Psychiatric diagnostic screening of social maladaptive behaviour in children with mild intellectual disability: differentiating disordered attachment and pervasive developmental disorder behaviour.
Attachment signs show up in almost half of kids with mild ID and rarely coincide with PDD, so double-screen before you treat.
01Research in Context
What this study did
The team interviewed parents of children with mild intellectual disability.
They asked about signs of disordered attachment and pervasive developmental disorder.
The goal was to see if the two sets of behaviors overlap or stay separate.
What they found
About four in ten children showed attachment-disorder symptoms.
Roughly one in four screened positive for PDD.
Most kids did not meet criteria for both; the problems sat in different groups.
How this fits with other research
van den Broek et al. (2006) and Pandey et al. (2008) warn that M-CHAT and SCQ miss higher-functioning autism.
P et al. now show that, even when IQ is low, attachment issues can look like PDD but are usually distinct.
Glenn et al. (2013) tried the SDQ in adults with Down syndrome and also found low specificity; together the papers say one questionnaire is never enough in ID samples.
Ridley et al. (2020) found social vulnerability across many syndromes; P et al. narrow the lens to attachment versus autism in mild ID and still find separation, backing the idea that social problems need syndrome-specific probes.
Why it matters
If you assess a child with mild ID who seems socially off, do not assume it is only autism.
Run screens for both attachment disorder and PDD; they can ride alone.
Pick tools that tease apart the two paths, then plan different supports for each.
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02At a glance
03Original abstract
BACKGROUND: Children with intellectual disability (ID) are at risk for maladaptive development of social relatedness. Controversy exists whether Pervasive Developmental Disorder (PDD) takes precedence over disordered attachment for describing maladaptive social behaviour. The aim of this study was to assess the prevalence of disordered attachment symptoms in children with ID referred for mental health diagnosis, and to study the potential diagnostic overlap between symptoms of disordered attachment and PDD symptoms. METHOD: Children (n = 102) in the age of 5-11 with IDs (borderline or mild; IQ 50-85) referred for psychiatric consultation were recruited. Parents were administered a screening interview for disturbances of attachment and teachers were administered a screening questionnaire for PDD. RESULTS: Behavioural symptoms of disordered attachment were reported for 42%* of the children, with 16%* showing symptoms of inhibited and 37%* showing symptoms of disinhibited attachment disorder. In 11% both types of symptoms were noted. Attachment disorder symptoms were not significantly associated with gender, ethnic background or age. Positive screening for PDD occurred for 27%. Positive screening for PDD was not significantly associated with symptoms of attachment disorder. CONCLUSIONS: Among children with ID referred for psychiatric consultation, Reactive Attachment Disorder (RAD) and PDD symptoms were both highly prevalent. RAD and PDD symptoms appear as distinct, but sometimes comorbid, forms of aberrant social relatedness.
Journal of intellectual disability research : JIDR, 2015 · doi:10.1111/jir.12079