Disinhibited Social Engagement Disorder (DSED):

According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), children must have at least two of the following symptoms to be diagnosed with DSED:

- intense excitement or a lack of inhibition over meeting or interacting with strangers or unfamiliar adults
- behaviors with strangers that are overly friendly, talkative, or physical and not age-appropriate or culturally acceptable
- willingness or desire to leave a safe place or situation with a stranger
- lack of desire or interest in checking in with a trusted adult prior to leaving a safe place, or in a situation that seems foreign, strange, or threatening

Reactive Attachment Disorder (RAD):

A) A consistent pattern of inhibited, emotionally withdrawn behavior toward adult caregivers, manifested by both of the following:

- The child rarely or minimally seeks comfort when distressed.
- The child rarely or minimally responds to comfort when distressed.

B) A persistent social or emotional disturbance characterized by at least two of the following:

- Minimal social and emotional responsiveness to others
- Limited positive affect
- Episodes of unexplained irritability, sadness, or fearfulness that are evident even during nonthreatening interactions with adult caregivers.

C) 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 caring 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)

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