Reactive attachment disorder and disinhibited social engagement disorder in adolescence: co-occurring psychopathology and psychosocial problems.

Insufficient care is associated with most psychiatric disorders and psychosocial problems, and is part of the etiology of reactive attachment disorder (RAD) and disinhibited social engagement disorder (DSED). To minimize the risk of misdiagnosis, and aid treatment and care, clinicians need to know to which degree RAD and DSED co-occur with other psychopathology and psychosocial problems, a topic little researched in adolescence. In a national study of all adolescents (N = 381; 67% consent; 12-20 years old; 58% girls) in Norwegian residential youth care, the Child and Adolescent Psychiatric Assessment interview yielded information about psychiatric diagnoses and psychosocial problems categorized as present/absent, and the Child Behavior Check List questionnaire was applied for dimensional measures of psychopathology. Most adolescents with a RAD or DSED diagnosis had several cooccurring psychiatric disorders and psychosocial problems. Prevalence rates of both emotional and behavioral disorders were high in adolescent RAD and DSED, as were rates of suicidality, self-harm, victimization from bullying, contact with police, risky sexual behavior and alcohol or drug misuse. Although categorical measures of co-occurring disorders and psychosocial problems revealed few and weak associations with RAD and DSED, dimensional measures uncovered associations between both emotional and behavioral problems and RAD/DSED symptom loads, as well as DSED diagnosis. Given the high degree of comorbidity, adolescents with RAD or DSED-or symptoms thereof-should be assessed for co-occurring psychopathology and related psychosocial problems. Treatment plans should be adjusted accordingly.

Validity of reactive attachment disorder and disinhibited social engagement disorder in adolescence.

Although reactive attachment disorder (RAD) and disinhibited social engagement disorder (DSED) are acknowledged as valid disorders in young children, controversy remains regarding their validity in adolescence. An unresolved question is whether symptoms of RAD and DSED are better conceptualized as other psychiatric disorders at this age. All adolescents (N = 381; 67% consent; 12-20 years old) living in residential youth care in Norway were interviewed to determine the symptoms and diagnosis of RAD/DSED and other common psychiatric disorders using the Child and Adolescent Psychiatric Assessment (CAPA). The construct validity of RAD and DSED, including structural and discriminant validity, was investigated using confirmatory factor analysis and latent profile analysis. Two-factor models distinguishing between symptoms of RAD and DSED and differentiating these symptoms from the symptoms of other psychiatric disorders revealed better fit than one-factor models. Symptoms of RAD and DSED defined two distinct latent groups in a profile analysis. The prevalence of RAD was 9% (95% CI 6-11%), and the prevalence of DSED was 8% (95% CI 5-11%). RAD and DSED are two distinct latent factors not accounted for by other common psychiatric disorders in adolescence. RAD and DSED are not uncommon among adolescents in residential youth care and therefore warrant easy access to qualified health care and prevention in high-risk groups.

Quality of life among adolescents living in residential youth care: do domain-specific self-esteem and psychopathology contribute?

PURPOSE: Many adolescents living in residential youth care (RYC) institutions perceive their quality of life (QoL) to be low. Enhancing QoL is thus important, but little is known about the potential contributors to their QoL. Early interpersonal trauma and subsequent removal from home and repeated relocations to new placements are expected to affect mental health and self-esteem. We therefore investigated if domain-specific self-esteem contributed to QoL among adolescents living in RYC institutions over and beyond their levels of psychopathology. METHODS: All youth in Norwegian RYC institutions between the ages 12-23 years were invited to participate. Of a total of 98 RYC institutions, 86 participated, and 400 of 601 eligible youths were examined. The participants' primary contact completed the Child Behavior Checklist to assess psychopathology. The adolescents completed a revised version of the Self-Perception Profile for Adolescents and the questionnaire for measuring health-related quality of life in children and adolescents (KINDL-R). RESULTS: After adjusting for psychopathology, age, and gender, self-esteem domains uniquely explained 42% of the variance in Qol, where social acceptance (ß = 0.57) and physical appearance (ß = 0.25) domains significantly predicted concurrent QoL. CONCLUSIONS: The self-esteem domains, social acceptance and physical appearance, add substantially to the explained variance in QoL among adolescents living in RYC institutions, over and beyond the levels of psychopathology. These self-esteem domains may be targets of intervention to improve QoL, in addition to treating their psychopathology.

The mediating role of social climate in the association of youth and residential service characteristics and quality of life.

Previous research has shown that social climate (SC) is important for the daily life of youths living in therapeutic residential youth care (TRC). However, little is known on how SC can promote a positive quality of life (QoL) for the heterogeneous TRC population. This study, therefore, investigates how TRC and youth characteristics are associated with SC and QoL. We employed a combination of person-centered and variable-centered approaches in a cross-sectional design using a sample of 400 Norwegian youths. We used previously established TRC and youth classes in a structural equation model, where these classes were regressed on latent SC and QoL. Both direct and indirect effects were analyzed. All youth classes were associated with SC and QoL, such that youth with family problems, incidental problems, and the migrant background class scored higher on SC and QoL compared to the severe problems class. In addition, SC mediated the association of the incidental problems and migrant background classes on QoL. TRC staff should acknowledge that a positive SC can strengthen the QoL of youths with severe problems. Future research should longitudinally investigate these associations to establish long-term effects on QoL during stay in TRC. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Self-esteem in adolescents with reactive attachment disorder or disinhibited social engagement disorder.

BACKGROUND: Low self-esteem predicts negative outcomes and mediates the association between childhood adversity and mental health problems in adolescence. Reactive attachment disorder (RAD) and disinhibited social engagement disorder (DSED) are presumably caused by early insufficient care, but their association with self-esteem is unknown. OBJECTIVE: Investigate global and domain-specific self-esteem in adolescents with RAD or DSED. PARTICIPANTS AND SETTING: All adolescents living in Norwegian residential youth care (RYC) (N = 306; age 12-20) were compared with a sample from the general Norwegian adolescent population (N = 10,480; age 12-20). METHODS: Self-esteem for scholastic competence (SC), social acceptance (SA), athletic competence (AC), physical appearance (PA), romantic appeal (RA), close friendship (CF), and self-worth (SW) was investigated using the revised version of the Self-Perception Profile for Adolescents. RESULTS: Compared to the general population, adolescents with RAD diagnosis had lower SC (mean difference, MD = -0.30, p = .020) and higher CF (MD = 0.25, p = .021), whereas adolescents with DSED diagnosis had lower SC (MD = -0.42, p = .005), SA (MD = -0.40, p = .015), AC (MD = -0.22, p = .038), PA (MD = -0.33, p = .048), and SW (MD = -0.37, p = .013). Compared to adolescents in RYC without RAD/DSED diagnoses, adolescents with DSED diagnoses had lower SA (MD = -0.42, p = .012) and SW (MD = -0.32, p = .037). More RAD symptoms were associated with lower SA (B = -0.051, p = .013), AC (B = -0.048, p = .028), RA (B = -0.053, p = .007), and CF (B = -0.052, p = .005). More DSED symptoms were associated with lower SC (B = -0.125, p = .038). CONCLUSION: Both global and domain-specific self-esteem in adolescents with RAD or DSED should be assessed; developmental support and treatment plans should be adjusted accordingly.

Preterm infants' timing strategies to optical collisions.

BACKGROUND: A virtual object approaching on a collision course will elicit defensive blinking in infants. Previous research has shown that when precisely timing their blinks, full-term infants shift from using a strategy based on visual angle/angular velocity to a strategy based on time between 22 and 30 weeks of age. AIM: To investigate which timing strategy preterm infants use to determine when to make the defensive blink. METHODS: Eight preterm infants were tested at 26 weeks, corrected for prematurity. For three of these infants, longitudinal data at 22, 26, and 30 weeks were available. The virtual object approached the infants with different constant velocities and constant accelerations. RESULTS: At 26 weeks, three infants blinked when the virtual object's visual angle reached a threshold value causing them to have problems with fast, accelerating approaches. Four infants blinked when the virtual object was a certain time away, allowing them to blink in time on all approach conditions. One infant stood out because he relied on a timing strategy based on angular velocity on all three test sessions, causing him to blink late on a large number of trials even at 30 weeks. CONCLUSION: As good timing is essential for successful interaction with the environment, the inability to switch from a timing strategy that is prone to errors to a strategy that enables successful defensive blinking reflects lack of flexibility to adjust appropriately to local circumstances. This might be an early indication of perceptuo-motor problems that warrants further investigation.

Refining the COPES to Measure Social Climate in Therapeutic Residential Youth Care.

BACKGROUND: Previous studies have shown that social climate in therapeutic residential youth care (TRC) is important to the welfare of residents, staff, and assessing treatment outcomes. The most influential theory on social climate in residential settings is the theory of Moos. The measurement of the concepts and aspects of this theory using the Community Oriented Programs Environment Scale (COPES) has repeatedly been criticized regarding usability, validity, and reliability, especially for TRC. OBJECTIVE: To improve the usability and psychometric quality of the COPES by shortening and refining the original subscale structure for usage in TRC. METHODS: Four-hundred adolescents living in Norwegian TRC participated. We supplemented confirmatory factor analysis (CFA) with item response theory (IRT) to evaluate model fit, investigate factor loadings, and shorten scales to improve their psychometric qualities and usability in describing social climate in TRC. RESULTS: The original subscales were not acceptable as evaluated by the criteria for CFA and IRT. By removing psychometrically weak items, the instrument was shortened to 40 items within the original ten subscales. This short version showed acceptable psychometric qualities based on both CFA and IRT criteria and the instrument retained its content validity. Finally, the original three higher-order dimensions was not supported. CONCLUSIONS: Compared to the original instrument, the refined 40-item version of the COPES represents a more usable instrument for measuring social climate in TRC. Future studies are needed to confirm the multifaceted refined short version in comparable samples of youth and staff to further investigate predictive value and construct validity.