Reactive attachment and disinhibited social engagement disorders
- Disorder
Two disorders of young children raised with severe neglect: one child withdraws from caregivers, the other goes to any stranger.
What it is
Both disorders follow grossly insufficient early care, such as neglect or abuse of a baby's needs for emotional bonds, food, safety and touch, or frequent changes of caregivers in orphanages or foster care. In reactive attachment disorder (RAD) the child avoids caregivers and physical contact, is hard to comfort and prefers to be alone. In disinhibited social engagement disorder (DSED) the child is indiscriminately friendly and seeks comfort and support from relatively unfamiliar adults, even when a familiar caregiver is present. The signs appear after about 9 months of age and before age 5.
Key facts
- RAD signs: avoids caregivers and physical contact, is hard to comfort and prefers to be alone.
- DSED signs: seeks comfort and support from relatively unfamiliar adults, even when a familiar caregiver is present.
- Cognitive and language difficulties are common alongside both disorders.
- ADHD often co-occurs (in one study about half of children with RAD had it), though children with ADHD show more hyperactivity than children with RAD or DSED.
- Untreated attachment disorders are linked to later anxiety, depression, post-traumatic stress and other emotional and behavior problems.
- The diagnosis rests on a complete history, a physical exam and a psychiatric evaluation.
Children who relate oddly to caregivers or strangers
| Condition | With caregivers | With strangers | Key clue |
|---|---|---|---|
| Reactive attachment disorder | Avoids caregivers, hard to comfort | Withdrawn, prefers to be alone | History of neglect; improves with appropriate intervention |
| Disinhibited social engagement disorder | Seeks comfort from others even when the caregiver is present | Indiscriminately friendly | History of neglect; signs may persist after leaving an institution |
| ADHD | Can co-occur with attachment disorders | Hyperactive and impulsive | More hyperactivity than in RAD or DSED |
| Child maltreatment (context) | Physical, sexual or emotional abuse, or neglect | Varies | The cause to look for; at least 1 in 7 US children a year |
Clinical notes
- Ensure safety first and involve social services when needed.
- Place the child in a safe environment where emotional and physical needs are met; this is the first step of treatment.
- Then work on the relationship with the caregiver, often through parenting classes and counseling, including for caregiver substance use or family violence.
- Do a physical exam and psychiatric evaluation, and look for cognitive and language difficulties.
- Once a child is placed in a family, keep disruptions of the placement to a minimum.
Test yourself
Think of the answer, then tap the question to see it.
What history is required for reactive attachment disorder and disinhibited social engagement disorder?
Grossly insufficient early care: neglect, abuse or frequent changes of caregiver.
A 3-year-old adopted from an institution climbs onto any visitor's lap and leaves with strangers. What is the diagnosis?
Disinhibited social engagement disorder.
Within what age window must the signs of these disorders appear?
After about 9 months of age and before age 5.
Does removing a child from an institution always resolve disinhibited social engagement disorder?
No; signs fall sharply in many children placed in foster care, but removal from institutional care does not reduce them in every child.
Elsewhere in DurgiPedia
- Mandatory reporting: public health, violence and abuse
- Child maltreatment: signs that should raise concern
Connections
Educational content on behavior and the clinical relationship; not a diagnostic or treatment guide and no substitute for assessment by a health professional. If you or someone near you is at risk, seek help now from an emergency service or a mental-health helpline.
Sources: Reactive attachment disorder of infancy or early childhood (MedlinePlus Medical Encyclopedia, U.S. National Library of Medicine, 2026); About Child Abuse and Neglect (Centers for Disease Control and Prevention (CDC), 2024); Reactive Attachment Disorder and Its Relationship to Psychopathology: A Systematic Review (Children (PubMed Central), 2023); Course of Disinhibited Social Engagement Disorder From Early Childhood to Early Adolescence (Journal of the American Academy of Child and Adolescent Psychiatry (PubMed Central), 2018).
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Representative model, for educational purposes only.