Discrimination between attention deficit hyperactivity disorder and reactive attachment disorder in school aged children.
Eight quick RAD signs—especially ‘cuddly with strangers’—spot attachment disorder and weed out ADHD copy-cats.
01Research in Context
What this study did
Michael et al. (2011) looked at eight key signs of Reactive Attachment Disorder. They asked if these signs could tell RAD apart from ADHD in school kids.
The team used a short checklist made just for RAD. They gave it to parents and teachers of children already diagnosed with RAD, ADHD, or no disorder.
What they found
The eight-item RAD scale worked. It cleanly split the RAD group from the ADHD group.
One item stood out: ‘cuddly with strangers.’ Kids with RAD scored high on this. Kids with ADHD did not.
How this fits with other research
Moss et al. (2009) and Matson et al. (2009) did the same kind of work, but for ASD vs ADHD. They also found short parent checklists that separate the two disorders. All three studies show that a few well-chosen items beat long forms.
Green et al. (2015) and Reus et al. (2013) looked at kids who have BOTH ADHD and ASD traits. They warn that ADHD can inflate autism scores. Michael’s RAD tool avoids this mix-up by using stranger-cuddliness, a trait unique to attachment problems.
DeRoma et al. (2004) tested an ADHD-only interview and found only modest accuracy. Michael’s study flips the task: start with RAD items first, then rule out ADHD. This reversed approach gives sharper answers.
Why it matters
If a child is hyper, defiant, and inattentive, you might think ADHD. But RAD can look the same. Use the eight-item RAD scale before you write the plan. One minute of parent questions can stop months of wrong treatment.
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02At a glance
03Original abstract
We aimed to determine whether it is possible to discriminate between children with attention deficit hyperactivity disorder (ADHD) and children with reactive attachment disorder (RAD) using standardized assessment tools for RAD. The study involved 107 children: 38 with a diagnosis of RAD and 30 with ADHD were recruited through community child and adolescent mental health services (CAMHS) and specialist ADHD clinics. In addition, 39 typically developing children were recruited through family practice. Clinicians were trained to use a standardized assessment package for RAD using a DVD with brief follow-up support. Discriminant function analysis was used to identify the items in the standardized assessment package that best discriminated between children with ADHD and children with RAD. Clinicians' ratings of RAD symptoms were reliable, particularly when focusing on eight core DSM-IV symptoms of RAD. Certain parent-report symptoms were highly discriminatory between children with ADHD and children with RAD. These symptoms included "cuddliness with strangers" and "comfort-seeking with strangers". A semi-structured interview with parents, observation of the child in the waiting room and teacher report of RAD symptoms aided diagnostic discrimination between the groups. Clinical diagnosis of RAD can be made reliably by clinicians, especially when focusing on eight core RAD symptoms. Clear discrimination can be made between children with RAD and children with ADHD.
Research in developmental disabilities, 2011 · doi:10.1016/j.ridd.2010.12.031