Disinhibited social engagement in postinstitutionalized children: Differentiating normal from atypical behavior

Abstract

The most commonly reported socially aberrant behavior in postinstitutionalized (PI) children is disinhibited social engagement (DSE; also known as indiscriminate friendliness). There is no gold standard for measurement of this phenomenon or agreement on how to differentiate it from normative behavior. We adopted a developmental psychopathology approach (Cicchetti, 1984) to study this phenomenon by comparing it to normative social development and by studying its patterns over time in 50 newly adopted PI children (16–36 months at adoption) compared with 41 children adopted early from foster care overseas and 47 nonadopted (NA) controls. Using coded behavioral observations of the child’s interaction with an unfamiliar adult, atypical behaviors were differentiated from normative behaviors. Principal components analysis identified two dimensions of social disinhibition. The nonphysical social dimension (e.g., initiations, proximity) showed wide variation in NA children and is therefore considered a typical form of sociability. Displays of physical contact and intimacy were rare in NA children, suggesting that they represent an atypical pattern of behavior. Both adopted groups demonstrated more physical DSE behavior than NA children. There were no group differences on the nonphysical factor, and it increased over time in all groups. Implications for understanding the etiology of DSE and future directions are discussed.

Deviations from the Expectable Environment in Early Childhood and Emerging Psychopathology

“…A recent study suggested that physical touching of unfamiliar adults during a laboratory paradigm in which the stranger makes overtures to the child may distinguish indiscriminate behavior from ordinary sociability more readily than verbal interaction (Lawler et al, 2014). In keeping with the link between social neglect and indiscriminate behavior, evidence is consistent that indiscriminate behavior is readily apparent in a minority of young children being raised in institutions Zeanah et al, 2005), adopted from institutions (Chisholm, 1998;O'Connor et al, 2003), and in maltreated children in foster care Zeanah et al, 2004).…”

Annual Research Review: Attachment disorders in early childhood – clinical presentation, causes, correlates, and treatment

“…Further, Rutter et al (2010) identified a group of 29 children who show continuously elevated signs of DSED from early childhood through 15 years of age. Lawler et al (in press) showed diminution in signs of physical (but not non-physical) social engagement with a stranger in young children adopted internationally from institutions and foster care over an 8-month beginning one to three months after adoption.…”

“…The rationale for defining the indiscriminate behavior phenotype as DSED in DSM-5 as opposed to disinhibited attachment disorder as in ICD-10, is that the data indicate that the core deficit of the disorder is not non-selective attachment behaviors, but more about unmodulated and indiscriminate social behavior, especially initial approaches to and interaction with unfamiliar adults. The justification for the change is supported by the assessment of indiscriminate behavior in numerous studies of institutionalized (Soares et al, 2014; Tizard & Rees, 1975; Zeanah et al, 2002, Zeanah et al, 2005) post-institutionalized (Bruce, Tarullo, & Gunnar, 2009; Smyke et al, 2010; Lawler et al, in press) and deprived children in foster care (Bruce, Tarullo & Gunnar, 2009; Oosterman & Schuengel, 2007; Pears et al, 2010; Zeanah et al, 2004). In these studies, what is disinhibited is children’s behavior with unfamiliar adults rather than with their putative attachment figures, for whom they may show focused attachment behaviors and preferential comfort seeking.…”

“…A recent short-term longitudinal study used a structured laboratory procedure to observe the behavior of young children who were adopted from 13 different countries at ages 16–36 months and then assessed 1–3 months and 8–11 months following adoption (Lawler et al, in press). As part of a larger assessment protocol, children’s behavior during a 10-minute interaction with a female adult stranger was coded.…”

ADHD Symptoms in Post-Institutionalized Children Are Partially Mediated by Altered Frontal EEG Asymmetry

“…Despite expectations that children adopted from institutions would display dysregulation in the form of marked increases in clinical levels of internalizing and externalizing problems, this has not been readily observed in childhood (Gunnar & van Dulmen, 2007; Juffer & Van Ijzendoorn, 2005), although it may emerge in adolescence (Kreppner et al, 2010). Unlike internalizing and externalizing disorders, dysregulation in the form of symptoms of disinhibited social engagement disorder (DSED; Lawler, Hostinar, Mliner, & Gunnar, 2014; Zeanah & Smyke, 2015) and attention-deficit/hyperactivity disorder (ADHD) are readily observed during childhood in post-institutionalized (PI) children (Pollak et al, 2010; Roy, Rutter, & Pickles, 2004; Rutter et al, 2001). These problems are so prevalent among PI children that some have suggested these excessive approach symptoms and lack of inhibition represent a core feature of institutional deprivation (Kreppner, O’Connor, & Rutter, 2001; Kumsta et al, 2010).…”