The primary defining feature of Disinhibited Social Engagement Disorder is a person’s pattern of behavior that involves culturally inappropriate, overly familiar behavior with relative strangers. This behavior violates the ordinary social customs and boundaries of the culture.
1. A pattern of behavior in which a child actively approaches and interacts with unfamiliar adults and exhibits at least 2 of the following:
- Reduced or absent reticence in approaching and interacting with unfamiliar adults.
- Overly familiar verbal or physical behavior (that is not consistent with culturally sanctioned and with age-appropriate social boundaries).
- Diminished or absent checking back with adult caregiver after venturing away, even in unfamiliar settings.
- Willingness to go off with an unfamiliar adult with minimal or no hesitation.
2. The above behaviors are not limited to impulsivity (as in attention deficit hyperactivity disorder) but include socially disinhibited behavior.
3. The child has experienced a pattern of extremes of insufficient care as evidenced by at least one of the following:
- 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 high child-to-caregiver ratios).
4. The care in the above behaviors (#3) is presumed to be responsible for the disturbed behavior in #1 — e.g., the behaviors in #1 began after the care in #3.
5. The child has a developmental age of at least 9 months old.
Persistent: The disorder has been present for more than 12 months.