A 5-year-old boy adopted from an overseas orphanage at age 3 is evaluated for behavioral concerns. His adoptive parents report that he approaches strangers without hesitation, climbs into unfamiliar adults' laps, and has wandered off with a stranger at a grocery store without any distress. He is excessively familiar and affectionate with people he has just met. Despite 2 years in a stable, loving home, he does not preferentially seek comfort from his adoptive parents over unfamiliar adults. He makes good eye contact, engages socially, and shows age-appropriate language skills.