A quick and reliable waiting room checklist for symptoms of disinhibited social engagement disorder

Background: Disinhibited social engagement disorder (DSED) is a psychosocial disorder, associated with child neglect, characterised by indiscriminate friendliness towards strangers. Some behavioural overlap between DSED and autism spectrum disorder (ASD) – a neurodevelopmental condition whose core symptoms include impaired communication – has been observed. Since DSED is associated with a maltreatment history and ASD is not, differential diagnosis is important. We aimed to establish norms and reference ranges for a clinic waiting room checklist (WRO) for the observation of DSED symptoms, and to examine its discrimination between DSED and ASD. Methods: Norms are provided for the WRO based on 56 children aged 5–12 with DSED and 151 typically developing controls, for whom a reference range is also provided. We modified the WRO based on both quantitative examination of discrimination between DSED and ASD (n = 16) and qualitative observations of typically developing children (n = 7), children with DSED (n = 5) and ASD (n = 6). Results: A WRO score >6 may indicate the need for a multi-informant assessment for DSED. In a waiting room, children from both atypical groups (ASD and DSED) were more likely to approach strangers than controls; however, while children with DSED symptoms appeared to take control of the social aspects of the situation, children with ASD followed a non-social agenda, with the stranger appearing irrelevant. Conclusion: The WRO is an efficient tool that, along with information from parents and teacher, can contribute to clinical decision-making regarding children who have difficulties with social relationships.