mar;50(3):216-231.e3. doi: 10.1016/j.jaac.2010.12.012. Epub 2011 Feb 1.
This study examined the validity of criteria for indiscriminately social/disinhibited and emotionally withdrawn/inhibited reactive attachment disorder (RAD).
As part of a longitudinal intervention trial of previously institutionalized children, caregiver interviews and direct observational measurements provided continuous and categorical data used to examine the internal consistency, criterion validity, construct validity, convergent and discriminant validity, association with functional impairment, and stability of these disorders over time.
As in other studies, the findings showed distinctions between the two types of RAD. Evidence-derived criteria for both types of RAD showed acceptable internal consistency and criterion validity. In this study, rates of indiscriminately social/disinhibited RAD at baseline and at 30, 42, and 54 months were 41/129 (31.8%), 22/122 (17.9%), 22/122 (18.0%), and 22/125 (17.6%), respectively. Signs of indiscriminately social/disinhibited RAD showed little association with caregiving quality. Nearly half of children with indiscriminately social/disinhibited RAD had organized attachment classifications. Signs of indiscriminately social/disinhibited RAD were associated with signs of activity/impulsivity and of attention-deficit/hyperactivity disorder and modestly with inhibitory control but were distinct from the diagnosis of attention-deficit/hyperactivity disorder. At baseline, 30, 42, and 54 months, 6/130 (4.6%), 4/123 (3.3%), 2/125 (1.6%), and 5/122 (4.1%) of children met criteria for emotionally withdrawn/inhibited RAD. Emotionally withdrawn/inhibited RAD was moderately associated with caregiving at the first three time points and strongly associated with attachment security. Signs of this type of RAD were associated with depressive symptoms, although two of the five children with this type of RAD at 54 months did not meet criteria for major depressive disorder. Signs of both types of RAD contributed independently to functional impairment and were stable over time.
Evidence-derived criteria for indiscriminately social/disinhibited and emotionally withdrawn/inhibited RAD define two statistically and clinically cohesive syndromes that are distinct from each other, shows stability over 2 years, have predictable associations with risk factors and attachment, can be distinguished from other psychiatric disorders, and cause functional impairment.
本研究检验了无辨别社交/去抑制型和情绪退缩/抑制型反应性依恋障碍（RAD）的诊断标准的有效性。
作为对先前被收容儿童进行的一项纵向干预试验的一部分，对照顾者进行访谈和直接观察测量，提供了连续和分类数据，用于检查这些障碍的内部一致性、效标效度、结构效度、聚合效度和区分效度、与功能障碍的相关性以及随时间的稳定性。
与其他研究一样，研究结果显示出两种类型的 RAD 之间的区别。两种类型的 RAD 的证据衍生标准均显示出可接受的内部一致性和效标效度。在这项研究中，基线时以及 30、42 和 54 个月时无辨别社交/去抑制型 RAD 的发生率分别为 41/129（31.8%）、22/122（17.9%）、22/122（18.0%）和 22/125（17.6%）。无辨别社交/去抑制型 RAD 的迹象与照顾质量几乎没有关联。近一半有无辨别社交/去抑制型 RAD 的儿童有组织的依恋分类。无辨别社交/去抑制型 RAD 的迹象与活动/冲动和注意缺陷/多动障碍的迹象相关，与抑制控制的相关性适度，但与注意缺陷/多动障碍的诊断不同。在基线时、30 个月、42 个月和 54 个月时，分别有 6/130（4.6%）、4/123（3.3%）、2/125（1.6%）和 5/122（4.1%）的儿童符合情绪退缩/抑制型 RAD 的标准。情绪退缩/抑制型 RAD 与前三个时间点的照顾中度相关，与依恋安全性强相关。这种类型的 RAD 的迹象与抑郁症状相关，尽管在 54 个月时有 5 名儿童中的 2 名患有这种类型的 RAD，但不符合重度抑郁症的标准。两种类型的 RAD 的迹象都独立地导致了功能障碍，并且随着时间的推移是稳定的。
无辨别社交/去抑制型和情绪退缩/抑制型 RAD 的证据衍生标准定义了两个在统计学和临床上相互一致的综合征，它们彼此不同，在 2 年内具有稳定性，与风险因素和依恋有可预测的关联，可以与其他精神障碍区分开来，并导致功能障碍。
