Attachment Disorders in Foster Care: A Preliminary Study of Functional Impairment in School-aged Children

• In Event: Poster Session 11
  In Poster Session: PS 11 Topic - Developmental Psychopathology

Abstract

Introduction.
Attachment disorders (AD), namely reactive attachment disorder (RAD) and disinhibited social engagement disorders (DSED), are psychiatric disorders that children may develop as a result of severe early adversity (Zeanah & Gleason, 2015). Data on functional impairment in RAD and DSED come from studies with previously institutionalized children (Bucharest early intervention project, etc.). These studies show that RAD seems to be associated with greater social/relational impairment than DSED, but both are associated with general functional impairment (Gleason et al., 2011). Given that psychiatric disorders usually involve functional impairment (FI), there are surprisingly few studies that document the functional impairment of children with an AD in child protective services (CPS). The objective of this study is to examine the association of RAD and DSED symptoms with functional impairment in foster care children.

Method

Sample. The sample consists of 75 foster parents of 6-12 year-old children (M age = 8.35, SD = 2.36, 59% boys). Children with ASD were excluded (because ASD symptoms can mimic those of RAD) and children had to have a stable primary caregiver for the last six months.

Measures. Foster parents completed a questionnaire assessing RAD (25 items) and DSED (16 items) symptoms based on DSM-5 criteria (ETRADQ; Monette et al., submitted). Functional impairment data (e.g. feeding, getting dressed, hygiene, elimination, mobility, impulse control, emotions, relational abilities, etc.) were extracted from an annual clinical interview (1h00) led by CPS professional and used to determine the annual financial support to foster families.

Results (table 1). RAD was significantly associated with the total score of functional impairment (r = .40), whereas DSED wasn’t. RAD was associated with deficits in many domains: mobility/stairs (r = .40), impulse control (r = .28), emotion regulation/identification (r = .23), relational abilities (r = .39) and self-destructive behaviors (r = .28). DSED was only associated with deficits in hygiene/bath-shower (r = .24) and mobility/moving around (r = .30).

Discussion. To our knowledge, this is the first study to explore functional impairment associated with RAD-DSED symptoms in children in foster care. Results indicate that DSED symptoms are not associated with global functional impairment, but with impairment in more specific domains (hygiene, mobility). The examples of behaviors noted by the interviewers (table 1) however suggest the mobility deficits simply reflect the known symptoms of DSED (putting oneself in danger when approaching strangers). Results indicate that RAD symptoms are associated with functional impairment in many domains and with global functional impairment (r = .40). This association of RAD with many functional deficits could explain the low rate of RAD found in foster care (3% in our data, but 2-5% also in Bruce et al. 2018; Jonkman et al., 2014), compared to residential care, suggesting that children with RAD typically do not succeed in staying in foster care and many of them end up being placed in residential care.

Authors

• Marie-Claude Long, L'Université du Québec à Montréal (UQAM)
  Presenting Author

• Sebastien Monette, Université du Québec à Montréal (UQAM)
  Non-Presenting Author

• Chantal Cyr, Université du Québec à Montréal (UQAM)
  Non-Presenting Author

• Miguel M. Terradas, Univerisité de Sherbrooke
  Non-Presenting Author

• Sophie Couture, Université de Sherbrooke
  Non-Presenting Author