270 Trauma- and Stressor-Related Disorders
Disinhibited social engagement disorder ha s been described from  the second year of
life through adolescence. There are some differences in manifestations of the disorder
from early childhood through adolescence. At  the youngest ages, across many cultures,
children show reticenc e when interacting with strangers. Young children with the disorder
fail to show reticence to approach, engage with, and even accompany adults. In preschool
children, verbal and social intrusiveness appear most prominent, often accompanied by
attention-seeking behavior. Ve rbal and physical overfamiliarity continue through middle
childhood, accomp anied by inauthentic expressions of  emotion. In adolescence, indis-
criminate behavior extends to peers. Relative to healthy adolescents, adolescents with the
disorder have more “superficial” peer relationships and more peer conflicts. Adult man-
ifestations of the disorder are unknown.
Risk and Prognostic Factors 
Environmental. Serious social neglect is a diagnost ic requirement for disinhibited social
engagement disorder and is also the only know n risk factor for the disorder. However, the
majority of severely neglected children do not develop the disorder . Neurobiological vul-
nerability may differentiate neglected childr en who do and do not develop the disorder.
However, no clear link with any specific neur obiological factors has been established. The
disorder has not been identified in children who experience social neglect only after age
2 years. Prognosis is only mode stly associated with quality of the caregiving environment
following serious neglect. In many cases, th e disorder persists, even in children whose
caregiving environment be comes markedly improved.
Course modifiers. Caregiving quality seems to moderate the course of disinhibited so-
cial engagement disorder. Nevertheless, ev en after placement in normative caregiving