Attachment Disorders

Disinhibited social engagement disorder

Reactive attachement disorder

Risk and Prognostic Factors

Development and Course

Prevalence and culture-related issues

Diagnostic Criteria

Differential Diagnosis

Development and Course

Risk and Prognostic Factors

Prevalence - unknown. Appears similarly across cultures

Differential Diagnosis

Diagnostic Criteria

Unknown prev.


Occurs similarly across cultures

Environmental: Serious social neglect, isolation.
Quality of caregiving environment may improve the condition

B. Persistent social and emotional disturbance characterised by 2+ of the following:

  1. Limited positive affect
  2. Episodes of unexplained irritability, fear or sadness
  3. Minimal social and emotional responsiveness to others

C. Experiences of extreme or insufficient care as evidenced by 1+ of following:

  1. Social neglect & deprivation - Failed to have their basic emotional needs (affection, stimulation and comfort) met by their caregiver
  2. Repetitive changing of caregivers, thus limiting their opportunity to form secure attachment
  3. Rearing in unusual settings, thus limiting their opportunity to form selective attachment

A. Pattern of socially withdrawn and unemotional behaviour towards adult CG characterised by the following:

  1. Does not seek comfort when distressed
  2. Does not respond to comfort when distressed

F. Sx's present before 5 years

G. Not ASD

D. Their experiences as defined by Criterion C are thought to be primarily responsible for Criterion A

E. Child's developmental age of at least 9 months

Onset in early development and Sx's are those as described below. Clinical features present between 9m and 5y. Diagnose over 5y with caution - unsure how the disorder presents in older children.

ASD - not usually in a neglectful and socially isolated environment

Depressive disorders - will still respond/seek comfort when distressed

IDD - do not show a profound reduction in positive affect

C. Experiences of extreme or insufficient care as evidenced by 1+ of following:

  1. Social neglect & deprivation - Failed to have their basic emotional needs (affection, stimulation and comfort) met by their caregiver
  2. Repetitive changing of caregivers, thus limiting their opportunity to form secure attachment
  3. Rearing in unusual settings, thus limiting their opportunity to form selective attachment

D. Their experiences as defined by Criterion C are thought to be primarily responsible for Criterion A

B. Behaviours in A are not limited to impulsivity but rather 'socially disinhibited behaviours'

E. Child has a developmental age of 9+ months

A. Pattern of behaviour in which the child actively approaches and interacts with unknown adults and exhibits 2+ of the following:

  1. Reduced reticence in interaction
  2. Overly familiar in V&NV behaviours
  3. Willingness to go off w/stranger
  4. Diminished 'checking back' when going off w/stranger, even in an unfamiliar environment

Preschoolers - show a lack of reticence in interaction and indiscriminate social behaviours
Middle childhood - indiscriminate social behaviours, overfamiliar V&NV expression and inauthentic expression of emotions
Adolescence - indiscriminate social behaviours extend to peers, resulting in 'superficial' relationships. More peer conflict

Environment - Serious social neglect. However, not all children who are neglected have this disorder, therefore there may be some (unknown) neurobiological factors which may predispose them the disorder development
Even when their primary CG and environment significantly changes, children still exhibit the disorder

ADHD - difference is between the presence of ritualised behaviours and difficulties with hyperactivity/attention.