Reactive Attachment Disorder

Diagnostic Criteria: 313.89 (F94.1)

A.    A consistent pattern of inhibited, emotionally withdrawn behavior toward adult caregivers, manifested by both of the following:

1. Rarely or minimally seeks comfort when distressed

2. Rarely or minimally responds to comfort offered when distressed

B.    A persistent social and emotional disturbance characterized by at least 2 of the following:

1. Minimal social and emotional responsiveness to others

2. Limited positive affect

3. Episodes of unexplained irritability, sadness, or fearfulness which are evident during non-threatening interactions with adult caregiver

C. Child has experienced a pattern of extremes of insufficient care (pathogenic care) as evidenced by at least one of the following:

1.Social neglect or deprivation in the form of persistent lack of having basic emotional needs for comfort, stimulation, and affection met by caregiving adults

2. Repeated changes of primary caregiver that limit opportunities to form stable attachments (e.g., frequent changes in foster care)

3. Rearing in unusual settings that severely limit opportunities to form selective attachments (e.g. institutions with high child-to-caregiver ratios)

D. The care in Criterion C is presumed to be responsible for the disturbed behavior in Criterion A (e.g. the disturbances in criterion A began following lack of adequate care in Criterion C)

E. The criteria are not met for autism spectrum disorder

F.  Disturbance is evident before age 5

G. The child has a developmental age of at least 9 months

Specify if:

Persistent: The disorder has been present for more than 12 months

Specify current severity:

Reactive Attachment Disorder is specified as severe when a child exhibits all symptoms of the disorder, with each symptom manifesting at relatively high levels.

6B44: Reactive Attachment Disorder

Reactive attachment disorder is characterized by grossly abnormal attachment behaviors in early childhood, occurring in the context of a history of grossly inadequate, childcare (e.g. severe neglect, multi treatment, institutional deprivation).

Even when an adequate primary caregiver is newly available, the child does not turn into the primary caregiver for comfort, support, and nurture rarely displays security seeking behaviors towards any other and does not respond when comfort is offered.

Reactive attachment disorder can only be diagnosed in children, and features of the disorder develop within the first five years of life. However, the disorder cannot be diagnosed before the age of one year (or developmental age of less than nine months, when the capacity for selective attachments may not be fully developed, or in the context of spectrum disorder.

Exclusions: Asperger syndrome (coded as 6A02) and inhibited attachment disorder of childhood (coded as 6B 45)