Reactive Attachment Disorder

Reactive attachment disorder (RAD) is categorized as a Trauma- and Stressor-Related Disorder in the fifth edition of The Diagnostic and Statistical Manual of Mental Disorders (DSM-5; American Psychiatric Association [APA], 2013). A RAD diagnosis may be assigned to children who have experienced gross neglect by caregivers and who subsequently have significant problems forming healthy, selective attachments to others. Children who exhibit RAD may demonstrate contradictory behaviors in social situations, including hypervigilance (intensely scrutinizing caregivers’ responses), ambivalence (not responding to caregiving), and incongruence (initiating social connections with caregivers then rebuffing caregivers’ responses). Although RAD symptoms may co-exist with other intellectual and developmental delays, RAD behaviors are not attributed to other mental health issues, medical disorders, or developmental delays. A RAD diagnosis may be considered for children older than 9 months of age who exhibit a range of unique and inappropriate social behaviors before age 5.