Reactive Attachment Disorder (RAD) is a disorder of infancy and early childhood, characterized by a pattern of significant disturbance and developmentally inappropriate attachment behaviors. The infant or child will rarely or minimally turn preferentially to an attachment figure for comfort, support, protection, and/or nurturance. At its core, there is an absent or severely underdeveloped attachment between the child and the caregiving adult(s).
A consistent pattern of inhibited, emotionally withdrawn behaviour toward adult caregivers, manifested by both of the following:
A persistent social and emotional disturbance characterized by at least 2
of the following:
The child has experienced a pattern of extremes of insufficient care as evidenced by at least 1
of the following:
The care in Criterion C
is presumed to be responsible for the disturbed behaviour in Criterion A
(e.g. - the disturbances in Criterion A
began following the lack of adequate care in Criterion C
).
The criteria are not met for autism spectrum disorder.
The disturbance is evident before age 5
years.
The child has a developmental age of at least 9
months.
Specify if:
12
months.Specify current severity:
Reactive Attachment Disorder | Disinhibited Social Engagement Disorder | |
---|---|---|
Etiology | Social neglect, inconsistent parenting | Social neglect, inconsistent parenting |
Internal/External | Internalizing Disorder | Externalizing Disorder |
Clinical Presentation | Withdrawn emotions, depressive symptoms, flat affect, unexplained sadness, and irritability. | Overly familiar with strangers, lack of hesitation to approaching and interact with them. Diminished checking back with adult caregiver. |
Treatment | Caregiving environment | Caregiving environment |
Prognosis | Not well understood | Superficial relationships with peers, more peer-to-peer conflicts |