Development and validation of an observational measure of symptoms of Reactive Attachment Disorder

ABSTRACT

Reactive Attachment Disorder (RAD) is presumed to be a consequence of social neglect and deprivation of the kind particularly associated with institutional care. Despite its clinical relevance there is a lack of assessment tools for RAD based on the direct observation of child–caregiver interaction.

Here we describe the development and validation of such a tool for use with preschool children, the Rating of Inhibited Attachment Disordered Behavior (RInAB). The RInAB is composed of 17 ratings grouped in three subscales assessing (1) Attachment, (2) Exploratory, and (3) Socioemotional behavior.

Participants were 134 institutionalized preschool children (M = 54.84 months; SD = 10.83; 60% boys) and their caregivers.

Adequate reliability was found for RInAB subscales and total score. Confirmatory factor analyses documented the three aforementioned RInAB subscales. Correlational analyses documented: (i) construct validity via positive and significant associations with caregiver sensitivity and quality of child–caregiver relationship; (ii) convergence validity via association evidence with some emotionally/withdrawn inhibited items of the Disturbed Attachment Interview (DAI), as well as, with Child Behavior Checklist (CBCL)’s somatic complaints and withdraw syndrome scales; and (iii) discriminant validity via nonsignificant or negative associations with DAI-indiscriminate subscale, Rating of Infant and Stranger Engagement (RISE) and CBCL-externalizing problems. Discussion highlights the contributions complementary roles of RInAB for a comprehensive assessment of child RAD-related functioning.

KEYWORDS:

• RAD
• institutionalization
• assessment
• observation
• preschoolers
• validation

Acknowledgments

This research was conducted at Psychology Research Centre (UID/PSI/01662/2013), University of Minho. The authors are very grateful to Elizabeth Carlson and Charles Zeanah for their important contributions to the development of the present observational measure. Also, the authors are thankful to the Koehler-Stiftung, Germany, (Grant number S112/10161/12) who supported the organization of three international workshops regarding assessment of inhibited attachment disorder. In addition, the authors acknowledge the collaboration of Inês Fachada (CIPsi) in the scale development, data collection and scoring observational data as well as Célia Moreira (CIPsi) for her helpful comments on data analyses. Finally, special thanks go to the children, caregivers, and other institutional staff, who made this study possible.

Additional information

Funding

This research was supported in part by the Fundação para a Ciência e a Tecnologia through national funds, under grant PTDC/PSI-PCL/101506/2008 and grant SFRH/BD/87495/2012, and co-financed by the European Regional Development Fund (FEDER) through COMPETE2020 under the PT2020 Partnership Agreement (POCI-01-0145-FEDER-007653). This work was also supported by the Köhler-Stiftung, Germany [grant number S112/10161/12].