title: Social relationship difficulties in autism and reactive attachment disorder: Improving diagnostic validity through structured assessment.
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.
  
  
  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.
  
  
  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.
  
  
  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.
authors.affiliation: Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK. Electronic address: claire.davidson@glasgow.ac.uk.
authors.forename: Claire
authors.initials: C
authors.lastname: Davidson
authors.affiliation: Department of Child Life and Health, University of Edinburgh, Edinburgh, UK. Electronic address: aohare@ed.ac.uk.
authors.forename: Anne
authors.initials: A
authors.lastname: O'Hare
authors.affiliation: Edinburgh Connect and North Edinburgh Team, Child and Adolescent Mental Health Service, North Edinburgh Team, Edinburgh, UK. Electronic address: Fiona.Mactaggart@nhslothian.scot.nhs.uk.
authors.forename: Fiona
authors.initials: F
authors.lastname: Mactaggart
authors.affiliation: Institute of Brain, Behaviour and Mental Health, University of Manchester, Manchester, UK. Electronic address: Jonathan.Green@manchester.co.uk.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Green
authors.affiliation: Department of Mathematics and Statistics, Strathclyde University, Glasgow, UK. Electronic address: David.Young@strath.ac.uk.
authors.forename: David
authors.initials: D
authors.lastname: Young
authors.affiliation: Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK; Gillberg Neuropsychiatry Centre, University of Gothenburg, Gothenburg, Sweden. Electronic address: christopher.gillberg@gnc.gu.se.
authors.forename: Christopher
authors.initials: C
authors.lastname: Gillberg
authors.affiliation: Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK.
authors.forename: Helen
authors.initials: H
authors.lastname: Minnis
mesh_terms: D000067877:Autism Spectrum Disorder / Q000175:diagnosis / Q000523:psychology; D001321:Autistic Disorder / Q000175:diagnosis / Q000523:psychology*; D002648:Child; D002675:Child, Preschool; D016002:Discriminant Analysis; D005260:Female; D006801:Humans; D007398:Interpersonal Relations; D008297:Male; D019962:Reactive Attachment Disorder / Q000175:diagnosis / Q000523:psychology*; D015203:Reproducibility of Results; D012919:Social Behavior; D066107:Social Skills
keywords: Autism spectrum disorder; Differential diagnosis; Indiscriminate friendliness; Observation; Reactive attachment disorder; Social relationships