The AACAP guidelines state that children with<unk>  are presumed to have grossly disturbed internal models for relating to others. However, the course of<unk>  is not well studied and there have been few efforts to examine symptom patterns over time. The few existing longitudinal studies (dealing with developmental change with age over a period of time) involve only children from poorly run Eastern European institutions. Findings from the studies of children from Eastern European orphanages indicate that persistence of the inhibited pattern of<unk>  is rare in children adopted out of institutions into normative care-giving environments. However, there is a close association between duration of deprivation and severity of<unk>  disorder behaviors. The quality of<unk> s that these children form with subsequent care-givers may be compromised, but they probably no longer meet criteria for inhibited<unk> . The same group of studies suggests that a minority of adopted, institutionalized children exhibit persistent indiscriminate sociability even after more normative caregiving environments are provided. Indiscriminate sociability may persist for years, even among children who subsequently exhibit preferred<unk>  to their new caregivers. Some exhibit hyperactivity and attention problems as well as difficulties in peer relationships. In the only longitudinal study that has followed children with indiscriminate behavior into adolescence, these children were significantly more likely to exhibit poor peer relationships. Studies of children who were reared in institutions have suggested that they are inattentive and overactive, no matter what quality of care they received. In one investigation, some institution-reared boys were reported to be inattentive, overactive, and markedly unselective in their social relationships, while girls, foster-reared children, and some institution-reared children were not. It is not yet clear whether these behaviors should be considered as part of disordered<unk> . There is one case study on maltreated twins published in 1999 with a follow-up in 2006. This study assessed the twins between the ages of 19 and 36 months, during which time they suffered multiple moves and placements. The paper explores the similarities, differences and comorbidity of<unk> , disorganized<unk>  and post traumatic stress disorder. The girl showed signs of the inhibited form of<unk>  while the boy showed signs of the indiscriminate form. It was noted that the diagnosis of<unk>  ameliorated with better care but symptoms of post traumatic stress disorder and signs of disorganized<unk>  came and went as the infants progressed through multiple placement changes. At age three, some lasting relationship disturbance was evident. In the follow-up case study when the twins were aged three and eight years, the lack of longitudinal research on maltreated as opposed to institutionalized children was again highlighted. The girl's symptoms of disorganized<unk>  had developed into controlling behaviors—a well-documented outcome. The boy still exhibited self-endangering behaviors, not within<unk>  criteria but possibly within "secure base distortion", (where the child has a preferred familiar caregiver, but the relationship is such that the child cannot use the adult for safety while gradually exploring the environment). At age eight the children were assessed with a variety of measures including those designed to access representational systems, or the child's "internal working models". The twins' symptoms were indicative of different trajectories. The girl showed externalizing symptoms (particularly deceit), contradictory reports of current functioning, chaotic personal narratives, struggles with friendships, and emotional disengagement with her caregiver, resulting in a clinical picture described as "quite concerning". The boy still evidenced self-endangering behaviors as well as avoidance in relationships and emotional expression, separation anxiety and impulsivity and attention difficulties. It was apparent that life stressors had impacted each child differently. The narrative measures used were considered helpful in tracking how early<unk>  disruption is associated with later expectations about relationships. One paper using questionnaires found that children aged three to six, diagnosed with<unk> , scored lower on empathy but higher on self-monitoring (regulating your behavior to "look good"). These differences were especially pronounced based on ratings by parents, and suggested that children with<unk>  may systematically report their personality traits in overly positive ways. Their scores also indicated considerably more behavioral problems than scores of the control children.
Reactive attachment disorder
Autism
Externalizing disorder
Immature personality disorder
Disinhibited attachment disorder
Internalizing disorder
Spectrum disorder
Haltlose personality disorder