Preliminary Results of Attachment Disorder Subtypes and Related DSM-IV Diagnoses

The Attachment Center at Evergreen has been using the RADQ (Randolph Attachment Disorder Questionnaire) to assess Attachment Disorder in clients for about two years. Subtype results and DSM-IV diagnoses were evaluated for children who tested in the Attachment Disordered range (>65). The following preliminary data represents 34 children and 41 RADQ scores. This information is being made available to stimulate interest and further research.

A. RADQ Subtypes

Of the 41 clients studied, most scored as Ambivalent sub-type. This is probably due to selection rather than a representation of the general population of Attachment Disordered children. Children with Ambivalent subtype tend to be more aggressive and destructive than children who tested in any of the other subtypes, making it more likely that their parents will seek treatment. This conclusion would also be supported by the finding that the smallest group had Avoidant subtype, the least behaviorally disruptive of the four subtypes.

Avoidant Subtype. Children whose test results place them in this category tend to try to avoid close contact with others. They do not make friends easily, and do not maintain those friendships they do have, thus isolating themselves from their peers. They tend to be compulsive about doing what they want to do, but need to have the approval of others. In order to get this approval, they can be extremely argumentative.

Anxious Subtype. Children with an Anxious Attachment Subtype are always trying to be who they think others want them to be. They are extremely anxious about how they should behave and mold themselves easily to whatever expectations they believe others have for them.

Ambivalent Subtype. The behavior of these children tends to be very aggressive and destructive. These children do whatever they want to do, regardless of the consequences. Some of the extreme behaviors which are often present include cruelty to other children and animals, fire setting, doing dangerous things and falsely accusing parents of abuse.

B. RADQ Subtypes by Gender

While the total number of males to females was almost equal (18 males, 16 females), 3 times more males than females scored as Ambivalent sub-type. Suicide research has found that males tend to use violent, aggressive means more often than females. It is uncertain whether the conclusions from suicide research will be found to also be true with Attachment Disordered children, but it may be that, compared to Ambivalent girls, the behavior of Ambivalent boys is more disturbing, and therefore more likely to garner therapeutic attention.

Children whose behaviors do not clearly indicate one of the other three subtypes are classified as Mixed subtype. More girls than boys were found to be of Mixed subtype, and girls were roughly equally divided among the subtypes. These results may support the possibility of male selection bias discussed above. A third possibility is that, for some reason, girls are more difficult to subtype than boys because they engage in less overtly aggressive behaviors. Research on the validity of the RADQ total scores indicates that the measure is not gender biased, but similar research has not been completed on subtype scores.

C. Diagnostic Frequency

Among the 41 clients, almost all met the DSM IV criteria for Reactive Attachment Disorder and Oppositional Defiant Disorder. As expected, many also have PTSD as a result of significant abuse histories commonly found in this population. About 65% of these clients were also found to have Bipolar Disorder. Dr. John Alston, consulting psychiatrist at the Attachment Center at Evergreen, has suggested that the high correlation between Bipolar disorder and Attachment Disorder may be because Bipolar Disorder is a genetic, inherited, familial disorder. It manifests in manic and/or depressive mood disturbances and is frequently diagnosed in adults who abuse or neglect their children. It then follows that this is the genetic disorder which many children with a coexistent Reactive Attachment Disorder inherit. According to Dr. Alston, "The degree of self-centeredness, irritability and intensity of rage reactions while in a manic state is frequently sufficient to create severe abusive conditions. Correspondingly, the degree of profound depression is likewise severe enough to create long standing neglectful circumstances."

D. Diagnosis by Gender

When diagnoses are separated by gender, girls and boys are almost equally represented in each of the diagnoses. It has been postulated by Dr. Liz Randolph and others that Attachment Disorder affects boys and girls equally, a finding which this preliminary data seems to support. There were more boys with Oppositional Defiant Disorder which may be the effect of selection bias; boys who are generally more aggressive may be somewhat more likely to be brought for treatment than girls.

© The Attachment Center at Evergreen