effort to obtain comfort, support, nurturance, or protection from caregivers. Furthermore,
when distressed, children with this disorder do not respond more than minimally to com-
forting efforts of caregivers. Thus, the disord er is associated with th e absence of expected
comfort seeking and response to comforting behaviors. As such, children with reactive
attachment disorder show dimi nished or absent expression of positive emotions during
routine interactions with caregivers. In addi tion, their emotion regulation capacity is com-
promised, and they displa y episodes of negative emotions of fear, sadness, or irritability
that are not readily explained. A diagnosis of reactive attachment disorder should not be
made in children who are developmentally unab le to form se lective attachments. For this
reason, the child must have a develo pmental age of at least 9 months.
Associated Features Supporting Diagnosis
Because of the shared etiologica l association with social negl ect, reactive attachment dis-
order often co-occurs with developmental dela ys, especially in delays in cognition and
language. Other associated features include stereotypies and other signs of severe neglect
(e.g., malnutrition or signs of poor care). 
Prevalence
The prevalence of reactive atta chment disorder is unknown, bu t the disorder is seen rela-
tively rarely in clinical settings. The disorder has been found in young children exposed to
severe neglect before being placed in foster care or raised in  institutions. However, even in
populations of seve rely neglected children, the disord er is uncommon, occurring in less
than 10% of such children.