Autism and reactive attachment/disinhibited social engagement disorders: Co-occurrence and differentiation
Abstract
DSM-5 ( Diagnostic and Statistical Manual of Mental Disorders, 5th edition) Reactive Attachment Disorder (RAD) and Disinhibited Social Engagement Disorder (DSED) are rare disorders sharing social difficulties with autism. The DSM-5 and ICD-10 (International Classification of Diseases, 10th revsion) state that RAD/DSED should not be diagnosed in children with autism. The purpose of our study is to determine whether children can meet criteria for both autism and RAD/DSED and to identify specific symptoms discriminating the disorders. Subjects were 486 children with autism and no RAD/DSED and 20 with RAD/DSED, 4-17 years of age. In total, 13 children with RAD/DSED met criteria for autism. Using the Checklist for Autism Spectrum Disorder (CASD), there was no overlap in total scores between the RAD/DSED with autism group (score range = 15-27) versus the RAD/DSED without autism group (range = 7-10 ). The autism with and without RAD/DSED groups did not differ in CASD scores. Nine of the CASD autism symptoms were found only in the autism with and without RAD/DSED groups. Our study demonstrates that children can meet criteria for both autism and RAD/DSED and that the disorders are easily differentiated by the presence of specific autism symptoms. Autism is a neurogenetic disorder, and RAD/DSED results from severe social-emotional maltreatment. Given the different etiologies, there is no reason why a child cannot have both disorders.
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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 Mayes et al. 2017
Cites
Regier, D. A., Narrow, W. E., Clarke, D. E., Kraemer, H. C., Kuramoto, S. J., Kuhl, E. A., & Kupfer, D. J. (2013) · American Journal of Psychiatry · doi:10.1176/appi.ajp.2012.12070999 · Cited by 1,163 · cited 1× · see citing works
“RAD and DSED are rare disorders (Zeanah & Gleason, 2010), published empirical studies are few (Cappelletty, Brown, & Shumate, 2005; Zeanah & Gleason, 2010), and RAD/DSED cases were absent or too few to analyze in the DSM-5 field trials (Regier et al., 2013).”
BackgroundAutism and ADHD: Overlapping and discriminating symptoms
Mayes, S. D., Calhoun, S. L., Mayes, R. D., & Molitoris, S. (2012) · Research in Autism Spectrum Disorders · doi:10.1016/j.rasd.2011.05.009 · Cited by 324 · see citing works
Self-citationMattison, R. E., & Mayes, S. D. (2012) · Journal of Attention Disorders · doi:10.1177/1087054710380188 · Cited by 110 · cited 1× · see citing works
“…and has been used to diagnose and differentiate psychological problems in several published studies (Conrad, Richman, Lindgren, & Nopoulos, 2010; Mattison & Mayes, 2012; Mayes, Calhoun, Mayes, & Molitoris, 2012b; Mayes, Calhoun, Murray, Ahuja, & Smith, 2011; Mayes et al., 2012a; Nichols et al.,…”
MethodSelf-citationPrevalence of reactive attachment disorder in a deprived population
Minnis, H., Macmillan, S., Pritchett, R., Young, D., Wallace, B., Butcher, J., Sim, F., Baynham, K., Davidson, C., & Gillberg, C. (2013) · British Journal of Psychiatry · doi:10.1192/bjp.bp.112.114074 · Cited by 107 · cited 1× · see citing works
“Using ICD-10 criteria, only one of 13 children with RAD had the inhibited type alone in a study by Minnis et al. (2013).”
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Mayes, S. D., Calhoun, S. L., & Waschbusch, D. A. (2021) · Clinical Child Psychology and Psychiatry · doi:10.1177/1359104520978459 · Cited by 46 · see citing works
Self-citationYuhi, T., Kyuta, H., Mori, H.-A., Murakami, C., Furuhara, K., Okuno, M., Takahashi, M., Fuji, D., & Higashida, H. (2017) · Brain Sciences · doi:10.3390/brainsci7110152 · Cited by 32 · see citing works
Mayes, S. D., Seebeck, J., & Waschbusch, D. A. (2022) · Journal of Autism and Developmental Disorders · doi:10.1007/s10803-021-05222-2 · Cited by 15 · see citing works
Self-citationNeurexin1α 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
“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).”
- Authors
- Mayes, S. D., Calhoun, S. L., Waschbusch, D. A., & Baweja, R.
- Affiliations
- Pennsylvania State University (US)
- Corresponding author
- Mayes, Susan Dickerson
- Venue
- Clinical Child Psychology and Psychiatry
- Publisher
- SAGE Publications
- Published
- 2016-11-28
- Volume
- 22
- Issue
- 4
- Pages
- 620-631
- ISSN
- 1359-1045 (ISSN-L)
- 1461-7021
- OpenAlex
- W2558538284
- Cited by
- 58
- References
- 4
- Citations by year
- 2026: 2 · 2025: 5 · 2024: 6 · 2023: 4 · 2022: 10 · 2021: 6 · 2020: 8 · 2019: 7 · 2018: 6 · 2017: 4
- FWCI
- 3.62
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Clinical Child Psychology and Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- 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 › Psychoanalysis and Psychopathology Research
- Keywords
- autism spectrum disorder, reactive attachment disorder, disinhibited social engagement disorder, co-occurrence of disorders, diagnostic differentiation, DSM-5 diagnostic criteria, children
- MeSH terms
- Autism Spectrum Disorder, Adolescent, Child, Child Behavior Disorders, Child, Preschool, Diagnosis, Differential, Female, Humans, Male, Psychiatric Status Rating Scales, Social Behavior Disorders, Comorbidity, Reactive Attachment Disorder
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