German Version of the Relationship Problems Questionnaire: Effective Screening for Attachment Disorder.

INTRODUCTION: Attachment disorder (AD), including reactive AD and disinhibited social engagement disorder, is a prevalent, yet underdiagnosed disorder in severely maltreated children. Because the condition is associated with significant psychiatric morbidity over the entire lifespan, a valid and economic screening tool to identify children with clinical symptoms of AD is needed to avoid unspecific or ineffective treatment. The present study aimed to assess the effectiveness and efficiency of the German version of the Relationship Problems Questionnaire (RPQ). METHODS: With a total of 135 children (mean age = 7.17 years, SD = 1.40, 63% male) from both general (34 children) and high-risk populations (69 in- and outpatients, 32 foster children), we investigated the sensitivity and specificity of the RPQ. AD was diagnosed using a standardized clinical interview (K-DIPS). 35 out of 135 children fulfilled the criteria for AD. RESULTS: The RPQ identified 74% of the children who fulfilled the criteria for AD in the standardized clinical interview. The optimal cut-off score of the RPQ for identifying AD was 4.5 with a moderate sensitivity of 0.74 and specificity of 0.68. CONCLUSIONS: The German version of the RPQ proved useful as a diagnostic indicator of clinical symptoms of AD. The tool is economic and suitable for the screening of AD in the general population as well as high-risk populations. We recommend the use of the RPQ in clinical and research settings, adding multi-method approaches after a positive screening.

Attachment disorder and attachment theory - Two sides of one medal or two different coins?

INTRODUCTION: Currently, attachment quality and attachment disorder exist in parallel, but the mutual association is still insufficiently clarified. For policy makers and clinical experts, it can be difficult to differentiate between these constructs, but the distinction is crucial to develop mental-health services and effective treatment concepts. We aimed to investigate the association between attachment representations (AR) and attachment disorders (AD), including Reactive Attachment Disorder (RAD) and Disinhibited Social Engagement Disorder (DSED) in children aged between 5 and 9. METHODS: A total of 135 children aged between 5 and 9 years (M=7.17 years, SD=1.40, 63% male) and their primary caregivers participated in the study. Children were interviewed with the story stem method to assess AR, and the primary caregiver completed diagnostic interviews and questionnaires on mental disorders, AD, emotional and behavioral problems, and intelligence and development. RESULTS: The prevalence of AR in children with AD was 28.6% for the 'secure' form of AR, 17.1% for the 'insecure-avoidant' form, 25.7% for the 'insecure-ambivalent' form, and 28.6% for the 'disorganized' form. Prevalences of the various AR forms did not differ statistically significantly, indicating that AR is conceptionally distinct from AD. Children with disorganized attachment scored significantly lower on language and intelligence skills than children with secure attachment. AD was significantly associated with a higher number of comorbidities, emotional and behavioral problems, and lower language skills. CONCLUSIONS: Longitudinal studies using standardized assessment instruments are needed to systematically provide comparable and reliable empirical findings to improve current understanding of AR and AD as well as their etiological models.

Measurement Invariance and Latent Mean Differences in the Reynolds Intellectual Assessment Scales (RIAS): Does the German Version of the RIAS Allow a Valid Assessment of Individuals with a Migration Background?

This study examined measurement invariance and latent mean differences in the German version of the Reynolds Intellectual Assessment Scales (RIAS) for 316 individuals with a migration background (defined as speaking German as a second language) and 316 sex- and age-matched natives. The RIAS measures general intelligence (single-factor structure) and its two components, verbal and nonverbal intelligence (two-factor structure). Results of a multi-group confirmatory factor analysis showed scalar invariance for the two-factor and partial scalar invariance for the single-factor structure. We conclude that the two-factor structure of the RIAS is comparable across groups. Hence, verbal and nonverbal intelligence but not general intelligence should be considered when comparing RIAS test results of individuals with and without a migration background. Further, latent mean differences especially on the verbal, but also on the nonverbal intelligence index indicate language barriers for individuals with a migration background, as subtests corresponding to verbal intelligence require higher skills in German language. Moreover, cultural, environmental, and social factors that have to be taken into account when assessing individuals with a migration background are discussed.