Social relationship difficulties in autism and reactive attachment disorder: Improving diagnostic validity through structured assessment
Open accessAbstract
Background Autism Spectrum Disorder (ASD) versus Reactive Attachment Disorder (RAD) is a common diagnostic challenge for clinicians due to overlapping difficulties with social relationships. RAD is associated with neglect or maltreatment whereas ASD is not: accurate differential diagnosis is therefore critical. Very little research has investigated the relationship between the two, and it is unknown if standardised measures are able to discriminate between ASD and RAD. The current study aimed to address these issues. Methods Fifty eight children with ASD, and no history of maltreatment, were group matched on age with 67 children with RAD. Group profiles on multi-informant measures of RAD were investigated and group differences explored. Discriminant function analysis determined assessment features that best discriminated between the two groups. Results Although, according to parent report, children with ASD presented with significantly fewer indiscriminate friendliness behaviours compared to the RAD group (p<0.001), 36 children with ASD appeared to meet core RAD criteria. However, structured observation clearly demonstrated that features were indicative of ASD and not RAD for all but 1 of these 36 children. Conclusions Children with RAD and children with ASD may demonstrate similar social relationship difficulties but there appears to be a difference in the social quality of the interactions between the groups. In most cases it was possible to differentiate between children with ASD and children with RAD via structured observation. Nevertheless, for a small proportion of children with ASD, particularly those whose difficulties may be more subtle, our current standardised measures, including structured observation, may not be effective in differentiating RAD from ASD.
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A lack of inhibition in both social and non-social situations has been reported in children diagnosed with ASD.
“This lack of inhibition in both social and non-social situations has been reported in children diagnosed with ASD (Davidson et al. 2015; Mayes et al. 2017).”
From Neurexin1α knockout in rats causes aberrant social behaviour: relevance for autism and schizophrenia (2025) · cites this paper as Davidson et al. 2015
The Discussion (page not indicated) reports that some children with ASD appeared to have disinhibited social symptoms, although most showed few observed signs of indiscriminate friendliness. The paper addresses social behaviour but does not report a lack of inhibition in non-social situations. (LLM, conf=0.85)
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Cites
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Cited by
Sorted by citations
Attachment in children with autism spectrum disorder: A systematic review
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Neurexin1α knockout in rats causes aberrant social behaviour: relevance for autism and schizophrenia
Achterberg, E. J. M., Biemans, B., & Vanderschuren, L. J. M. J. (2025) · Psychopharmacology · doi:10.1007/s00213-024-06559-z · Cited by 9 · see citing works
“Importantly, ASD and SCZ manifest already in childhood or adolescence, indicating that the development of the social brain is a process vulnerable to early disturbances.”
Influential
- Authors
- Davidson, C., O’Hare, A., Mactaggart, F., Green, J., Young, D., Gillberg, C., & Minnis, H.
- Affiliations
- University of Glasgow (GB)
- National Health Service Scotland (GB)
- University of Manchester (GB)
- University of Strathclyde (GB)
- Corresponding author
- Davidson, Claire
- Venue
- Research in Developmental Disabilities
- Publisher
- Elsevier BV
- Published
- 2015-05
- Volume
- 40
- Pages
- 63-72
- ISSN
- 0891-4222 (ISSN-L)
- OpenAlex
- W2036418942
- Cited by
- 74
- References
- 9
- Citations by year
- 2025: 5 · 2024: 8 · 2023: 6 · 2022: 8 · 2021: 5 · 2020: 6 · 2019: 8 · 2018: 10 · 2017: 7 · 2016: 7 · 2015: 3
- FWCI
- 5.40
- Type
- journal article
- Language
- en
- Open access
- Locations
- Research in Developmental Disabilities (publishedVersion)
- PubMed (publishedVersion)
- Research Explorer (The University of Manchester) (publishedVersion)
- Strathprints: The University of Strathclyde institutional repository (University of Strathclyde) (submittedVersion)
- ENLIGHTEN (Jurnal Bimbingan dan Konseling Islam) (submittedVersion)
- Topics
- Life Sciences › Neuroscience › Cognitive Neuroscience › Autism Spectrum Disorder Research
- Health Sciences › Medicine › Psychiatry and Mental health › Child Nutrition and Feeding Issues
- Social Sciences › Psychology › Clinical Psychology › Child Abuse and Trauma
- Keywords
- autism spectrum disorder, reactive attachment disorder, differential diagnosis, structured observation, multi-informant assessment, diagnostic validity, children
- MeSH terms
- Autism Spectrum Disorder, Autistic Disorder, Child, Child, Preschool, Female, Humans, Interpersonal Relations, Male, Social Behavior, Reproducibility of Results, Discriminant Analysis, Reactive Attachment Disorder, Social Skills
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