Children with Reactive Attachment Disorder, as defined by the DSM-5, exhibit:
- A consistent pattern of inhibited and emotionally withdrawn behavior toward caregivers; only occasional or minimal signs of seeking or responding to comfort when distressed
- At least two of the following:
- Minimal social and emotional responsiveness to others
- Limited positive affect
- Unexplained instances of irritability, sadness, or fear
- A past experience of extremely insufficient care, involving at least one of the following:
- Social neglect or deprivation, with basic needs for comfort, stimulation, and affection unmet
- Repeated change of primary caregivers that limits opportunities to form a stable attachment with a caregiver
- Growing up in an environment that seriously limits opportunities to form a stable attachment with a caregiver
For a child diagnosed with RAD, the experience of insufficient care is believed to account for the subsequent inhibited behavior toward caregivers. A child who receives this diagnosis should be at least 9 months of age, and the symptoms should be apparent before age 5. The child must not meet the criteria for Autism Spectrum Disorder.