Disturbances in attachment: inhibited and disinhibited symptoms in foster children

Abstract

BackgroundPrevious DSM-versions recognized an inhibited and a disinhibited subtype of the Reactive Attachment Disorder (RAD). The current DSM-5 distinguishes two different disorders, instead of two subtypes of RAD. This study examined whether a split-up of the subtypes is valid.MethodIn 126 foster children, attachment disorder symptoms were assessed with the Disturbances of Attachment Interview. Forms of pathogenic care were identified based on dossier analyses. Associations between symptoms of attachment disorder with internalizing and externalizing problems (Child Behavior Checklist and Teacher Report Form) were examined.ResultsOmnibus tests showed no significant association between type of symptoms and type of pathogenic care. Exploratory analyses did reveal an univariate association between disinhibited symptoms and history of physical abuse. Disinhibited symptoms were associated with more internalizing and externalizing problems (d’s < 0.50).ConclusionThe distinction of inhibited and disinhibited subtypes of RAD seems valid regarding their emotional and behavioral correlations. Whereas inhibited symptoms lack a correlation, disinhibited symptoms seem to have an externalizing and internalizing correlation.Trial registrationNTR1747

The interactive effect of maltreatment in the family and unstable institutional caregiving in predicting behavior problems in toddlers

“…Scores on the subscale of internalizing behavior-assessing emotionally reactive, anxious/depressed, somatic complaints, and withdrawn behavior-and on the subscale of externalizing behavior-assessing attention problems and aggressive behavior-were calculated for this study. The CBCL has been extensively used and shown to have good internal consistency (internalizing subscale, coefficient alpha of .91, and externalizing subscale, coefficient alpha of .96, for a sample of children in foster care; Jonkman et al, 2014). In the present study, the internal consistency of the CBCL proved to be more than adequate, with a coefficient alpha of .79 for internalizing problems, and .82 for externalizing problems.…”

Inhibited attachment behaviour and disinhibited social engagement behaviour as relevant concepts in referred home reared children

“…Children in the FC group had been placed in the foster family a few weeks before entering the study. The 59 FC children were also described within a larger sample of a previous study, with the aim to validate the split‐up of IAB and DSEB in foster care (Jonkman et al ). All caregivers signed an informed consent to use the data for scientific research and knew that participation in the study would not influence the treatment.…”

“…Research provided evidence that the two subtypes can be reliably identified and are distinct from other psychiatric disorders (O'Connor & Rutter ; Boris et al ; Gleason et al ; Giltaij et al ; Zeanah & Gleason ). Evidence for different symptomatology and prognosis of the subtypes, suggested that the inhibited type and disinhibited type could be better described as two distinct disorders (Rutter et al ; Gleason et al ; Jonkman et al ; Zeanah & Gleason ). Children with the inhibited type were found to have absent or nearly absent selective attachment relationships, while children with the disinhibited type were sometimes found to have selective attachment relationships with a preferred caregiver, including even secure attachment (Smyke et al ; Zeanah et al ; Lyons‐Ruth et al ; Zeanah & Gleason ).…”

“…In institutionalized children, more IAB was found to be associated with internalizing problem behaviour such as depressive symptoms, whereas more DSEB was found to be associated with externalizing problem behaviour such as aggression and hyperactivity (Gleason et al ). In foster children, evidence was found for an association between DSEB and more internalizing and externalizing problem behaviour (Jonkman et al ). Also, an association was found between DSEB and previous exposure to physical abuse (Jonkman et al ).…”

“…In foster children, evidence was found for an association between DSEB and more internalizing and externalizing problem behaviour (Jonkman et al ). Also, an association was found between DSEB and previous exposure to physical abuse (Jonkman et al ).…”