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. 2025 Sep;32(6):839-858.
doi: 10.1177/10731911241276625. Epub 2024 Sep 25.

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

Maude Archambault  1   2 , Chantal Cyr  1   2 , Helen Minnis  3 , Stine Lehmann  4 , Sebastien Monette  1   2
Affiliations

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

Maude Archambault et al. Assessment. 2025 Sep.

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.

Keywords: attachment disorders; child protective services; disinhibited social engagement disorder; maltreatment; out-of-home care; reactive attachment disorder.

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Conflict of interest statement

Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.
CFA: Model comparison. RAD = reactive attachment disorder; DSED = disinhibited social engagement disorder; RAD A = A criteria for RAD in DSM-5: low attachment selectivity; RAD B1–B2 = B1 and B2 criteria for RAD in DSM-5: low social and emotional responsiveness; RAD B3 = B3 criterion for RAD in DSM-5: emotional unpredictability.
Figure 2.
Figure 2.
Best fitting models for the RADA. RAD = reactive attachment disorder; DSED = disinhibited social engagement disorder; RAD A = A criteria for RAD in DSM-5: low attachment selectivity; RAD B1 -B2 = B1 and B2 criteria for RAD in DSM-5: low social and emotional responsiveness; RAD B3 = B3 criterion for RAD in DSM-5: emotional unpredictability.
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