Validity of Evidence-Derived Criteria for Reactive Attachment Disorder: Indiscriminately Social/Disinhibited and Emotionally Withdrawn/Inhibited Types
Validity of Evidence-Derived Criteria for Reactive Attachment Disorder: Indiscriminately Social/Disinhibited and Emotionally Withdrawn/Inhibited Types
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DOI：
10.1016/j.jaac.2010.12.012
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发表时间：
2011-03-01
影响因子：
13.3
通讯作者：
Zeanah, Charles H.
中科院分区：
文献类型：
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作者：
Gleason, Mary Margaret;Fox, Nathan A.;Zeanah, Charles H.
目的：本研究检验了不加区别的社交/去抑制和情感退缩/抑制反应性依恋障碍（RAD）标准的有效性。方法：作为对先前收容儿童的纵向干预试验的一部分，看护者访谈和直接观察测量提供了连续和分类数据，用于检查这些疾病的内部一致性、标准有效性、构建有效性、收敛和判别有效性、与功能障碍的关联以及这些疾病随时间的稳定性。结果：与其他研究一样，研究结果显示了两种类型的 RAD 之间的区别。两种 RAD 类型的循证标准均显示出可接受的内部一致性和标准有效性。在这项研究中，基线时以及 30、42 和 54 个月时不加区别地社交/解除抑制的 RAD 发生率分别为 41/129 (31.8%)、22/122 (17.9%)、22/122 (18.0%) 和 22/125 (17.6%)。不加区别地社交/去抑制 RAD 的迹象与护理质量几乎没有关联。近一半患有不加区别的社交/去抑制 RAD 的儿童已经组织了依恋分类。不加区别的社交/去抑制 RAD 的迹象与活动/冲动和注意力缺陷/多动障碍的迹象相关，并与抑制控制适度相关，但与注意力缺陷/多动障碍的诊断不同。在基线、30、42 和 54 个月时，6/130 (4.6%)、4/123 (3.3%)、2/125 (1.6%) 和 5/122 (4.1%) 的儿童符合情绪孤僻/抑制的 RAD 标准。情绪退缩/抑制的 RAD 与前三个时间点的护理中度相关，与依恋安全性密切相关。此类 RAD 的体征与抑郁症状相关，尽管 5 名 54 个月时患有此类 RAD 的儿童中有 2 名不符合重度抑郁症的标准。两种类型的 RAD 症状均独立地导致功能障碍，并且随着时间的推移保持稳定。结论：不加区别的社交/解除抑制和情感退缩/抑制 RAD 的循证标准定义了两种统计和临床上相互独立的综合征，它们显示出 2 年以上的稳定性，与危险因素和依恋具有可预测的关联，可以与其他精神疾病区分开来，并导致功能障碍。 J. Am.阿卡德。儿童青少年。精神病学，2011；50(3)：216-231。临床试验注册信息-布加勒斯特早期干预项目，URL：http://www.clinicaltrials.gov，唯一标识符：NCT00747396。
Objective: This study examined the validity of criteria for indiscriminately social/disinhibited and emotionally withdrawn/inhibited reactive attachment disorder (RAD). Method: As part of a longitudinal intervention trial of previously institutionalized children, caregiver interviews and direct observational measurements provided continuous and categorical data used to examine the internal consistency, criterion validity, construct validity, convergent and discriminant validity, association with functional impairment, and stability of these disorders over time. Results: As in other studies, the findings showed distinctions between the two types of RAD. Evidencederived criteria for both types of RAD showed acceptable internal consistency and criterion validity. In this study, rates of indiscriminately social/disinhibited RAD at baseline and at 30, 42, and 54 months were 41/129 (31.8%), 22/122 (17.9%), 22/122 (18.0%), and 22/125 (17.6%), respectively. Signs of indiscriminately social/disinhibited RAD showed little association with caregivirig quality. Nearly half of children with indiscriminately social/disinhibited RAD had organized attachment classifications. Signs of indiscriminately social/disinhibited RAD were associated with signs of activity/impulsivity and of attention-deficit/hyperactivity disorder and modestly with inhibitory control but were distinct from the diagnosis of attention-deficit/hyperactivity disorder. At baseline, 30, 42, and 54 months, 6/130 (4.6%), 4/123 (3.3%), 2/125 (1.6%), and 5/122 (4.1%) of children met criteria for emotionally withdrawn/inhibited RAD. Emotionally withdrawn/inhibited RAD was moderately associated with caregiving at the first three time points and strongly associated with attachment security. Signs of this type of RAD were associated with depressive symptoms, although two of the five children with this type of RAD at 54 months did not meet criteria for major depressive disorder. Signs of both types of RAD contributed independently to functional impairment and were stable over time. Conclusions: Evidencederived criteria for indiscriminately social/disinhibited and emotionally withdrawn/inhibited RAD define two statistically and clinically cohesive syndromes that are distinct from each other, shows stability over 2 years, have predictable associations with risk factors and attachment, can be distinguished from other psychiatric disorders, and cause functional impairment. J. Am. Acad. Child Adolesc. Psychiatry, 2011;50(3):216-231. Clinical trial registration information-The Bucharest Early Intervention Project, URL: http://www.clinicaltrials.gov, unique identifier: NCT00747396.