title: Autism and reactive attachment/disinhibited social engagement disorders: Co-occurrence and differentiation.
abstract: DSM-5 ( Diagnostic and Statistical Manual of Mental Disorders, 5th edition) Reactive Attachment Disorder (RAD) and Disinhibited Social Engagement Disorder (DSED) are rare disorders sharing social difficulties with autism. The DSM-5 and ICD-10 (International Classification of Diseases, 10th revsion) state that RAD/DSED should not be diagnosed in children with autism. The purpose of our study is to determine whether children can meet criteria for both autism and RAD/DSED and to identify specific symptoms discriminating the disorders. Subjects were 486 children with autism and no RAD/DSED and 20 with RAD/DSED, 4-17 years of age. In total, 13 children with RAD/DSED met criteria for autism. Using the Checklist for Autism Spectrum Disorder (CASD), there was no overlap in total scores between the RAD/DSED with autism group (score range = 15-27) versus the RAD/DSED without autism group (range = 7-10 ). The autism with and without RAD/DSED groups did not differ in CASD scores. Nine of the CASD autism symptoms were found only in the autism with and without RAD/DSED groups. Our study demonstrates that children can meet criteria for both autism and RAD/DSED and that the disorders are easily differentiated by the presence of specific autism symptoms. Autism is a neurogenetic disorder, and RAD/DSED results from severe social-emotional maltreatment. Given the different etiologies, there is no reason why a child cannot have both disorders.
authors.affiliation: Department of Psychiatry (H073), Penn State College of Medicine, Penn State Health Milton S. Hershey Medical Center, USA.
authors.forename: Susan Dickerson
authors.initials: SD
authors.lastname: Mayes
authors.affiliation: Department of Psychiatry (H073), Penn State College of Medicine, Penn State Health Milton S. Hershey Medical Center, USA.
authors.forename: Susan L
authors.initials: SL
authors.lastname: Calhoun
authors.affiliation: Department of Psychiatry (H073), Penn State College of Medicine, Penn State Health Milton S. Hershey Medical Center, USA.
authors.forename: Daniel A
authors.initials: DA
authors.lastname: Waschbusch
authors.affiliation: Department of Psychiatry (H073), Penn State College of Medicine, Penn State Health Milton S. Hershey Medical Center, USA.
authors.forename: Raman
authors.initials: R
authors.lastname: Baweja
mesh_terms: D000293:Adolescent; D000067877:Autism Spectrum Disorder / Q000175:diagnosis* / Q000453:epidemiology; D002648:Child; D002653:Child Behavior Disorders / Q000175:diagnosis* / Q000453:epidemiology; D002675:Child, Preschool; D015897:Comorbidity; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D008297:Male; D011569:Psychiatric Status Rating Scales; D019962:Reactive Attachment Disorder / Q000175:diagnosis* / Q000453:epidemiology; D012920:Social Behavior Disorders / Q000175:diagnosis* / Q000453:epidemiology
keywords: Reactive attachment disorder; autism; disinhibited social engagement disorder