Attachment disorder in autism spectrum disorder and intellectual disability

Published date04 March 2019
DOIhttps://doi.org/10.1108/AMHID-09-2018-0039
Pages57-66
Date04 March 2019
AuthorArvid Nikolai Kildahl,Maria Hagen Engebretsen,Sissel Berge Helverschou
Subject MatterHealth & social care,Learning & intellectual disabilities
Attachment disorder in autism spectrum
disorder and intellectual disability
Arvid Nikolai Kildahl, Maria Hagen Engebretsen and Sissel Berge Helverschou
Abstract
Purpose Autism spectrumdisorder (ASD) is an exclusioncriterion for one of the two attachmentdisorders in
the DSM5. However, previous findingsindicate that ASD andattachment disorder areunrelated conditionsand
may co-occur. Thepurpose of this paper is to explorethe diagnostic assessment of an adolescent male with
ASD, intellectualdisability (ID), severe challenging behaviour and a suspected attachmentdisorder.
Design/methodology/approach Case study methodology was chosen because of its suitability in the
exploration of complex clinical phenomena where prior knowledge is sparse.
Findings It was possible to identify symptoms of attachment disorder in a case involving ASD, ID, anxiety
and severe challenging behaviour. The Disturbances of Attachment Interview was particularly useful in this
assessment, as was assessment of ASD symptoms and developmental history. Differentiating the two
attachment disorders proved challenging.
Research limitations/implications There is a need for further research in ASD and attachment disorders
not limited by current diagnostic categories.
Practical implications Co-occurring symptoms of attachment disorder may be identified in individuals
with ASD and ID, and exploration of these symptoms in assessments of children and adolescents with ASD/
ID and challenging behaviour may be beneficial.
Originality/value The study adds to previous findings on attachment disorder in ASD, demonstrating that
identification of attachment disorder is possible even in the presence of a highly complex clinical picture
involving severe challenging behaviour. It may also assist other clinicians in identifying and making more
accurate assessment of attachment disorder in ASD and ID.
Keywords Intellectual disability, Assessment, Autism spectrum disorder, Attachment disorder,
Disinhibited social engagement disorder, Reactive attachment disorder
Paper type Case study
Introduction
The essential feature of attachment disorder is absent, disturbed or grossly underdeveloped
attachment between the child and putative caring adults (Zeanah and Gleason, 2010, 2015). The
DSM 5 includes criteria for two attachment disorders: reactive attachment disorder (RAD) and
disinhibited social engagement disorder (DSED) (American Psychiatric Association, 2013). Main
criteria for RAD include inhibited, emotionally withdrawn behaviour towards adult caregivers and
social/emotional disturbance. Main criteria for DSED include behaviours in which children actively
approach and interact with unfamiliar adults in overly familiar ways, and a lack of checking back
with familiar adults. A history of extremes of insufficient care presumed to be responsible for the
disturbed behaviour must be present for both disorders, as well as a developmental age of at
least nine months. RAD also requires that the disturbance is evident before age five years, as well
as the exclusion of autism spectrum disorder (ASD) (American Psychiatric Association, 2013; see
also the ICD 10, World Health Organization, 1992).
According to Zeanah and Gleason (2015), RAD and DSED are most appropriately conceptualised as
separate, rather than subtypes of the same disorder. RAD requiring the exclusion of ASD seeks to
distinguish between deficient social behaviour induced by neglect and deprivationfrom that caused
by innate neurodevelopmental disorders such as ASD (Zeanah and Gleason, 2015; Lai et al., 2014).
However, during revision of the DSM, Zeanah and Gleason (2010, p. 11) concluded that data were
Received 7 September 2018
Revised 7 February 2019
10 April 2019
Accepted 10 April 2019
The authors would like to thank
Professor emerita Patricia Howlin
for her helpful comments in the
preparation of this manuscript, as
well as Trine Lise Bakken, Jane
Hellerud, Espen Arnfinn Winther
Matre, Trine Elisabeth Iversen,
Anne Lise Enger Nilssen and Dina
Tegle Stenstad for valuable
discussions on anxiety and
attachment in ASD and for
contributing to making this
study possible.
Arvid Nikolai Kildahl is based at
Regional Section Mental Health,
Intellectual Disabilities/Autism,
Oslo University Hospital, Oslo,
Norway and
NevSom NorwegianCentre of
Expertise for
Neurodevelopmental Disorders
and Hypersomnias, Oslo
UniversityHospital,
Oslo, Norway.
Maria Hagen Engebretsen is
based at Regional Section
Mental Health, Intellectual
Disabilities/Autism, Oslo
University Hospital,
Oslo, Norway.
Sissel Berge Helverschou is
based at NevSom Norwegian
Centre of Expertise for
Neurodevelopmental Disorders
and Hypersomnias, Oslo
University Hospital,
Oslo, Norway.
DOI 10.1108/AMHID-09-2018-0039 VOL. 13 NO. 2 2019, pp.57-66, © Emerald Publishing Limited, ISSN 2044-1282
j
ADVANCESIN MENTAL HEALTH AND INTELLECTUAL DISABILITIES
j
PAGE57

To continue reading

Request your trial

VLEX uses login cookies to provide you with a better browsing experience. If you click on 'Accept' or continue browsing this site we consider that you accept our cookie policy. ACCEPT