Reactive attachment disorder
The broad theoretical framework for current versions of RAD is attachment theory, based on work conducted from the 1940s to the 1980s by John Bowlby, Mary Ainsworth and René Spitz. Attachment theory is a framework that employs psychological, ethological and evolutionary concepts to explain social behaviors typical of young children. Attachment theory focuses on the tendency of infants or children to "seek proximity" to a "particular attachment figure" (familiar caregiver), in situations of alarm or distress, behavior which appears to have survival value. This is known as a discriminatory or selective attachment. Subsequently, the child begins to use the caregiver as a base of security from which to explore the environment, returning periodically to the familiar person. Attachment is not the same as love and/or affection although they are often associated. Attachment and attachment behaviors tend to develop between the ages of six months and three years. Infants become attached to adults who are sensitive and responsive in social interactions with the infant, and who remain as consistent caregivers for some time. Caregiver responses lead to the development of patterns of attachment, that in turn lead to internal working models which will guide the individual's feelings, thoughts, and expectations in later relationships. For a diagnosis of reactive attachment disorder, the child's history and atypical social behavior must suggest the absence of formation of a discriminatory or selective attachment.
Attachment theory
In his 1951 monograph for the World Health Organization, "Maternal Care and Mental Health", Bowlby put forward the hypothesis that "the infant and young child should experience a warm, intimate, and continuous relationship with his mother in which both find satisfaction and enjoyment", the lack of which may have significant and irreversible mental health consequences. This was also published as "Child Care and the Growth of Love" for public consumption. The central proposition was influential but highly controversial. At the time there was limited empirical data and no comprehensive theory to account for such a conclusion. Nevertheless, Bowlby's theory sparked considerable interest in the nature of early relationships, giving a strong impetus to, (in the words of Mary Ainsworth), a "great body of research" in an extremely difficult, complex area. Bowlby's work (and Robertson's films) caused a virtual revolution in hospital visiting by parents, hospital provision for children's play, educational and social needs and the use of residential nurseries. Over time, orphanages were abandoned in favour of foster care or family-style homes in most developed countries.
Following the publication of "Maternal Care and Mental Health", Bowlby sought new understanding from the fields of evolutionary biology, ethology, developmental psychology, cognitive science and control systems theory. He formulated the innovative proposition that mechanisms underlying an infant's emotional tie to the caregiver(s) emerged as a result of evolutionary pressure. He set out to develop a theory of motivation and behaviour control built on science rather than Freud's psychic energy model. Bowlby argued that with attachment theory he had made good the "deficiencies of the data and the lack of theory to link alleged cause and effect" of "Maternal Care and Mental Health".