DEFINITION

• Disorder of early childhood characterized by a consistent demonstration of withdrawal from adult caregivers[1]
  • Child rarely seeks comfort, mostly does not respond to emotional cues from others, rarely expresses positive affect, and has emotional outbursts that are not congruent with expected responses to current situations.[1]
  • Child was raised in a severely undernourished social environment (i.e. neglect, frequent foster care changes, or an institutional setting with limited child-adult attachment formation).[1]
• Classified under the Trauma- and Stressor-Related Disorders section of the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition, Text Revision (DSM-5-TR). The 2022 revision of the DSM distinguished reactive attachment disorder (RAD) as separate from Disinhibited Social Engagement Disorder (DSED), emphasized that early childhood neglect is a necessary feature, and expanded on the importance of cultural considerations.[1]