Institute of Brain, Behaviour and Mental Health, Room 4.321, Fourth Floor (East), University of Manchester, Jean McFarlane Building, Oxford Road, Manchester, UK M13 9PL.
J Abnorm Child Psychol. 2013 May;41(4):571-81. doi: 10.1007/s10802-012-9705-9.
Reactive Attachment Disorder (RAD) remains one of the least evidence-based areas of DSM and ICD nosology. Recent evidence from severely deprived institutional samples has informed review of RAD criteria for DSM-V; however, this data is not necessarily generalizable to expectable child environments in the developed world. We provide the first systematic study of this important syndrome in maltreated non-institutionalized adolescents from a high-income country. 153 high-risk adolescents in English out-of-home Looked After Care (LAC: mean age 174 months, SD 23, 52 % male) and 42 low-risk (LR) community controls (mean age 168 months, SD 18, 38 % male) were assessed for RAD behaviors. Data on maltreatment and care history were collected from social work reports and concurrent psychopathology from caregiver report. Triangulated data sources informed independent researcher ratings of adaptive functioning. LAC adolescents showed high prevalence of RAD behaviors. Factor analysis showed four symptom groups; Disinhibited Indiscriminate, Attention Seeking, Superficial Relationships and Unpredictability. RAD was associated with multiple maltreatment experience, earlier entry to care and increased rates of psychopathology. Superficial Relationships and Attention Seeking factors showed strong independent association with particularly pervasive functional impairment. Disinhibited RAD behaviors are identifiable with high prevalence in non-institutionalized high-risk adolescents. They are strongly associated with psychopathology and functional impairment. Retention of this subtype in DSM-V is supported. Findings on the inhibited subtype in adolescence are less persuasive. RAD behavior is a relevant marker of developmental impairment, has significant clinical implications and is deserving of further study within non-institutionalized risk populations.
反应性依附障碍（RAD）仍然是 DSM 和 ICD 分类中最缺乏证据支持的领域之一。最近，来自严重剥夺机构样本的证据为 DSM-V 的 RAD 标准审查提供了信息；然而，这些数据不一定适用于发达国家可预期的儿童环境。我们首次在一个高收入国家对受虐待的非机构化青少年中的这种重要综合征进行了系统研究。153 名高危青少年在英语寄宿照护中（平均年龄 174 个月，标准差 23，52%为男性）和 42 名低危（LR）社区对照组（平均年龄 168 个月，标准差 18，38%为男性）接受了 RAD 行为评估。虐待和照顾史的数据来自社会工作报告，同期的精神病学数据来自照顾者报告。三角化的数据来源为适应功能的独立研究者评分提供了信息。寄宿照护中的青少年表现出高比例的 RAD 行为。因子分析显示出四个症状群：脱抑制无差别、寻求注意、表面关系和不可预测性。RAD 与多种虐待经历、更早进入照顾和更高的精神病理学发生率有关。表面关系和寻求注意因素与特别普遍的功能障碍有强烈的独立关联。脱抑制 RAD 行为在非机构化的高风险青少年中具有高患病率。它们与精神病理学和功能障碍有很强的关联。DSM-V 保留这种亚型是有支持的。关于青少年中抑制型的发现则不太有说服力。RAD 行为是发育障碍的一个相关标志物，具有重要的临床意义，值得在非机构化风险人群中进一步研究。
