It is often the case that children are perceived as very social and do not feel any sense of alienation from other people as a positive thing. Friendly, affectionate and sympathetic people that parents are usually proud of.
Although these behaviours do not necessarily pose a problem, when they are expressed in an excessive way they may be a reflection or manifestation of the uninhibited social relationship disorder , which we will discuss throughout this article.
What is uninhibited social relationship disorder?
Traditionally, uninhibited social relationship disorder (USDD) was considered part of a broader diagnosis known as reactive childhood bonding disorder. However, in the latest update of DSM-V it is now established as a specific and independent diagnostic label.
This type of psychological alteration occurs exclusively in childhood and is characterized by a specific pattern of behavior in which the child does not present any type of fear or discretion in relation to initiating any type of contact with unknown adults .
These children present a totally uninhibited behavior in which they feel comfortable talking, initiating physical contact or even leaving with a stranger.
This particular pattern of behaviour appears around the first five years of life , so it can only be diagnosed as such between the child’s nine months and five years of age. In addition, these behaviours tend to persist over time regardless of the circumstances or changes in the environment.
Development throughout childhood
When the social relationship disorder is consolidated, the child shows a tendency to exhibit attachment seeking behaviors, as well as persistent behaviors that reveal a non-selective attachment. That is to say, the child is capable of maintaining attachments to any person .
Around the age of four, these types of bonds are maintained. However, attachment seeking behaviours are replaced by constant demands for attention and by manifestations of indiscriminate affection and love.
By the end of childhood, the child may have established a number of bonds with specific individuals, although the affection-demanding behaviours tend to remain. Uninhibited behavior with schoolmates or peers is common.
Furthermore, depending on the context or the reactions of the people around him, the child may also develop behavioural alterations and emotional changes .
This disorder has been observed more or less regularly in children whose parents or caregivers show frequent changes in the manifestations of attachment, insufficient care, abuse, traumatic events, poor or insufficient social relations.
Although they can also appear under other conditions, the highest incidence of this alteration usually occurs in children who have spent the first years of their lives in institutions for children .
What symptoms do you have?
The main symptoms of uninhibited social relationship disorder are behavioral in nature and are reflected in the way the child relates to others, especially adults.
The main symptoms of this condition include
- Absence of feelings of fear or dread of strangers
- Active and uninhibited interaction with any non-family or known adult.
- Verbal behaviour and excessively familiar manifestations of physical affection , taking into account the social norms and the age of the child
- Tendency not to need to return or turn to parents or caregivers after being in a strange or alien environment
- Tendency or willingness to leave with a strange adult .
What are the causes?
Although a large number of psychological disorders characteristic of childhood are often attributed to some kind of genetic defect, uninhibited social relationship disorder is a state that is based on a history of conflicting care and social relationships.
However, there are certain theories that point to the possibility that certain biological conditions associated with the temperament of the child and affective regulation. According to these theories, functional alterations in some specific brain areas such as the amygdala, the hippocampus, the hypothalamus or the prefrontal cortex, may lead to changes in behaviour and in the child’s ability to understand what is happening around him.
Whether or not these theories are true, social neglect and quality of care deficits have been established as the major causes of the development of uninhibited social relationship disorder.
The contexts of family violence, the deficit of basic emotional assistance, the education in non-family contexts such as orphanages or the constant changes in terms of primary caregivers are the breeding ground for the impossibility of elaborating a stable attachment and the consequent development of this disorder.
Diagnostic criteria for TRSD
Because children with uninhibited social relationship disorder may appear impulsive or have attention problems, the diagnosis may be confused with that of Attention Deficit Hyperactivity Disorder.
However, there are a number of diagnostic criteria that allow the correct detection of this syndrome. In the case of the Diagnostic and Statistical Manual of Mental Disorders (DSM-V), the child must present the following diagnostic requirements
1. Approaches to and active interaction with adult strangers
Two or more of the following criteria are also presented:
- Partial or complete absence of distrust for interacting with adults other than the child.
- Verbal or physical behavior patterns that are too familiar according to social or cultural norms
- Lack of need for caregiver after exposure to unknown or strange contexts.
- Partial or complete willingness to leave with a strange adult.
Behaviours under this criterion need not be limited to impulsivity, but should include socially uninhibited behaviour.
2. The child has been involved in deficit care situations or contexts
- Deficits in meeting basic emotional needs.
- Negligent situations .
- Constant changes in custody or primary caregivers.
- Education in unusual contexts such as institutions with a large number of children per caregiver.
Furthermore, it must be deduced that the care factor of the second criterion is responsible for the behaviours of the first point.
3. The child’s age must be between 9 months and 5 years
This criterion serves to delimit the age range in which this mental disorder is considered to have its own characteristics.
4. Behaviors must remain for more than 12 months
A criterion for establishing the persistence of symptoms.
Is there a treatment?
The treatment of uninhibited social relationship disorder aims not only to modify the child’s behaviour, but also that of the parents .
In the case of parents or caregivers, actions must be taken on certain aspects of the relationship with the child. Working on the transmission of security, the permanence of the attachment figure and the emotional sensitivity or availability are the three pillars to start perceiving changes in the child.
In addition, the health professional must also carry out psychological treatment with the child to enable him/her to rebuild and restore his/her sense of security.