Reactive Attachment Disorder of Infancy and Early Childhood

The essential feature of a reactive attachment disorder (RAD) is a marked disturbance in social relatedness that begins before age five years (in most contexts) and is associated with gross pathological care, which is presumed to be the cause of the disturbed social relatedness (Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition [DSM-IV], American Psychiatric Association, 1994). Gross pathological care includes a persistent disregard for the child's basic emotional and/or physical needs—a condition associated with child maltreatment. It can also include a lack of opportunity for the child to form a stable attachment with a primary caregiver, a circumstance that is associated with orphanages and multiple moves in the foster care system. However, gross pathological care does not always result in the development of ...