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Cited by 75Child Welfare and AdoptionChild Abuse and TraumaAttachment and Relationship Dynamics

Signs of reactive attachment disorder and disinhibited social engagement disorder at age 12 years: effects of institutional care history and high-quality foster care

Open access
Humphreys, Kathryn L., Nelson, Charles A., Fox, Nathan A., Zeanah, Charles H.·2017·Development and Psychopathology
DOI 10.1017/s0954579417000256PMC PMC5777580
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Abstract

Two disorders of attachment have been consistently identified in some young children following severe deprivation in early life: reactive attachment disorder and disinhibited social engagement disorder. However, less is known about whether signs of these disorders persist into adolescence. We examined signs of reactive attachment disorder and disinhibited social engagement disorder at age 12 years in 111 children who were abandoned at or shortly after birth and subsequently randomized to care as usual or to high-quality foster care, as well as in 50 comparison children who were never institutionalized. Consistent with expectations, those who experienced institutional care in early life had more signs of reactive attachment disorder and disinhibited social engagement disorder at age 12 years than children never institutionalized. In addition, using a conservative intent-to-treat approach, those children randomized to foster care had significantly fewer signs of reactive attachment disorder and disinhibited social engagement disorder than those randomized to care as usual. Analyses within the ever institutionalized group revealed no effects of the age of placement into foster care, but number of caregiving disruptions experienced and the percentage of the child's life spent in institutional care were significant predictors of signs of attachment disorders assessed in early adolescence. These findings indicate that adverse caregiving environments in early life have enduring effects on signs of attachment disorders, and provide further evidence that high-quality caregiving interventions are associated with reductions in both reactive attachment disorder and disinhibited social engagement disorder.

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Crossref · 10.1017/s0954579417000256

Cites

48 of 48 references verified0 citation errors · 0 not checkable

Statistics

Claims the paper makes

0 of 42 cited sources checked · 0 supported · 0 flagged

  • Findingown data

    Among children with institutional care histories, assignment to foster care was associated with fewer reactive attachment disorder signs at age 12 compared to assignment to care as usual, in an intent-to-treat analysis.

    “those children randomized to foster care had significantly fewer signs of reactive attachment disorder and disinhibited social engagement disorder than those randomized to care as usual”
    • Also stated in: § Disturbances of Attachment Interview Scores by Intent-to-Treat Groupings · plain
      “The care as usual group (M=4.28, SE=0.65; 95% CI [3.18, 5.77]) had significantly higher scores than the foster care group (M=1.75, SE=0.30; 95% CI [1.11, 3.96]).”
    Quote in the paperSubstantial claim
    • Rests on an assumption: The Disturbances of Attachment Interview yields comparable measurements of attachment disorder signs when administered to different types of caregivers (institutional caregivers, foster parents, biological parents).
  • Findingown data

    Within the ever institutionalized group, age of placement into foster care was not associated with disinhibited social engagement disorder signs at age 12.

    “Analyses within the ever institutionalized group revealed no effects of the age of placement into foster care”
    • Also stated in: § Age of Placement · plain
      “There was no association between age of placement and disinhibited social behavior (Wald χ2=1.68, df=1, p=.20).”
    Quote in the paperSubstantial claim
    • Rests on an assumption: The Disturbances of Attachment Interview yields comparable measurements of attachment disorder signs when administered to different types of caregivers (institutional caregivers, foster parents, biological parents).
  • Findingown data

    Among children with institutional care histories, assignment to foster care was associated with fewer disinhibited social engagement disorder signs at age 12 compared to assignment to care as usual, in an intent-to-treat analysis.

    “those children randomized to foster care had significantly fewer signs of reactive attachment disorder and disinhibited social engagement disorder than those randomized to care as usual”
    • Also stated in: § Disturbances of Attachment Interview Scores by Intent-to-Treat Groupings · plain
      “The care as usual group (M=1.81, SE=0.30; 95% CI [1.30, 2.52]) had significantly higher scores than the foster care group (M=0.92, SE=0.18; 95% CI [0.63, 1.36]).”
    Quote in the paperSubstantial claim
    • Rests on an assumption: The Disturbances of Attachment Interview yields comparable measurements of attachment disorder signs when administered to different types of caregivers (institutional caregivers, foster parents, biological parents).
  • Findingown data

    Children with a history of institutional care in early life had higher scores on inhibited social behavior (reactive attachment disorder signs) at age 12 than children who were never institutionalized.

    “those who experienced institutional care in early life had more signs of reactive attachment disorder and disinhibited social engagement disorder at age 12 years than children never institutionalized”
    • Also stated in: § Disturbances of Attachment Interview Scores by History of Institutional Care · plain
      “The ever institutionalized group (M=3.01, SE=0.33; 95% CI [2.43, 3.74]) had significantly higher scores than the never institutionalized group (M=0.47, SE=0.14; 95% CI [0.27, 0.84]).”
    Quote in the paperSubstantial claim
    • Rests on an assumption: The never institutionalized comparison children are representative of typically developing Romanian children without institutional rearing.
    • Rests on an assumption: The Disturbances of Attachment Interview yields comparable measurements of attachment disorder signs when administered to different types of caregivers (institutional caregivers, foster parents, biological parents).
  • Findingown data

    Children with a history of institutional care in early life had higher scores on disinhibited social behavior (disinhibited social engagement disorder signs) at age 12 than children who were never institutionalized.

    “those who experienced institutional care in early life had more signs of reactive attachment disorder and disinhibited social engagement disorder at age 12 years than children never institutionalized”
    • Also stated in: § Disturbances of Attachment Interview Scores by History of Institutional Care · plain
      “The ever institutionalized group (M=1.37, SE=0.17; 95% CI [1.07, 1.75]) had significantly higher scores than the never institutionalized group (M=0.14, SE=0.06; 95% CI [0.06, 0.34]).”
    Quote in the paperSubstantial claim
    • Rests on an assumption: The never institutionalized comparison children are representative of typically developing Romanian children without institutional rearing.
    • Rests on an assumption: The Disturbances of Attachment Interview yields comparable measurements of attachment disorder signs when administered to different types of caregivers (institutional caregivers, foster parents, biological parents).
  • May combine two claims. 20
  • The quote only partly states this claim. 2
  • Classified as probably not a substantial claim. 21

  • May combine two claims.

    Findingown data

    Among ever institutionalized children, the number of caregiving disruptions experienced and the percentage of the child's life spent in institutional care were significant predictors of signs of attachment disorders assessed at age 12.

    “number of caregiving disruptions experienced and the percentage of the child’s life spent in institutional care were significant predictors of signs of attachment disorders assessed in early adolescence”
    Quote in the paperSubstantial claim
    • Rests on an assumption: The number of caregiving disruptions and the percentage of time spent in institutional care are valid markers of the child's caregiving history.

  • May combine two claims.

    Findingown data

    By age 12, most children in the care-as-usual group had experienced family care through adoption, government foster care, or return to biological families, and only six children remained continuously institutionalized through age 12.

    “Given that by age 12 years, most children in care as usual group had experienced family care via adoption, government foster care, or return to biological families (only 6 children were continuously institutionalized through 12 years)”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Group significantly affected inhibited social behavior in both girls (Wald χ2=17.97, df=1, p<.001) and boys (Wald χ2=13.58, df=1, p<.001).

    “Among both girls and boys, there was a significant effect of group on inhibited social behavior (Wald χ2=17.97, df=1, p<.001 and Wald χ2=13.58, df=1, p<.001, respectively).”
    Quote in the paperSubstantial claim

  • The quote only partly states this claim.

    Findingown data

    At age 12, children who had been placed in high-quality foster care still displayed fewer signs of disinhibited social engagement disorder than children in the care-as-usual group.

    “The most important finding is that 8 years after the trial ended, children placed in high-quality foster care continued to show fewer signs of both reactive attachment disorder and disinhibited social engagement disorder.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Separate estimated group differences were significant for girls (95% CI [0.82, 1.74]) and boys (95% CI [0.55, 1.71]).

    “Estimated averages were calculated for group differences within girls (95% CI [0.82, 1.74]) and boys (95% CI [0.55, 1.71]) separately, which both indicated significant group differences.”
    Quote in the paperNot a substantial claim

  • The quote only partly states this claim.

    Findingown data

    At age 12, children who had been placed in high-quality foster care still displayed fewer signs of reactive attachment disorder than children in the care-as-usual group.

    “The most important finding is that 8 years after the trial ended, children placed in high-quality foster care continued to show fewer signs of both reactive attachment disorder and disinhibited social engagement disorder.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    A group × sex interaction for disinhibited social behavior could not be estimated because every never institutionalized female scored 0.

    “The possibility for a group × sex interaction was examined; however the model was unable to compute an estimate because all never institutionalized females had scores of 0.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Premisecitation

    Attachment disorders are linked to severe social deprivation.

    “It has been known that serious social deprivation is associated with attachment disorders for decades.”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites Goldfarb, 1945

      Not checked in the free run.

    • cites Levy, 1947

      Not checked in the free run.

    • cites Tizard & Rees, 1975

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Among children adopted from institutions, indiscriminate social behavior is a highly persistent abnormality that often persists after adoptive attachments form, while inhibited social behavior resolves as attachment relationships develop.

    “Indiscriminate social behavior is one of the most persistent social abnormalities in children adopted from institutions, often remaining evident even after children have formed attachments to their adoptive parents, where inhibited social behavior disappears with the development of attachment relationships”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites Rutter et al., 2010

      Not checked in the free run.

    • cites Rutter et al., 2009

      Not checked in the free run.

    • cites Zeanah & Gleason, 2015

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Premisecitation

    These disorders emerge when early social neglect disrupts the child's first attachment relationships during their formation.

    “There is also a consensus that these disorders arise when the child’s first attachment relationships are still forming and are compromised by early social neglect”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Zeanah & Gleason, 2015

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Institutionalized children showed atypical social behaviors such as social inhibition, unresponsiveness, social disinhibition, and boundary violations.

    “descriptive, cross-sectional studies demonstrated that children raised in institutions exhibited unusual social behaviors, including social inhibition and unresponsiveness and social disinhibition and boundary violations”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites Goldfarb, 1945

      Not checked in the free run.

    • cites Levy, 1947

      Not checked in the free run.

    • cites Provence & Lipton, 1962

      Not checked in the free run.

  • Classified as probably not a substantial claim. May combine two claims.

    Premisecitation

    Two clinical patterns of attachment disorders in young children have been described: an emotionally withdrawn/inhibited pattern (reactive attachment disorder) and an indiscriminately social pattern (disinhibited social engagement disorder).

    “Two clinical patterns, an emotionally withdrawn/inhibited pattern (i.e., reactive attachment disorder) and an indiscriminately social pattern (i.e., disinhibited social engagement disorder) have been described.”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites Rutter, Kreppner, & Sonuga-Barke, 2009

      Not checked in the free run.

    • cites Zeanah & Gleason, 2015

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Institutionalized young children display comparable signs of attachment and social behavior disturbances.

    “More recently, several groups have reported that young children living in institutions have similar signs of disturbances in their attachment and social behaviors”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites Dobrova-Krol et al., 2010

      Not checked in the free run.

    • cites Smyke et al., 2002

      Not checked in the free run.

    • cites Zeanah et al., 2005

      Not checked in the free run.

  • May combine two claims.

    Interpretationown data

    Interventions providing high-quality caregiving are linked to decreases in both reactive attachment disorder and disinhibited social engagement disorder.

    “provide further evidence that high-quality caregiving interventions are associated with reductions in both reactive attachment disorder and disinhibited social engagement disorder”
    Quote in the paperSubstantial claim
    • Rests on an assumption: The Disturbances of Attachment Interview yields comparable measurements of attachment disorder signs when administered to different types of caregivers (institutional caregivers, foster parents, biological parents).

  • May combine two claims.

    Premisecitation

    In this sample at age 12, more placement disruptions were linked to more behavior problems, lower IQ scores, and poorer coping strategies.

    “We elsewhere have reported that number of disruptions was associated with more behavior problems, lower IQ scores, and poorer coping strategies in this sample at age 12 years (Almas et al., 2016).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Almas et al., 2016

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductown data

    Approval for the study came from the three principal investigators' institutional review boards and Bucharest's local Commissions on Child Protection.

    “Following approvals by the institutional review boards of the three principal investigators (CHZ, NAF, CAN), and by the local Commissions on Child Protection in Bucharest, the study commenced in collaboration with the Institute of Maternal and Child Health of the Romanian Ministry of Health.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    Bucharest's data safety monitoring board reviewed the current follow-up assessments.

    “A data safety monitoring board in Bucharest reviewed the assessments for the current follow-up.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Study design and conductown data

    Disinhibited social engagement disorder signs at age 12 also correlated with signs at 54 months (r(127) = .46, p < .001) and 8 years (r(156) = .55, p < .001).

    “Similar correlations were found with the association between disinhibited social engagement disorder signs at this follow-up and signs measured at age 54 months (r(127) = .46, p < .001) and 8 years (r(156) = .55, p < .001).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Study design and conductcitation

    At baseline, the care-as-usual and foster care groups did not differ on age, gender, ethnicity, birth weight, developmental quotient, observed caregiving environment, caregiver-rated behavior problems, or competence.

    “The children in the two groups were comparable on age, gender, ethnicity, birth weight, developmental quotient, observed caregiving environment, caregiver ratings of behavior problems, and competence at baseline (Smyke et al., 2007).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Smyke et al., 2007

      Not checked in the free run.

  • Classified as probably not a substantial claim. May combine two claims.

    Study design and conductreasoning

    Questions about validity arise because these disorders have not been studied much in this age range, and the clinical presentation of adolescents diagnosed with reactive attachment disorder or disinhibited social engagement disorder is unknown and may differ from that of young children.

    “Of course this raises questions of validity, given that these disorders have not been studied nearly as much in this age range, and we do not know the presentation of adolescents diagnosed with reactive attachment disorder or disinhibited social engagement disorder and whether and how this may differ from young children with these disorders.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Placement into foster care at an earlier age was linked to fewer disinhibited social engagement disorder signs.

    “In previous assessments, earlier foster placement was associated with reduced signs of disinhibited social engagement disorder (Smyke et al., 2012).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Smyke et al., 2012

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductnone given

    Bilingual research staff translated the Disturbances of Attachment Interview into Romanian, back-translated it into English, and checked meaning at each stage.

    “The Disturbances of Attachment Interview was translated into Romanian, back-translated into English, and assessed for meaning at each step by bilingual research staff.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductcitation

    The Disturbances of Attachment Interview, a caregiver structured interview about disordered attachment signs, has been widely used and validated in younger children.

    “This measure is a structured interview of caregivers about signs of disordered attachment that has been extensively used and validated at younger ages (Gleason et al., 2011; Smyke et al., 2012; Zeanah et al., 2005).”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites Gleason et al., 2011

      Not checked in the free run.

    • cites Smyke et al., 2012

      Not checked in the free run.

    • cites Zeanah et al., 2005

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductnone given

    Each child's legal guardian provided signed consent under Romanian law, and the children gave assent for each procedure.

    “Consent was obtained and signed for by each child’s legal guardian as per Romanian law. Assent for each procedure was obtained from the children.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Premisecitation

    Some researchers have conducted longitudinal studies of the disinhibited social engagement disorder phenotype.

    “The phenotype of disinhibited social engagement disorder has been studied longitudinally by some investigators (e.g., Hodges & Tizard, 1989; Rutter et al., 2010)”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites Hodges & Tizard, 1989

      Not checked in the free run.

    • cites Rutter et al., 2010

      Not checked in the free run.

  • May combine two claims.

    Study design and conductown data

    Internal consistency was high for both scales, with Cronbach's α = .88 for reactive attachment disorder signs and .82 for disinhibited social engagement disorder signs.

    “The coefficient alpha for both scales were very good (Cronbach’s α = .88 and .82, for reactive attachment disorder and disinhibited social engagement disorder signs, respectively), indicating high internal consistency.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    All analyses adjusted for participant ethnicity and sex.

    “Participant ethnicity and sex were included as covariates in all analyses.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Study design and conductown data

    Assignment to care as usual or foster care was randomized by drawing names from a hat.

    “Following baseline assessment, children were randomly assigned to the care as usual group or foster care group by drawing names from a hat.”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim. May combine two claims.

    Study design and conductnone given

    Although each caregiver may bring different biases, in every case the caregivers lived with the child and knew the child well.

    “Though each caregiver may bring different biases to bear, in each case, caregivers live with their child and know them well.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductnone given

    The children resided in varied settings, and the reporters therefore included biological, adoptive, and foster parents as well as unrelated caregivers in group settings.

    “Third, children are living in different settings, so that reporters include biological parents, adoptive parents, foster parents, and unrelated caregivers in group settings (e.g., caregivers in group homes or institutions).”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Study design and conductreasoning

    The study aimed to obtain reports on each child's behavior from that child's primary caregiver.

    “but in every case, we sought to have each child’s primary caregiver report on the child’s behavior.”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim. May combine two claims.

    Study design and conductreasoning

    Attachment disorders were assessed using caregiver reports of the children's behavior, and the children themselves did not provide reports.

    “First, beyond issues of validity of the Disturbances of Attachment Interview in early adolescence, we relied on caregiver reports of the children’s behaviors to assess attachment disorders, and we did not include children’s reports.”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim. May combine two claims.

    Study design and conductcitation

    Caregiver reports are an acceptable method for assessing child psychopathology, and because many children in this sample had intellectual disabilities and appeared not to understand several probes, caregiver reports were preferable for this sample.

    “This is, of course, an acceptable method of assessing psychopathology in children, and given the large numbers of children in this sample with intellectual disabilities (see Almas, Degnan, Nelson, Zeanah, & Fox, in press) who appeared not to understand a number of probes, we believe caregiver reports to be preferable in this sample.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Almas, Degnan, Nelson, Zeanah, & Fox, in press

      Not checked in the free run.

33 of 33

  • The paper relies on this without support.

    The never institutionalized comparison children are representative of typically developing Romanian children without institutional rearing.

    “The remaining 50 children (21 boys and 29 girls) were a never institutionalized Romanian children recruited from pediatric clinics or schools in Bucharest who were included as a typically developing comparison group of Romanian children.”

  • The paper relies on this without support.

    The Disturbances of Attachment Interview yields comparable measurements of attachment disorder signs when administered to different types of caregivers (institutional caregivers, foster parents, biological parents).

    “For children living with biological parents or foster parents, the mother reported on the child’s behavior. For children living in institutions, an institutional caregiver who worked with the child regularly and knew the child well reported on the child’s behavior.”

  • The paper relies on this without support.

    The number of caregiving disruptions and the percentage of time spent in institutional care are valid markers of the child's caregiving history.

    “Thus, we examined the total number of placement disruptions for all ever institutionalized children, as well as the percentage of time that children spent in any institutional care, in order to assess how variation in these markers of child’s caregiving history may related to signs of reactive attachment disorder and disinhibited social engagement disorder.”

  • The paper relies on this without support.

    The BEIP was the first experimental study of how different caregiving environments affect attachment disorder signs in young children, and this follow-up is the longest reported to date.

    “The BEIP is the first study to examine experimentally the effects of different caregiving environments on signs of attachment disorders in young children and the present study is the longest longitudinal follow-up reported to date.”

  • The paper relies on this without support.

    There are relatively few descriptive studies of reactive attachment disorder and disinhibited social engagement disorder in adolescence, since most research on attachment disorder signs has focused on early childhood.

    “Descriptive studies of reactive attachment disorder and disinhibited social engagement disorder in adolescence are relatively rare, as the majority of work documenting signs of attachment disorders focus on early childhood.”

  • The paper relies on this without support.

    No prior longitudinal study has assessed the emotionally withdrawn/inhibited form of reactive attachment disorder.

    “but this is the first longitudinal assessment of the emotionally withdrawn/inhibited phenotype of reactive attachment disorder.”

  • The paper relies on this without support.

    The Disturbances of Attachment Interview has extensive validation for use with younger children.

    “though it has been validated extensively when used with younger children.”
7 of 7

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

Statistics recomputed

Every reported test result, recomputed from its test statistic and degrees of freedom. A result shows as not adding up only once an independent check has confirmed it.

  • Consistentr(128) = 0.52reported p < .001 · recomputed p < .001

    “r(128) = .52, p < .001”

  • Consistentr(156) = 0.61reported p < .001 · recomputed p < .001

    “r(156) = .61, p < .001”

  • Consistentr(127) = 0.46reported p < .001 · recomputed p < .001

    “r(127) = .46, p < .001”

  • Consistentr(156) = 0.55reported p < .001 · recomputed p < .001

    “r(156) = .55, p < .001”

4 of 4

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

  • Disinhibited-behavior result is called significant despite its reported p-value

    Minor

    The reported p=.091 is above the conventional .05 threshold, but the next sentence calls the group difference significant. The reported Wald statistic of 6.73 with one degree of freedom also appears inconsistent with p=.091, so the result needs correction.

  • Boys-only analysis switches the stated outcome

    Minor

    This boys-only analysis follows a discussion of disinhibited social behavior, but its result is labeled as inhibited social behavior. The same paragraph describes the girls' and boys' estimates as group differences for the disinhibited outcome.

2 of 2

Cites

Flagged first, then by citations

Research works printed but not linked: 4

  1. 1980, Diagnostic and statistical manual of mental disorders
  2. 1994, Diagnostic and statistical manual of mental disorders
  3. 1987, Diagnostic and statistical manual of mental disorders
  4. 2013, Diagnostic and statistical manual of mental disorders: DSM-5

Cited by

Sorted by citations

Related

Authors
Humphreys, K. L., Nelson, C. A., Fox, N. A., & Zeanah, C. H.
Affiliations
  • Tulane University (US)
  • Boston Children's Hospital (US)
  • University of Maryland, College Park (US)
Corresponding author
Zeanah, Charles H.
ORCID
Venue
Development and Psychopathology
Publisher
Cambridge University Press (CUP)
Published
2017-04-12
Volume
29
Issue
2
Pages
675-684
ISSN
  • 0954-5794 (ISSN-L)
  • 1469-2198
DOI
10.1017/s0954579417000256
PMC
PMC5777580
OpenAlex
W2606571808
Cited by
74
References
47
Citations by year
2026: 9 · 2025: 4 · 2024: 4 · 2023: 6 · 2022: 7 · 2021: 8 · 2020: 9 · 2019: 6 · 2018: 15 · 2017: 5 · 2016: 1
FWCI
21.97
Type
journal article
Language
en
Open access
Licence
www.cambridge.org/core/terms (unspecified)
Locations
  • Development and Psychopathology (publishedVersion)
  • PubMed (publishedVersion)
  • Europe PMC (PubMed Central) (acceptedVersion)
  • PubMed Central (acceptedVersion)
Funders
  • National Institute of Mental Health (F32MH107129, R01MH091363)
  • Eunice Kennedy Shriver National Institute of Child Health and Human Development (U54HD090255)
Topics
  • Social Sciences › Safety Research › Child Welfare and Adoption
  • Social Sciences › Psychology › Clinical Psychology › Child Abuse and Trauma
  • Social Sciences › Psychology › Social Psychology › Attachment and Relationship Dynamics
Keywords
reactive attachment disorder, disinhibited social engagement disorder, attachment disorders, institutional care, foster care, early childhood deprivation, child abandonment, early adolescence
MeSH terms
Child, Child Care, Child, Institutionalized, Female, Foster Home Care, Humans, Male, Reactive Attachment Disorder

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Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

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