Social relationship difficulties in autism and reactive attachment disorder: improving diagnostic validity through structured assessment

Davidson, C., O’Hare, A., Mactaggart, F., Green, J., Young, D., Gillberg, C. and Minnis, H. (2015) Social relationship difficulties in autism and reactive attachment disorder: improving diagnostic validity through structured assessment. Research in Developmental Disabilities, 40, pp. 63-72. (doi:10.1016/j.ridd.2015.01.007)

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Abstract

Background: Autism Spectrum Disorder (ASD) versus Reactive Attachment Disorder (RAD) is a common diagnostic challenge for clinicians due to overlapping difficulties with social relationships. RAD is associated with neglect or maltreatment whereas ASD is not: accurate differential diagnosis is therefore critical. Very little research has investigated the relationship between the two, and it is unknown if standardised measures are able to discriminate between ASD and RAD. The current study aimed to address these issues.<p></p> Methods: Fifty eight children with ASD, and no history of maltreatment, were group matched on age with 67 children with RAD. Group profiles on multi-informant measures of RAD were investigated and group differences explored. Discriminant function analysis determined assessment features that best discriminated between the two groups.<p></p> Results: Although, according to parent report, children with ASD presented with significantly fewer indiscriminate friendliness behaviours compared to the RAD group (p < 0.001), 36 children with ASD appeared to meet core RAD criteria. However, structured observation clearly demonstrated that features were indicative of ASD and not RAD for all but 1 of these 36 children.<p></p> Conclusions: Children with RAD and children with ASD may demonstrate similar social relationship difficulties but there appears to be a difference in the social quality of the interactions between the groups. In most cases it was possible to differentiate between children with ASD and children with RAD via structured observation. Nevertheless, for a small proportion of children with ASD, particularly those whose difficulties may be more subtle, our current standardised measures, including structured observation, may not be effective in differentiating RAD from ASD.<p></p>

Item Type:Articles
Status:Published
Refereed:Yes
Glasgow Author(s) Enlighten ID:Gillberg, Professor Christopher and Minnis, Professor Helen and Davidson, Miss Claire
Authors: Davidson, C., O’Hare, A., Mactaggart, F., Green, J., Young, D., Gillberg, C., and Minnis, H.
College/School:College of Medical Veterinary and Life Sciences > Institute of Health and Wellbeing > Mental Health and Wellbeing
Journal Name:Research in Developmental Disabilities
Publisher:Elsevier Ltd.
ISSN:0891-4222
ISSN (Online):1873-3379
Published Online:06 March 2015

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Project CodeAward NoProject NamePrincipal InvestigatorFunder's NameFunder RefLead Dept
535661Do Children with Autism have symptoms suggestive of reactive attachment disorder?Helen MinnisScottish Executive Health Department (SEHHD-CSO)CZH/4/651IHW - MENTAL HEALTH & WELLBEING