The DSM-5 has released DSED, a new diagnosis of disordered attachment that replaces RAD for children who have no natural reservation about approaching strangers or non-family members. DSED is still based on Attachment Theory and represents a disorder of attachment. Standing for Disinhibited Social Engagement Disorder, children with DSED may share many of not most characteristics with children diagnosed with RAD but with one difference. RAD, or Reactive Attachment Disorder, is typically associated with withdrawn and distant social engagement while DSED indicates a child who is disinhibited socially, meaning the infant or child has little or no inhibition from strangers or non-family members.
DSED is an important diagnosis to understand for parents contemplating adoption or foster care. Children with disordered attachment, whether RAD or DSED, may exhibited a wide range of disturbing and inappropriate behaviors. Parents of these precious children must engage not only in therapeutic parenting but also a social and emotional curriculum to promote development of healthy attachment.
Parents contemplating fostering or adopting are recommended to explore this option first. Bring older infants and children into the home first, so parents are able to invest fully in a child who requires intensive care and intervention. Parents who bring children with disordered attachment into a family that already has children are typically stretched beyond reasonable limits; the attachment disordered child often requires such intensive and sometimes exclusive attention that other children are deprived of reasonable parental engagement.
What is more concerning is that disorders of attachment may be associated with intensely jealous, deceptive, and predatory behavior. Children with this type of disorder of attachment, whether DSED or RAD, may become aggressive, sadistic, or predatory towards siblings, putting them at risk. So the recommendation to adopt a foster or adoptive child first is an intensely practical one.
Infants and children coming into a new family must establish a primary child-caregiver bond and attachment formation must develop. In some cases, children will easily be able to work through this critical developmental window. The brain is optimized for attachment formation very early in life; the older a child becomes, the more difficult attachment formation becomes.
DSED is a challenging condition that must be addressed with intensive therapy and a comprehensive social, emotional, and self-regulatory curriculum. Follow along as we continue to share critical information and release valuable information about how parents can use a DSED or RAD Curriculum to modify parenting and child rearing strategies to meet the complex needs of infants and children of disordered attachment.
Darleen Claire is a Parenting Expert with a background in Clinical Mental Health, Education, and Brain-Based strategies for promoting healthy growth and development – including healthy Attachment Formation. She is available for individual consultation and can work with parents, school, and mental health professionals to collaborate toward effective parenting, child rearing, education, and therapeutic strategies to support children with DSED or RAD.