Overview
Disinhibited Social Engagement Disorder is a rare childrenโs disorder. In this disorder, a child engages quite personally with random strangers. They show no hesitation in approaching and get overly familiarised with strangers.
They may venture out and not be bothered about their caregivers. Their over familiarization may come off as socially inappropriate and alarming to an individual on the receiving end.ย ย
Research discussing causes of state childhood neglect as a major contributor for the disorder. It is commonly seen in institutions where the child to caregiver ratio is quite high. The child is not able to form secure childhood bonds with the caregiver and is often neglected.
The child then becomes trusting of anyone or no one, exhibiting symptoms of Disinhibited Social Engagement Disorder. Other contributing factors warrant further research.ย
Among toddlers, this can be seen when the child fails to present reticence in the presence of an adult. As they grow, verbal and physical intrusiveness is quite apparent. They tend to be overly physical in showing affection and use the vocabulary associated with it.
They may engage in attention seeking behaviours. As they grow into adolescence, these behaviours are expressed towards peers causing conflicts or dependency.ย
Children with this disorder are often unbothered by the presence or absence of their caregivers. They familirialise and get close to strangers easily and to a point of causing discomfort to the strangers.
They lack an understanding of social boundaries and may throw themselves at people just to feel a sense of attachment and gain attention.ย
Disinhibited Social Engagement Disorder impairs the childโs social functioning. It may cause them to face difficulty while relating to adults and peers.
Common Signs and Symptoms
Children with this disorder exhibit:
- Extremely personal and emotional connection with random strangers.
- Not being bothered by the presence or absence of the caregiver.
- Wandering away from the caregiver and not worrying about returning back to them or getting lost.
- Getting physically affectionate with strangers, especially adults.
- Getting verbally affectionate with strangers, especially adults.
- Among adolescents, there are a lot of peer related conflicts and a sense of a very superficial relationship.
- They donโt show any hesitation while approaching or going off with strangers.
Risk Factors
Most of the academic literature present for Disinhibited Social Engagement Disorder refers to social neglect as the most common risk factor. Childhood social neglect is common among children of drug abusers, children in child care institutions such as orphanages and the foster care system. Not all children who face childhood neglect suffer from Disinhibited Social Engagement Disorder causing researchers to dig further into the arena.
Another study conducted on English and Russian Adoptees Study states that there is a crucial period when the child is able to form bonds. Children who were pulled out of the adoptive system before 27 months of age showed lesser symptoms, especially indiscriminate behaviour. This means that the earlier a child is removed from adversity, lesser the likelihood of indiscriminate behaviour from the child.
Some theories link biological and genetic causes for Disinhibited Social Engagement Disorder but research in those domains remains largely unexplored.
Diagnosis
Child Psychologists are often able to diagnose children with this condition. They may ask questions to the caregivers regarding the childโs behaviour and backgrounds. There are no formal or standardised assessments for the diagnosis of Disinhibited Social Engagement Disorder.
However, clinical guidelines suggest observing the child with caregivers, unfamiliar situations and with unfamiliar adults, checking for comorbidities among other things.ย
To be diagnosed with Disinhibited Social Engagement Disorder, following criteria must be met:
- The child should be developmentally 9 months in age.
- The child shows no hesitation or reticence in approaching strangers, particularly adults.
- Overly familiar verbal or physical behaviour.
- Absence of checking back with the caregiver after venturing away, even in unfamiliar settings.
- Willingness to go off with an unfamiliar adult without any hesitation
Psychologists are to conduct a thorough background check noting any associations with social neglect or limited opportunities to form social attachments in the past. Noting the social institutional background may help with the diagnosis. They are to note the severity of the disorder as well as persistence of such behaviour for at least 12 months.
Treatment
Disinhibited Social Engagement Disorder is a rare disorder limiting research options. Lack ofย a proper attachment figure is often lacking in this case.
Hence, onus should be given to developing a strong emotional connection with a caregiver and providing a secure and emotionally available attachment figure if there is an absence of such a figure.ย
The psychologist generally works through the caregivers teaching them to gain the childโs trust. The trusting child needs to feel a sense of security when communicating with the caregiver. Sometimes, the caregiverโs own anger, frustration and anxiety comes in the way.
It is of utmost importance that the psychologist addresses these issues before educating them on how to interact with the child. Then the onus of psychotherapy is to provide positive interactions with the child that cause them to feel secure and open.ย
Video based intervention models may also be used. Video-based Intervention to Promote Positive Parenting and Circle of Security are two video based home interventions where parents learn to provide positive interactions that help the child feel secure. However, there is limited data supporting the use of these interventions for the treatment of Disinhibited Social Engagement Disorder.
Dyadic Therapy, therapy conducted with both caregivers and child, is shown to help with the treatment of Disinhibited Social Engagement Disorder. The basic tenet of this kind of therapy is to reinforce positive interactions between the caregiver and the child by appreciating the strengths in parenting and reinforcing them. Once the trust of the caregiver is gained, space is provided to point and work on moments of frustrations.
Differential Diagnosis
1. Attention-deficit/hyperactivity disorder: Because of social impulsivity that sometimes accompanies attention-deficit/hyperactivity disorder (ADHD), it is necessary to differentiate the two disorders. Children with disinhibited social engagement disorder may be distinguished from those with ADHD as children with disinhibited social engagement disorder do not show difficulties with attention or hyperactivity.
Comorbidity
Conditions associated with neglect, including cognitive delays, language delays, and stereotypies, may co-occur with disinhibited social engagement disorder. Children may be diagnosed with ADHD and disinhibited social engagement disorder simultaneously.
Specialists
A child psychologist is often referred to in the treatment of Disinhibited Social Engagement Disorder.
In Conclusion
If untreated, DSED can be a major issue that affects a person’s ability to operate in social situations. The best treatment for DSED is counseling, despite the fact that it can take some time. Make sure to recommend counseling and therapy if you spot the symptoms in your friends or family.
Book and get personalized therapy sessions with Ananda and minimize the symptoms of DSED.
