Disinhibited social engagement disorder

The most common symptom of DSED is unusual interaction with strangers. A child with DSED shows no sign of fear or discomfort when talking to, touching, or accompanying an adult stranger. A disorganized attachment style is associated with DSED. Disorganized attachment is common amongst children living in institutions such as foster care. Children living in these institutions have an increased risk of DSED. DSED can cause symptoms commonly associated with attention deficit hyperactivity disorder (ADHD) and can be comorbid with cognitive, language and speech delay. ==Risk factors==

DSED is a result of negligent, absent, or inconsistent primary caregivers in the first few years of childhood. Children who are institutionalized may receive inconsistent care or become isolated during hospitalization (as when children may be cared for by many different staff members during an inpatient stay). Parental issues such as mental health problems, depression, personality disorder, absence, poverty, teen parenting, or substance abuse interfere with attachment. == Diagnosis ==

The ICD-10 definition is: "A particular pattern of abnormal social functioning that arises during the first five years of life and that tends to persist despite marked changes in environmental circumstances, e.g. diffuse, nonselectively focused attachment behavior, attention-seeking and indiscriminately friendly behavior, poorly modulated peer interactions; depending on circumstances, there may also be associated emotional or behavioral disturbance." Differential diagnosis can be attention deficit hyperactivity disorder. Adolescents who exhibit symptoms of DSED can often be misdiagnosed due to several contributing factors, such as a history of neglect, an overidentifying or misidentifying of symptoms through incorrect differential diagnosis, and disregarding comorbid conditions that could account for their symptoms. However, it is essential to mention the intersectionality between contributing factors and DSED and how they influence the symptomatic behavior of children diagnosed with DSED. For example, adolescents diagnosed with DSED and ADHD experience overlapping symptoms that are essential to identify in order to make appropriate diagnoses and treatment plans. ==Treatment==

Two effective treatment approaches are play therapy or expressive therapy which help form attachment through multi-sensory means. Some therapy can be nonverbal. == Prognosis ==

Over time, the nature of the behaviors of a child with disinhibited social engagement disorder can evolve during their preschool, middle school, and adolescent years. Preschool: In this early stage DSED is exhibited by a need for attention such as being overly boisterous at the playground in attempts to get the attention of unfamiliar adults. Middle School: There are two main identifiers of DSED in this stage, including physical and verbal overfamiliarity of inauthentic emotions and being overly forward. This can be seen as appearing sad in front of others in efforts to manipulate a social situation or being overly insistent upon going over to a classmate's house when they first meet them. Adolescent: Amongst this stage children with DSED are likely to develop problems with their peers and other authority figures such as parents and coaches. "They [also] tend to develop superficial relationships with others, struggle with conflict, and continue to demonstrate indiscriminate behavior toward adults." ==Epidemiology==

The exact prevalence is unknown. In high-risk individuals, the prevalence rate is 20%. ==History==

Disinhibited Social Engagement Disorder (DSM-5 313.89 (F94.2)) is the 2013 Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) name formerly listed as a sub-type of reactive attachment disorder (RAD) called disinhibited attachment disorder (DAD). According to the American Psychiatric Association, "...Disinhibited Social Engagement Disorder more closely resembles ADHD; it may occur in children who do not necessarily lack attachments and may have established or even secure attachments. The two disorders differ in other important ways, including correlates, course, and response to intervention, and for these reasons are considered separate disorders." == Research ==

In a study aiming to show that reactive attachment disorder and DSED were separate concepts, a sample of school-aged foster children were tested and their foster parents and social workers completed questionnaires to better understand the children and to pinpoint signs of DSED. The results of the study provided evidence that DSED is indeed its own separate dimension of psychology. == See also ==