Center for the Protection of Children, Penn State Children's Hospital, Hershey, PA, USA.
Departments of Pediatrics and Psychiatry, Penn State College of Medicine, Hershey, PA, USA.
Child Adolesc Ment Health. 2020 Feb;25(1):4-10. doi: 10.1111/camh.12338. Epub 2019 Jun 27.
While considered a rare diagnosis, reactive attachment disorder (RAD) is simultaneously the subject of considerable debate. A recent report suggested that RAD is overdiagnosed in community settings and that conduct problems may be used to make a diagnosis of RAD (Woolgar & Baldock, Child and Adolescent Mental Health, 20, 2015, 34-40). This study seeks to replicate and extend these findings.
Clinical assessment data from 100 consecutive admissions of maltreated foster and adopted children (ages 3-17) to a specialty treatment clinic in the United States were reviewed. Measures included semi-structured interviews of RAD and disinhibited social engagement disorder (DSED) symptoms and caregiver-report questionnaires of emotional problems, conduct problems, and the quality of the parent-child relationship.
Of the 100 cases reviewed, 39 presented with a diagnostic history of RAD, DSED, or 'attachment disorder'. Of these cases, three were diagnosed in-clinic with DSED; no cases met diagnostic criteria for RAD according to DSM-5 criteria. However, analyses found that those diagnosed with RAD by community-based clinicians were significantly more likely to display conduct problems and to be adopted (as opposed to in foster care).
These findings confirm those of Woolgar and Baldock (Child and Adolescent Mental Health, 20, 2015, 34-40). It appears that the diagnostic criteria of RAD are commonly being inaccurately applied in general community-based practice. Clarification of diagnostic criteria for RAD in recent revisions of diagnostic taxonomies, the accumulation of empirical data on RAD, and improved instrumentation are either poorly disseminated or inadequately implemented in community-based practice settings.
尽管被认为是一种罕见的诊断，但反应性依恋障碍（RAD）同时也是相当有争议的话题。最近的一份报告表明，RAD 在社区环境中被过度诊断，而行为问题可能被用来诊断 RAD（Woolgar & Baldock，儿童和青少年心理健康，20，2015，34-40）。本研究旨在复制和扩展这些发现。
对美国一家专业治疗诊所收治的 100 名受虐待寄养和收养儿童（3-17 岁）的临床评估数据进行了回顾。评估工具包括 RAD 和去抑制性社会参与障碍（DSED）症状的半结构化访谈，以及情绪问题、行为问题和亲子关系质量的照顾者报告问卷。
在回顾的 100 例病例中，39 例有 RAD、DSED 或“依恋障碍”的诊断史。这些病例中，有 3 例在诊所被诊断为 DSED；根据 DSM-5 标准，没有病例符合 RAD 的诊断标准。然而，分析发现，那些被社区临床医生诊断为 RAD 的儿童更有可能表现出行为问题和被收养（而不是寄养）。
这些发现证实了 Woolgar 和 Baldock 的研究结果（儿童和青少年心理健康，20，2015，34-40）。RAD 的诊断标准似乎在一般的社区实践中被不准确地应用。最近修订的诊断分类学中对 RAD 诊断标准的澄清、RAD 的实证数据的积累以及改进的诊断工具，在社区实践环境中的传播或实施情况较差或不充分。
