A Systematic Review on Assessing Assessments: Unveiling Psychometric Properties of Instruments for Reactive Attachment Disorder and Disinhibited Social Engagement Disorder in Minors under Protective Measures
Abstract
:1. Introduction
1.1. Instruments Assessing Attachment Disorders
- Disturbance Attachment Interview (DAI): The DAI, developed by Smyke and Zeanah [31], is a semi-structured interview consisting of 12 items administered to a primary caregiver or someone well-acquainted with the child. It aims to assess signs related to disordered attachment and symptoms of both RAD and DSED. The items cover inhibited behaviors for RAD diagnosis, such as the absence of a preferred adult, lack of comfort-seeking, and limited social reciprocity. For DAI diagnosis, disinhibited behaviors are evaluated, including a lack of caution with strangers and a willingness to go with unknown adults. Scoring for the DAI ranges from 0 to 10 for RAD and 0 to 8 for DSED [32].
- The Preschool Age Psychiatric Assessment (PAPA): The authors of [33] developed the PAPA, a caregiver-reported questionnaire designed for preschoolers aged 2–8 years. This assessment evaluates RAD and DSED based on DSM-5 criteria. RAD classification requires meeting RAD criteria A1 and one or more criteria B. For DSED, participants must meet at least two DSED criteria [34].
- Reactive Attachment Disorder and Disinhibited Social Engagement Disorder Assessment (RADA): Developed by Lehmann et al. [26], the RADA assessment follows DSM-5 criteria. It features 11 items for RAD and 9 for DSED. TAR includes two factors, incapacity to seek/accept comfort and low socioemotional responsiveness/emotional dysregulation, whereas DSED has one factor related to indiscriminate behaviors [26].
- Development and Well-Being Assessment RAD/DSED (DAWBA RAD/DSED): A section within the DAWBA interview [25] that includes 14 items derived from the Child and Adolescent Psychiatric Assessment for RAD/DSED. These items assess social behaviors of concern to caregivers, scoring from 0 to 10 for TAR and 0 to 18 for DSED [37].
- RAD Questionnaire (Questionnaire Disorder Attachment Reactive): The RAD Questionnaire, developed by Minnis et al. [38,39], consists of 17 items evaluating both reactive and disinhibited attachment disorders concurrently. Scores on this questionnaire range from 0 to 51, with higher scores indicating more severe attachment disorder symptoms [28].
1.2. The Current Study
2. Materials and Methods
2.1. Search Strategy
2.2. Study Selection
2.3. Procedure
2.4. COSMIN Checklist for Systematic Reviews of PROMs
3. Results
3.1. Characteristics of the Samples of the Studies Analyzed
3.2. Methodological and Measurement Quality of the Instruments Results
- Disturbance Attachment Interview (DAI): In the majority of instances, the primary focus lies on structural validity and internal consistency. In this context, two out of the four studies conducted analyses on structural validity, both employing confirmatory factor analysis. However, one of them [43] had a limited sample size (<5 times the number of items). Regarding criterion validity, only one study examined it [43]. Concerning hypothesis testing and construct validity, several tests were conducted, but without establishing a priori hypotheses.
- The Preschool Age Psychiatric Assessment (PAPA): A study conducted by Seim et al. [33] evaluated the psychometric properties of the PAPA, with a primary focus on criterion validity, measurement error, and discriminant validity. The study produced positive results concerning the two-factor factorial structure (inhibited and disinhibited) as well as discriminant validity. It was observed that RAD and DSED were distinct constructs from each other and other mental health issues.
- Relationship Patterns Questionnaire (RPQ): A study conducted by Schöder et al. [42] examined the internal consistency and measurement error of the RPQ. The study reported satisfactory values for internal consistency (overall scale α = 0.82; inhibition subscale α = 0.75; disinhibition subscale α = 0.81). Regarding criterion validity analysis and responsiveness, calculations were undertaken in the study by Schröder et al. [15]. Significant Area Under the Curve (AUC) values were obtained, signifying diagnostic accuracy, with lower accuracy observed in boys compared to girls. The study also proposed diagnostic cut-off points.
- Reactive Attachment Disorder and Deshinhibited Social Engagement Disorder Assessment (RADA): A singular study evaluated the psychometric properties of the RADA [26]. The study centered on analyzing its factorial structure by suggesting a three-construct factorial solution (DSED: indiscriminate behaviors with strangers; RAD1: inability to seek/accept comfort; RAD2: withdrawal/hypervigilance). Additionally, the study explored internal consistency, as well as criterion and construct validity.
- Developmental and Well-Being Assessment RAD/DSED (DAWBA RAD/DSED): Lehmann et al. [12] examined structural validity through a confirmatory factor analysis with two factors, aligning with the DSM-5 definition. Concerning construct validity, the study sought to differentiate difficulties between SDQ, DSED, and RAD.
- RAD Questionnaire: Minnis et al. [39] evaluated structural validity, internal consistency, temporal consistency, measurement error, and criterion validity. Adequate indicators were obtained in all cases. Consequently, the tool demonstrated satisfactory internal consistency for use in research settings (α = 0.7). The relationship between the questionnaire and the SDQ was examined, revealing very high correlations, which, in general terms, may not necessarily be positive.
3.3. Criteria Measurement: Quality of the Instruments
3.4. Strength of Evidence
4. Discussion
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Questionnaires | Psychometric Properties | Samples | ||
---|---|---|---|---|
Disturbance Attachment Interview OR DAI The Preschool Age Psychiatric Assessment OR PAPA Relationship Patterns Questionnaire OR RPQ Reactive Attachment Disorder and Disinhibited Social Engagement Disorder Assessment OR RADA Developmental and Well-Being Assessment RAD/DSED OR DAWBA RAD/DSED Questionnaire Disorder Attachment Reactive OR RAD Questionnaire | AND | validity OR measurement error OR reliability OR invariance OR cross OR retest OR consistency OR responsive | AND | foster OR adopt OR residential foster care |
Article and Instrument | Application Information (Procedure) | Country, Sample, and Characteristics of Samples |
---|---|---|
Kliewer-Neumann et al. (2018)—DAI and RAD [28] | Audio-recorded interviews with parents and observation of the child in the laboratory. Time 30 min. Two trained evaluators independently analyzed the interviews. | Germany. n = 55. Foster children from German youth welfare programs. The children ranged in age from 12 to 82 months (M = 35.87; SD = 18.37), with 50.9% being female (n = 28). These children had been in foster care for an average of 78 days, and some of them had experienced up to 5 changes in placement or families. |
Kliewer-Neumann et al. (2015)—DAI [43] | Two observations are made of the caregiver–child interaction. In the home, the Stranger at the Door procedure and questionnaires are administered. Door procedure and questionnaires are administered. It is videotaped for 3 h. In the laboratory, the Stranger at the Door procedure and the IAD are administered. Door procedure and the DAI. | Germany. n = 50. Foster children aged between 34 and 104 months (M = 68.32; SD = 19.29), with 48% being female (n = 24). The children had been living with their foster families for an average of 45.36 months. |
Smyke et al. (2002)—DAI [32] | Interview educators in the foster care institution and foster parents at home. In addition, files of institutionalized children are reviewed. Interviews are conducted in Romanian and English with the help of an interpreter. The duration of the assessment is not specified. Foster mothers receive a compensation of USD 10. | Romania. n = 94. Children residing in a large institution in Bucharest (n = 32), young children residing in the same institution but in a pilot unit (n = 29), and young children living in foster care who had never been institutionalized (n = 33). All children ranged in age from 4 months to 68 months. |
Elovainio et al. (2015)—DAI [15] | Self-report questionnaires are administered to children and adoptive parents. The duration of the assessment is not specified. | Finland. n= 853. Boys and girls adopted as part of a Finnish adoption study (FinAdo), involving international adoption. The participants’ ages ranged from 6 to 15 years (M = 8.5; SD = 2.9), and they had been adopted for an average of 2.4 years (SD = 1.3). Prior to adoption, they had experienced various placement resources, including foster care and residential care, among others. An adapted version of the DAI was administered. |
Seim et al. (2020)—PAPA [33] | Psychiatric interviews are conducted with the adolescents and their primary educators in the residential centers. Four trained and experienced researchers conduct the assessment. Data are collected between June 2011 and July 2014. The duration of the assessment is not specified. | Norway. n = 400. Adolescents aged between 12 and 23 years, residing in Norwegian residential centers. The participants had a mean age of M = 16.7 (SD = 3.9), an average of 3.3 out-of-home placements (SD = 2.4), and the mean age of their first out-of-home placement was 12.5 years (SD = 3.9). |
Schröder et al. (2019)—RPQ [42] | Children and parents are informed of the purpose of the study. Children’s and parents’ assessments are videotaped and transcribed. Evaluators are trained and certified to carry out the assessment of the instruments. Time of application and number of sessions are not specified. | Switzerland and Germany. n = 135. Children with a mean age of 7.17 years (SD = 1.40). The sample divided participants into three groups: general population (n = 34), with a mean age of 6.36 years (SD = 1.06); hospitalized and outpatient patients (n = 69), with a mean age of 7.39 years (SD = 1.42); and the foster care group (n = 32), with a mean age of 7.52 years (SD = 1.42). Children with an IQ ≤ 70 or with ASD were excluded. |
Lehmann et al. (2020)—RADA [26] | The assessment takes place between October 2016 and March 2017. Foster parents and adolescents complete the instruments online or by telephone. Teenagers receive a gift card of 33 USD. | Norway. n = 320. Youth living in foster care for an average of 6.6 years (SD = 4.3), aged between 11 and 17 years (M = 14.8, SD = 2.0), with 56.8% being boys. |
Lehmann et al. (2016)—DAWBA [12] | Data are collected between September 2011 and February 2012. Each child’s social worker completes The Child Protection Questionnaire. Approximate time between 10 and 20 min. Foster parents complete the questionnaires online. First the SDQ (approximately 10 min) and then the DAWBA RAD/DSED (approximately 5 min). Subsequently, they complete The Child Protection Questionnaire. | Norway. n = 122. Adopted children aged between 0 and 10 years in Norway, of which 57% were girls. Children with severe neurological problems are not included in the study. |
Minnis et al. (2002)—RAD Questionnaire [39] | The RAD is filled in by the foster parents independently. Between 3 and 5 weeks later, they fill in the RAD again. Social workers provide information regarding the child protection file. | Scotland. n = 182. Scottish children residing in foster homes aged between five and sixteen years (M = 11) and had spent an average of 2.5 years with their current foster caregivers. |
Psychometric Property | Articles | Psychometric Property | Articles |
---|---|---|---|
Structural validity | Measurement error | ||
Excellent | 4, 5, 7, 8, 10 | Excellent | |
Good | Good | ||
Fair | Fair | ||
Poor | 2 | Poor | |
Unknown/NA | 1, 3, 10 | Unknown/NA | 1, 2, 3, 4, 5, 6, 7, 8, 9, 10 |
Internal consistency | Criterion validity | ||
Excellent | 2, 3, 6, 7, 10 | Excellent | 2, 4, 5, 6, 7, 10 |
Good | Good | ||
Fair | Fair | ||
Poor | 5 | Poor | |
Unknown/NA | [12,15,28] | Unknown/NA | 1,3,8 |
Cross-cultural validity/ measurement invariance | Hypothesis testing for construct validity | ||
Excellent | Excellent | 1 | |
Good | Good | 9 | |
Fair | Fair | ||
Poor | Poor | ||
Unknown/NA | 1, 2, 3, 4, 5, 6, 7, 8, 9, 10 | Unknown/NA | 1,2,3,4,5,6,7,8,9,10 |
Reliability | Responsiveness | ||
Excellent | 1, 3, 10 | Excellent | |
Good | Good | ||
Fair | Fair | ||
Poor | Poor | ||
Unknown/NA | 1, 3, 4, 5, 6, 7, 8, 9 | Unknown/NA | 1, 2, 3, 4, 5, 6, 7, 8, 9, 10 |
Study and Instrument | Structural Validity | Internal Consistency | Crosscultural Validity Measurement Invariance | Reliability | Measurement Error | Criterion Validity | Hypothesis Testing for Content Validity | Responsiveness |
---|---|---|---|---|---|---|---|---|
Kliewer-Neumann et al. (2018)—DAI [28] | ? | ? | ? | + | ? | ? | + | ? |
Kliewer-Neumann et al. (2015)—DAI [43] | ? | + | − | ? | ? | + | ? | ? |
Smyke et al. (2002)—DAI [32] | ? | + | ? | + | ? | ? | ? | ? |
Elovainio et al. (2015)—DAI [15] | + | ? | ? | ? | ? | + | ? | ? |
Seim et al. (2020)—PAPA [33] | + | + | ? | ? | ? | + | ? | ? |
Schröder et al. (2019)—RPQ [42] | + | ? | ? | ? | + | ? | ? | |
Lehhmann et al. (2020)—RADA [26] | + | + | ? | ? | ? | + | ? | ? |
Lehmann et al. (2016)—DAWBA [12] | + | ? | ? | ? | ? | ? | ? | ? |
Kliewer-Neumann et al. (2018)—RAD [28] | ? | ? | ? | ? | ? | ? | + | ? |
Minnis et al. (2002)—RAD [39] | + | ? | ? | ? | ? | + | ? | ? |
Study and Instrument | Structural Validity | Internal Consistency | Crosscultural Validity/ Measurement Invariance | Reliability | Measurement Error | Criterion Validity | Hypothesis Testing for Content Validity | Responsi Veness | % Strong- Moderate Evidence | Average Percentage Evidence of Instruments |
---|---|---|---|---|---|---|---|---|---|---|
Kliewer-Neumann et al. (2018)—DAI [28] | U | U | U | S | U | U | S | U | 25% | 28.13% |
Kliewer Neumann et al. (2015)—DAI [43] | U | S | M | U | U | S | U | U | 37.5% | |
Smyke et al. (2002)—DAI [32] | U | S | U | S | U | U | U | U | 25% | |
Elovainio et al. (2015)—DAI [15] | S | U | U | U | U | S | U | U | 25% | |
Seim et al. (2019)—PAPA [33] | S | S | U | U | U | S | U | U | 37.5% | 37.5% |
Schröder et al. (2019)—RPQ [42] | U | S | U | U | U | S | U | U | 25% | 25% |
Lehmann et al. (2020)—RADA [26] | S | S | U | U | U | S | U | U | 37.5% | 37.5% |
Lehmann et al. (2016)—DAWBA [12] | S | U | U | U | U | U | U | U | 12.5% | 12.5% |
Kliewer-Neumann et al. (2018)—RAD [28] | U | U | U | U | U | U | S | U | 12.5% | 18.7% |
Minnis et al. (2002)—RAD [39] | S | U | U | U | U | S | U | U | 25% | |
% strong-moderate evidence | 40% | 50% | 0% | 20% | 0% | 60% | 20% | 0% | ||
% limited conflicting evidence | 0% | 0% | 0% | 80% | 0% | 0% | 0% | 0% | ||
% unknown evidence | 50% | 50% | 90% | 80% | 100% | 40% | 80% | 100% |
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Talmón-Knuser, F.; Soler, M.; González-Sala, F.; Lacomba-Trejo, L.; Samper-García, P. A Systematic Review on Assessing Assessments: Unveiling Psychometric Properties of Instruments for Reactive Attachment Disorder and Disinhibited Social Engagement Disorder in Minors under Protective Measures. Children 2024, 11, 144. https://doi.org/10.3390/children11020144
Talmón-Knuser F, Soler M, González-Sala F, Lacomba-Trejo L, Samper-García P. A Systematic Review on Assessing Assessments: Unveiling Psychometric Properties of Instruments for Reactive Attachment Disorder and Disinhibited Social Engagement Disorder in Minors under Protective Measures. Children. 2024; 11(2):144. https://doi.org/10.3390/children11020144
Chicago/Turabian StyleTalmón-Knuser, Florencia, Miriam Soler, Francisco González-Sala, Laura Lacomba-Trejo, and Paula Samper-García. 2024. "A Systematic Review on Assessing Assessments: Unveiling Psychometric Properties of Instruments for Reactive Attachment Disorder and Disinhibited Social Engagement Disorder in Minors under Protective Measures" Children 11, no. 2: 144. https://doi.org/10.3390/children11020144