Attachment refers to the intimate bond formed between an infant or very young child and the primary caregiver. This bond, or attachment, is considered vital to the child's emotional development and ability to establish other healthy social relationships. When infants and children under the age of five show disturbed and developmentally inappropriate social relatedness and do not initiate or respond to most social interactions, a diagnosis of Reactive Attachment Disorder is considered. The difficulties of children who develop this disorder are due primarily to a grossly deprived environment. There may be repeated changes of caregivers, or caregivers who persistently disregard the child's physical needs or emotional needs for comfort, stimulation and affection.