Autism and attachment disorder symptoms in the general population: Prevalence, overlap, and burden

Helen Minnis* (Corresponding Author), Claudia-Martina Messow, Alex McConnachie, Paul Bradshaw, Andrew Briggs, Philip Wilson, Christopher Gillberg

*Corresponding author for this work

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Co-occurring trauma-related and neurodevelopmental problems are common in maltreated children. In population research and clinical practice, these tend to be considered separately. Overlapping health problems, that is, “multi-morbidity,” in adulthood is associated with increased service burden and costs, but this has not been investigated in childhood.
Using well-validated parent-report questionnaires, we examined the overlap between symptoms of the neurodevelopmental disorder autism (autism spectrum disorder, ASD) and symptoms of the trauma- and stressor-related disorders (reactive attachment disorder [RAD] and disinhibited social engagement disorder [DSED]) in a representative general population sample of over 3,300 children aged 5–6 years of age. We investigated sociodemographic factors, service burden, and costs in association with these problems when considered separately and when co-occurring.
Nearly 2% of this population had symptoms suggestive of both ASD and RAD/DSED. High symptom scores for ASD were associated with male gender, (younger) age of mother at birth, and being in a single-parent family, while high symptom scores for RAD/DSED were associated with (younger) age of mother at birth, being in a single-parent family, and the number of accidents reported. Service use costs per likely case of both ASD and RAD/DSED in the preschool years were increased by £348.62 (95% confidence interval 121.04–391.11)—nearly double the costs of ASD alone.

There is considerable overlap between symptoms of ASD and RAD/DSED in the general population, indicating that multi-morbidity is already present in childhood and is associated with increased service use and costs even in the preschool years.
Original languageEnglish
Pages (from-to)37-51
Number of pages15
JournalDevelopmental Child Welfare
Issue number1
Early online date17 Feb 2020
Publication statusPublished - 1 Mar 2020

Bibliographical note

This work was supported by the Chief Scientist Office of the Scottish Government (CZG/2/565) and the Gillberg Neuropsychiatry Centre. We are grateful to all of the participants and to the Growing up in Scotland team for their support with this study.
The author(s) received no financial support for the research, authorship, and/or publication of this article


  • autism spectrum disorder
  • disinhibited social engagement disorder
  • general population
  • reactive attachment disorder


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