DSM 5 Diagnosis: evident before 5 years, evident after 9 months, pt isn't on Autism spectrum, The child rarely or minimally seeks comfort when distressed. The child rarely or minimally responds to comfort when distressed. Minimal social and emotional responsiveness to others. Limited positive affect. Episodes of unexplained irritability, sadness, or fearfulness that are evident even during nonthreatening interaction with adult caregivers. Social neglect or deprivation in the form of persistent lack of having basic emotional needs for comfort, stimulation, and affection met by caregiving adults. Repeated changes of primary caregivers that limit opportunities to form stable attachments (e.g., frequent changes in foster care.) Rearing in unusual settings that severely limit opportunities to form selective attachments (e.g. institutions with child-to-caregiver-ratios.)