Reactive attachment disorder in maltreated toddlers.
OBJECTIVE
To determine if Reactive Attachment Disorder (RAD) can be reliably identified in maltreated toddlers in foster care, if the two types of RAD are independent, and to estimate the prevalence of RAD in these maltreated toddlers.


METHODS
Clinicians treating 94 maltreated toddlers in foster care were interviewed regarding signs of attachment disorder at intake in an intervention program.


RESULTS
Using categorical and continuous measures, both types of RAD can be reliably identified in maltreated toddlers. Both continuous scores and categorical diagnoses indicated that a substantial minority of maltreated young children do exhibit signs of attachment disorders sufficient to meet criteria in DSM-IV and ICD-10. The two types were moderately convergent and at times co-occurred in the same child. Prevalence of RAD in this high-risk sample was 38-40%. Indiscriminate/disinhibited RAD was identified in children with and without an attachment figure. Within this maltreated group, toddlers whose mothers had a history of psychiatric disturbance were more likely to be diagnosed with attachment disorders.


CONCLUSIONS
RAD may be reliably identified in maltreated toddlers. Emotionally withdrawn/inhibited and indiscriminate/disinhibited types of RAD are not entirely independent.
Zeanah
Charles H
CH
Institute of Infant and Early Childhood Mental Health, Tulane University Health Sciences Center, 1440 Canal Street TB-52, New Orleans, LA 70112, USA.
Scheeringa
Michael
M
Boris
Neil W
NW
Heller
Sherryl S
SS
Smyke
Anna T
AT
Trapani
Jennifer
J
D000328:Adult; D002649:Child Abuse / Q000175:diagnosis* / Q000523:psychology; D016241:Child of Impaired Parents / Q000523:psychology; D002675:Child, Preschool; D016000:Cluster Analysis; D039721:Diagnostic and Statistical Manual of Mental Disorders; D005260:Female; D005581:Foster Home Care; D006801:Humans; D007223:Infant; D038801:International Classification of Diseases; D007407:Interviews as Topic; D008145:Louisiana / Q000453:epidemiology; D008297:Male; D008425:Maternal Behavior / Q000523:psychology*; D001523:Mental Disorders / Q000523:psychology; D015995:Prevalence; D019962:Reactive Attachment Disorder / Q000175:diagnosis* / Q000453:epidemiology