Short summary

The study aims to examine the validity of ICD-10 diagnoses Reactive Attachment Disorder and Disinhibited Attachment Disorder based on a cohort of danish children and adolescents 0-17 years. Hospital records on the cohort will be retrived. Records will be reviewed and rated accoring to a checklist for relevant information. The validity will be calculated using Positive Predictive Value (all patients with a diagnosis justified by hospital record review divided by the total reviewed sample).

Rationale

Attachment disorder reflects a condition, where a child´s normal and expected development of selective attachment towards the primary caregiver(s) has been interrupted, with severe implications for the child´s mental health. The disorders are caused by environmental factors described in ICD-10 as severe neglect, abuse or mishandling (Reactive Attachment Disorder) or a longstanding lack of opportunity to develop selective attachment due to a regular change in primary caregiver(s) (Disinhibited Attachmet Disorder). Attachment disorders are major risk factors for developing psychopathology such as depression and ADHD. Furthermore, studies show that children with attachment disorders have altered brain structure and function especially in areas connected to regulation of emotion. Hence, attachment disorders impact the ability to form healthy attachments. Attachment disorders of infancy and early childhood are rare diagnoses. The current evidence about the diagnoses are limited, as most studies are based on populations reared under extreme conditions with severe deprivation such as children growing up in Romanian orphanages. Therefore knowledge about predictors, characteristics, and long term outcomes of attachment disorders in Western societies are sparse. In the clinical setting, the diagnostic process of attachment disorders is complicated by difficulties in gaining valid information regarding neglect, abuse or mishandling in the early life years from caregivers. This in addition challenges the validity of the attachment disorder diagnoses. The aim of this study is to examine the validity of the ICD-10 diagnoses Reactive Attachment Disorder (RAD) and Disinhibited Attachment Disorder (DAD) registered for children 0-18 years old in the Danish National Patient Register. The characteristics of children and adolescents with these disorders such as gender, age, early development, and family - and rearing conditions will also be investigated.

Description of the cohort

We will identify all children and adolescents who received a first time primary or secondary diagnosis of attachment disorder at age 0-17 years during 2010-2022 from the National Patient Register. A random sample of N = 500 will be extracted and linked using the personal identification number with the Danish National Health Data Authority.

Data and biological material

Hospital records on the diagnostic process retrieved from the psychiatric clinic that assigned the diagnosis.

Collaborating researchers and departments

Clinical Pharmacology, Pharmacy and Environmental Medicine, University of Southern Denmark

• Anton Pottegaard
• Helene Christine Kildegaard Jensen
• Rikke Wesselhøft