domains of early childhood.
Differential Diagnosis
Autism spectrum disorder. Aberrant social behaviors mani fest in young children with
reactive attachment disorder, but they also ar e key features of auti sm spectrum disorder.
Specifically, young children with either co ndition can manifest dampened expression of
positive emotions, cognitive and language delays, and impairments in social reciprocity.
As a result, reactive attachment disorder must  be differentiated from  autism spectrum dis-
order. These two disorders can be distinguished based on differential histories of neglect
and on the presence of restricted interests or ritualized behaviors, specific deficit in social
communication, and selective attachment beha viors. Children with reactive attachment
disorder have experienced a history of severe so cial neglect, although it is not always pos-
sible to obtain detailed historie s about the precise nature of th eir experiences, especially in
initial evaluations. Children with autistic spec trum disorder will only rarely have a history
of social neglect. The restricted interests an d repetitive behaviors ch aracteristic of autism
spectrum disorder are not a feature of reactive attachment disorder. These clinical features
manifest as excessive adherenc e to rituals and routines; restricted, fixated interests; and
unusual sensory reactions. However, it is important to note that children with either con-
dition can exhibit stereotypic behaviors such as rocking or flapping. Children with either
disorder also may exhibit a range of intellectual functioning, but only children with autis-