Conditions associated with neglect, includin g cognitive delays, language delays, and ste-
reotypies, often co-occur with reactive atta chment disorder. Medical conditions, such as
severe malnutrition, may accompany signs of the disorder. Depressive symptoms also
may co-occur with reactive attachment disorder. 
Disinhibited Social Engagement Disorder
Diagnostic Criteria 313.89 (F94.2)
A. A pattern of behavior in which a child actively approaches and interacts with unfamiliar
adults and exhibits at least two of the following:
1. Reduced or absent reticence in approaching and interacting with unfamiliar adults.
2. Overly familiar verbal or physical behavior (that is not consistent with culturally
sanctioned and with age-appropriate social boundaries).
3. Diminished or absent checking back with adult caregiver after venturing away, even
in unfamiliar settings.
4. Willingness to go off with an unfamiliar adult with minimal or no hesitation.
B. The behaviors in Criterion A are not limited to impulsivity (as in attention-deficit/hyper-
activity disorder) but include socially disinhibited behavior. 
C. The child has experienced a pattern of extremes of insufficient care as evidenced by
at least one of the following:
1. Social neglect or deprivation in the form of persistent lack of having basic emotional
needs for comfort, stimulation, and affection met by caregiving adults.
2. Repeated changes of primary caregivers that limit opportunities to form stable at-
tachments (e.g., frequent changes in foster care).
3. Rearing in unusual settings that severely limit opportunities to form selective at-
tachments (e.g., institutions with high child-to-caregiver ratios).