Validation of the Reactive Attachment Disorder and Disinhibited Social Engagement Disorder Assessment (RADA): A DSM-5 Semistructured Interview

Abstract

Very few empirically validated tools exist for assessing reactive attachment disorder (RAD) and disinhibited social engagement disorder (DSED). The RAD and DSED assessment interview (RADA), a semistructured diagnostic interview, was updated in 2018 from the CAPA-RAD interview to reflect the diagnostic criteria changes in the Diagnostic and statistical manual of mental disorders (5th ed.; DSM-5). The aim of this study was to validate the RADA on school-age children in Canada. Caregivers of 5 to 12-year-old children from the community (n = 98), in foster care (n = 147), and in residential care (n = 123) completed the RADA interview and a series of questionnaires. Confirmatory factor analysis (CFA) of the RADA interview supported a four-factor structure similar to the DSM-5 symptom clusters. A short “strictly DSM-5” version of the RADA showed a two-factor structure—RAD and DSED—and an excellent fit to the data. Scales of both structures showed good-to-excellent internal consistency, interrater reliability, convergent validity, and known-group validity. Classifying the children yielded RAD and DSED rates of <1% and 18%, respectively, for children in foster care and 7% and 10%, respectively, for children in residential care. This study supports the validity of the RADA interview for school-age children and is the first to provide RAD and DSED rates for children in residential care.