Reactive attachment disorder is a trauma- and stressor-related early childhood syndrome caused by social neglect or maltreatment, according to the DSM-5. Children with this condition have trouble making emotional connections, cannot feel pleasant emotions, cannot tolerate physical or emotional contact, and may react aggressively when held, caressed, or comforted. Children with this condition are unpredictable, hard to soothe, and hard to discipline. Children may seem to live in a “flight, fight, or freeze” state due to mood swings. Most want to control their surroundings and make decisions. Sudden routine changes, punishment efforts, or unwanted consolation may cause fury, aggression, or self-harm. These obstacles hinder academic learning and lead to teacher and peer rejection.

Social functioning is severely impaired by reactive attachment disorder (RAD). Research suggests that children with RAD may have low cognitive and verbal skills, although it is mostly from biased, institutionalized samples. An epidemiological study of 1,600 children examined the incidence of reactive attachment disorder in the general community. All children who were suspected or likely diagnosed with RAD were included in the study. It was found that children with RAD are more likely to have multiple comorbidities, lower IQs than population norms, more disorganized attachment, more problem behaviors, and poorer social skills than the general population, resulting in ESSENCE-like complexity.

Sources report that this condition is considered to be quite uncommon, with an estimated frequency of 0.9% in 1.5-year-olds. Research conducted to determine the prevalence of RAD in a community of children that come from a poor background revealed that 23 children were definitively diagnosed with RAD, indicating that the prevalence of RAD in this community of 1.40%.

The diagnostic criteria and features of RAD in the light of DSM 5 TR are given below:

Diagnostic Criteria

A. A continuous pattern of constrained, emotionally detached conduct toward adult caregivers, as evidenced by both of the following:
1. When the kid is disturbed, he or she seeks just limited reassurance.
2. When the kid is unhappy, he or she responds very little to consolation.
B. A persistent social and emotional disturbance that includes at least two of the following:
1. Low social and emotional receptivity to others.
2. Limited beneficial impact.
3. Unexplained irritation, sorrow, or fearfulness that persists even during nonthreatening encounters with adult caregivers.
C. The kid has had a pattern of extremely inadequate care, as shown by at least one of the following:
1. Social neglect or deprivation is defined as a continuous absence of essential emotional requirements for comfort, excitement, and love supplied by caring adults.
2. Frequent changes in main caregivers restrict the possibility of building solid relationships (for example, in foster care).
3. Raising children in atypical circumstances that significantly limit possibilities for selective attachment (for example, institutions with high child-to-caregiver ratios).
D. The care in Criterion C is assumed to be accountable for the disturbed behavior in Criterion A (for example, the disruptions in Criterion A began as a result of the absence of proper care in Criterion C).
E. The autism spectrum disorder diagnostic criteria are not met.
F. The disruption appears before the age of five years.
G. The child’s developmental age is at least nine months.
Specify if
Persistent: The condition has existed for longer than 12 months.
Specify the current severity:
Reactive attachment disorder is considered severe when a kid displays all of the condition’s symptoms at relatively high levels.

Diagnostic Features

• Developmentally inappropriate attachment behaviors are called reactive attachment disorder.
• This condition causes a youngster to seldom seek comfort, support, protection, and care from an attachment figure.
• The child’s lack of contact with caregivers is the key indicator.
• Some believe reactive attachment disorder youngsters can form choice attachments. However, they don’t exhibit selective bonding behavior since they don’t have many opportunities to do so as young animals.
• They don’t always seek comfort, support, care, or protection from guardians when disturbed.
• Kids with this condition don’t react well to adult soothing attempts when distressed. Thus, the condition involves not seeking or responding to soothing techniques.
• This makes reactive attachment disorder youngsters less pleased with their caretakers.
• They also have problems managing their emotions, causing unexplained dread, despair, and fury.
• Reactive attachment disorder should not be diagnosed in youngsters who cannot build selected attachments yet. For this, the youngster must be 9 months old.
• Multiple sources aid diagnosis, demonstrating that signals are visible in varied circumstances.