A disorder of infancy or early childhood, with onset before the child is 5 years old, characterized by markedly disturbed and developmentally inappropriate social relatedness. In the inhibited type of reactive attachment disorder, failure to respond predominates, and responses are hypervigilant, avoidant, or highly ambivalent and contradictory. In the disinhibited type, indiscriminate sociability is characteristic, such as excessive familiarity with relative strangers or lack of selectivity in choice of attachment figures. Most children who develop this disorder are from a setting in which care has been grossly pathogenic. Typically, either the caregivers have neglected the child’s basic physical and emotional needs or repeated changes of the primary caregiver have prevented the formation of stable attachments.
Reactive attachment disorder (RAD) is characterized by a pervasive disturbance in social relatedness and associated with a history of inadequate care, in which a child’s physical and emotional needs are often neglected, attachment is disrupted by repeated change in the primary caregiver, or both. Not all children who experience neglect or abuse develop RAD, however; many of the children who are spared have formed stable relationships with other significant adults.
A developmental disorder of infancy or early childhood marked either by social isolation and withdrawal or by indiscriminate sociability. The disorder may result from neglect of the child by his or her primary caregiver or from frequent changes in caregivers (especially in children who have lost their parents or who have been moved frequently from one foster home to another).