Disinhibited Social Engagement Disorder

A child with DSED may experience several signs and symptoms. Signs can be present before the child turns a year old. These signs may vary in severity and frequency and sometimes be challenging to address. Notably, children with DSED often show:

• Reduced hesitation to approach or engage with unfamiliar adults
• Extremely familiar verbal or physical behavior around strangers
• Lack of checking in with parents or caregivers
• Willingness to leave with strangers with little or no hesitation

Apart from these behavioral symptoms, the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) indicates specific criteria for a diagnosis. Children must show at least two symptoms mentioned above for a DSED diagnosis. In addition, a diagnosis of DSED may involve the following:

• The child does not show these signs because they act impulsively or without thinking.
• The child must have experienced at least one of the following, which has caused the signs of DSED: 
• A persistent lack of emotional support or attention.
• Frequent changes in primary caregivers. 
• Growing up in places where it was difficult to form close relationships, such as crowded orphanages.

In addition, the child must be at least nine months old, and the signs of the disorder must be present for at least 12 months. After evaluating the signs and the severity of the disorder, a mental health professional may be able to provide an accurate diagnosis. 

Left unaddressed, DSED may lead to various problems related to attachment and social development. By identifying these symptoms early and seeking professional help, parents and caregivers can better support children with DSED as they develop into young adults.

DSED is primarily caused by a history of neglect, trauma, abandonment, or abuse in early childhood. One of the critical factors that may increase the risk of this disorder is the absence of a stable, long-term caregiver. Without the appropriate child-rearing, a child may not have their needs met or adequately learn about social norms and boundaries.³ 

Children not receiving consistent, nurturing care during their early years may also struggle to form healthy emotional bonds with others. A lack of secure attachment can lead to a wide range of problematic behaviors, including a tendency to seek attention from strangers without fear or hesitation.

Some common risk factors associated with the development of DSED include:

• They often have different caregivers or people looking after them.
• Their parents or caregivers don't provide enough emotional support or attention.
• They've witnessed family fights, the death of a parent, or other traumatic events at home.
• They've spent an extended period away from their primary caregivers, such as in an orphanage or foster home.
• They've been through physical or sexual abuse.

Misconceptions 

These situations may increase the risk of DSED developing in the child. In addition, there may be some misunderstandings surrounding the causes of DSED. These may include:

• Poor Parenting: Some people may assume that DSED arises solely from poor parenting habits. While neglectful care can be a factor, the causes often include complex circumstances like frequent caregiver changes or institutional care.
• Genetics Alone: Some might believe that DSED is mainly a genetic disorder, like other mental health conditions. However, DSED is also linked to environmental factors, such as insufficient care and unstable caregiving environments.
• Need for Attention: People may believe the child with DSED is deliberately acting out or seeking attention. However, the child often responds to a history of inconsistent caregiving or neglect.
• Spoiling the Child: Some may think that DSED results from giving a child excessive attention or spoiling them. However, it often arises when basic emotional and social needs are unmet.

A healthcare professional may examine the potential causes and risk factors to determine the correct diagnosis. This process may involve ruling out other conditions to create an appropriate treatment plan. 

The treatment for DSED typically involves various types of therapy. The main goal of treatment is to help the affected children form deep and meaningful connections with others while teaching appropriate social boundaries.

Medication

There are no specific medications approved for treating DSED. However, some may be prescribed to treat co-occurring challenges, such as anxiety, depression, or attention-deficit hyperactivity disorder (ADHD). Consult with a healthcare professional to discuss the potential benefits and risks associated with medication use. In addition, do not start, change, or stop your child’s medication without consulting a doctor. 

Other treatment options

Additional treatment options may be explored if necessary to support the child's overall well-being and development. These can include:

• Occupational therapy: This type of treatment helps the child improve their sensory processing, motor skills, and self-regulation, which may potentially improve their social interaction skills.
• Social skills training: Social skills training may involve a structured program to help the child learn and practice specific social behaviors. As a result, they may improve their ability to interact appropriately with others.

Self-care and lifestyle changes 

Parents and caregivers can help support a child with DSED through various lifestyle changes. Some lifestyle changes that may help include:

• Consistency: Caregivers can aim to provide a stable and structured environment with clear expectations and routines. This environment can help the child be more secure and safe to form meaningful attachments.
• Safety precautions: Be mindful of potential safety risks associated with excessive trust in strangers and monitor the child's interactions with unfamiliar people.

Through a combination of therapies and lifestyle changes, children with DSED may be able to develop healthy relationships and improve their social functioning.

Different resources may be available to help support those with DSED and their loved ones. One resource to consider may be online therapy platforms. For example, online platforms like BetterHelp offer therapy services that may be convenient for those seeking professional assistance. It allows individuals to receive therapy from the comfort of their home. 

Families or caregivers of children with DSED may also find support through various mental health organizations. These organizations may include: 

• United Brain Association: This non-profit organization is dedicated to raising awareness about various mental health-related problems, including DSED. They provide information to help people understand the disorder and its implications. 
• National Federation of Families: The National Federation of Families offers a wide range of resources, focused mainly on disorders like DSED that affect the family unit. Whether looking for articles, toolkits, or community resources, this organization offers comprehensive support for managing DSED.
• Better Care Network: Specializing in a continuum of care resources, including those for adoptive families and caregivers, the Better Care Network provides insightful information on identifying and caring for DSED. The network’s offerings are beneficial for families experiencing adoption and attachment problems, and they provide various tools and articles to help families understand and manage DSED more effectively.
• American Academy of Child and Adolescent Psychiatry (AACAP): The AACAP provides professional guidelines on various psychiatric conditions, including DSED. However, they also provide credible and clinically backed information for individuals and families. These guidelines can help people understand the disorder's complexities and offer guidance on how to approach treatment.

Individuals and families living with DSED can learn more about the disorder through these organizations. They may also find the support and resources they need to manage the challenges of the disorder.

If you’re a teen or child experiencing or witnessing abuse of any kind from a family member or caregiver, reach out to the Child Help Hotline at 1-800-422-4453 or use the online chat feature.

For those experiencing abuse, contact the Domestic Violence Hotline at 1-800-799-SAFE (7233). Support is available 24/7. Please also see our Get Help Now page for more immediate resources.

DSED has been a topic of interest in research within the field of child and adolescent psychiatry. As researchers analyze the underlying causes and potential treatment options, new studies continue to be published.

One study examined a group of children who had experienced early emotional and social neglect, such as being in institutional care. The key finding was that having DSED during early childhood was linked to various problems during early teenage years. These problems involved relationships with family and friends, school performance, physical and mental health, substance use, and risk-taking behaviors. These results were consistent even for those who no longer showed signs of DSED by 12.

Another study investigated how DSED progresses in children who experience severe neglect during their early years. The researchers found that signs of DSED decreased when children were moved to foster care. In addition, transferring children to families early and keeping them there may help reduce DSED symptoms. This study emphasizes minimizing children's time in institutions and ensuring stable placements to improve outcomes for those with DSED.

Ten weeks of therapy can improve symptoms in children with DSED

In a study of children with disinhibited social engagement disorder (DSED), ten weeks of filial therapy were found to greatly diminish symptoms of the disorder. This treatment was conducted with the child and their caregivers.¹

¹European Psychiatry

Below are more statistics about disinhibited social engagement disorder: 

• Around 9% of adolescents were diagnosed with reactive attachment disorder (RAD) and 8% with DSED in a study involving 400 participants from 2011 to 2014. The participants, aged 12 to 20 years old, were primarily exposed to in-family neglect and maltreatment, with 71% self-reporting such experiences.
• An estimated one in five children aged 16 to 36 months in institutional settings may meet the criteria for DSED. If the behaviors of DSED increase quickly after being adopted, there’s an increased risk of developing DSED by age five. 
• A comprehensive study found that of 20 kids diagnosed with either RAD or DSED, 25% had DSED with no RAD. Meanwhile, a significant 75% had both disorders, underscoring how it may be rare to find RAD without DSED.
• Around 1.4% of children aged six to eight were likely to have RAD in one study. This study highlights how early identification is critical for attachment disorders like RAD and DSED.
• Studies find that therapy for DSED can significantly improve the chances of recovery and connection between children and their caregivers.