Reactive Attachment Disorder (RAD)

Reactive Attachment Disorder (RAD)

Currently Reactive Attachment Disorder (RAD) is the diagnosis associated with attachment impairment. There is little research available as to the prevalence of this disorder, but there are thousands of children who have been impacted by trauma and exhibit many of the symptoms that are part of the definition below. Some children are diagnosed with PTSD or other conditions instead of (or in addition to) RAD. The DSM-5 is slated to be published in 2013 and is likely to contain a much different definition of attachment disorders. For now, this is the official definition:

Definition from the DSM-IV 313.89: Reactive Attachment Disorder of Infancy or Early Childhood

Markedly disturbed and developmentally inappropriate social relatedness in most contexts, beginning before age 5 years, as evidenced by either (1) or (2):
persistent failure to initiate or respond in a developmentally appropriate fashion to most social interactions, as manifest by excessively inhibited, hypervigilant, or highly ambivalent and contradictory responses (e.g., the child may respond to caregivers with a mixture of approach, avoidance, and resistance to comforting, or may exhibit frozen watchfulness)

diffuse attachments as manifest by indiscriminate sociability with marked inability to exhibit appropriate selective attachments (e.g., excessive familiarity with relative strangers or lack of selectivity in choice of attachment figures)


The disturbance in Criterion A is not accounted for solely by developmental delay (as in Mental Retardation and does not meet criteria for a Pervasive Development Disorder)

Pathogenic care as evidenced by at least one of the following:

persistent disregard of the child’s basic emotional needs for comfort, stimulation, and affection

persistent disregard of the child’s basic physical needs

repeated changes of primary caregiver that prevent formation of stable attachments (e.g., frequent changes in foster care)


There is a presumption that the care in Criterion C is responsible for the disturbed behavior in Criterion A (e.g., the disturbances in Criterion A began following the pathogenic care in Criterion C).

Specify type:

Inhibited Type: if Criterion A1 predominates in the clinical presentation
Disinhibited Type: if Criterion A2 predominates in the clinical presentation