RAD is diagnosed only when the child has experienced extreme insufficient care such as social deprivation (i.e., the child’s basic emotional needs for comfort, stimulation, and affection by caregiving adults are not met), repeated changes in primary caregivers, or rearing in unusual settings (e.g., institutions) that severely limit opportunities to form selective attachments.
The primary symptoms of RAD are as follows:
- Emotionally withdrawn behavior toward adult caregivers, as evidenced by a failure to seek and respond to comfort when distressed.
- Persistent social and emotional disturbances, including being minimally socially and emotionally responsive to others, limited positive affect, and/or unexplained irritability, sadness, or fearfulness even during nonthreatening interactions with adult caregivers.
RAD may be specified as “persistent” when the symptoms last longer than 12 months and as “severe” when all the symptoms are met at high levels. Note that RAD cannot be diagnosed in individuals with autism spectrum disorder.