The PMHNP is evaluating a 4-year-old boy who is brought in by his foster mother. The child has been living with her for 1 week, and she is concerned about this behavior. Staff at the day care center he attends report that he displays fear unrelated to particular activities. Even when distressed, he does not seek comfort in, nor respond to, any staff members. What additional information about this child would be important in determining whether his symptoms represent reactive attachment disorder (RAD) or autism spectrum disorder (ASD)?

Choice A reason: Family history about siblings may provide context for genetic predispositions but is not determinative for distinguishing RAD from ASD. Choice B reason: History of language delay is important because language deficits are a core feature of ASD but not typically present in RAD, helping differentiate between the two conditions. Choice C reason: Presence of selective attachment behaviors can help distinguish RAD, which is characterized by limited or absent attachment behaviors, from ASD, where children may form attachments but have social communication deficits. Choice D reason: Indications of severe social neglect are critical for RAD diagnosis, as this disorder results from pathogenic caregiving environments, distinguishing it from neurodevelopmental conditions such as ASD.