The diagnosis of Reactive Attachment Disorder (RAD) (or the other subtype Disinhibited Social Engagement Disorder refers to the abnormal process of attachment due to social neglect or other situations that limit a young child’s opportunity to form selective attachments. RAD has several criteria that must be met in order to meet the diagnosis according to the DSM-5. Although sharing this etiological pathway, the two disorders differ in important ways.
Because of dampened positive affect, reactive attachment disorder more closely resembles internalizing disorders; it is essentially equivalent to a lack of or incompletely- formed preferred attachments to caregiving adults. In contrast, disinhibited social engagement disorder more closely resembles ADHD; it may occur in children who do not necessarily lack attachments and may have established or even have secure attachments. The two disorders differ in other important ways, including correlates, course, and response to intervention, and for these reasons are considered separate subtypes of the disorders.