Attachment and Behavioural Disorders Flashcards
When does reactive attachment disorder (RAD) usually develop, and when does it usually present?
Usually develops before the age of 5
Does not present until teenage years but can be traced back
What disturbance’s in a young child’s upbringing can predispose to an attachment disorder?
- persistent disregard for child’s emotional needs (e.g. comfort, stimulation, and affection)
- Persistent disregard for child’s physical needs
- Repeated changes of primary caregivers
What are the main difficulties of an attachment disorder?
- difficulty forming lasting/intimate relationships
Medically:
- malnutrition, vitamin deficiencies and growth delay
- evidence of physical abuse
What is the prevalence of attachment disorders in children, and in what environments is this higher?
1% for population
20% of children in care
Increased likelihood if child is orphaned
What is the earliest that an attachment disorder can really be noticed?
2 months
What are the two subtypes of RAD?
Inhibited
Disinhibited
Describe Inhibited RAD
- children continually respond to social interactions in an inappropriate way
- they use various approaches, avoidance, resist comfort
- often hypervigilant or highly ambivalent
A child or infant that does not seek comfort from a parent or caregiver during times of threat, alarm or distress is an example of which subtype of RAD?
Inhibited
Describe Disinhibited RAD and how its different from inhibited RAD
Disinhibited = child has an inability to display appropriate selective attachments Inhibited = disability to form any attachment
Give an example of a child who has Disinhibited RAD
child displays excessive familiarity with strangers
=> lack of selectivity in their choices of attachment figure
Why is attachment important?
Development of an attachment disorder can affect a healthy personality and result in a personality disorder later in life
What elements are involved in a healthy personality, that are often lost if there is an attachment disorder?
- Development of a conscience
- Ability to become self-reliant
- Ability to think logically
- Ability to cope with frustration and stress
- Ability to handle fear or a threat to self
- Development of relationships
What specific causes are related to the development of an attachment disorder?
- Frequent changes in primary caregiver
- Extended separation from the parent/primary caregiver
- Frequent moves in foster care/ institutions
- Parental Neglect
- Abuse
- Potential neurodevelopmental difficulties (e.g. Autism = often found in combination with attachment disorders)
What symptoms in young children should raise urgent concerns of an attachment disorder?
- Persistent/medically unexplained severe Colic
- Poor eye contact
- No reciprocal smile
- Delayed gross motor skill development
- Difficulty being comforted
- Resists affection
- Poor sucking response when eating
What symptoms commonly present in older children with attachment disorders?
- impulsive
- Speech and language delays
- Lack of conscience / no empathy
- often in others personal space
- Indiscriminately affectionate with strangers
- Avoids/overseeks physical contact
- Hyperactive
- Aggressive
- Destructive towards self/property/others
- Food issues: gorges, refuses to eat, hides food
- Prefers to play alone
Why is important to look behind the anger of an aggressive child with an attachment disorder?
- anger has resulted from past experiences of humiliation where they are made to feel worthless
=> the anger is to stop them from feeling this way again and we must understand this when consulting with them
Describe how childhood experiences can change how the brain is developing to cause a change in behaviour
Constant stress from difficult childhood experiences = increase in serum cortisol
=> changes the cortical development in the frontal lobe of the brain
=> this area is responsible for sensibility when making decisions etc
What are the usual other differential diagnoses when suspecting a child has an attachment disorder?
Conduct Disorder (CD)
Depression
Autism Spectrum Disorder
ADHD
How is Conduct Disorder different from an attachment disorder?
Children with CD are able to form some satisfying relationships with peers and adults unlike those with attachment disorders
How is Depression different from an attachment disorder?
Depressed children are often able to form appropriate social relations with those who reach out to them, whereas those with attachment disorders will not regardless of who it is.
How is Autism Spectrum Disorder different from RAD?
- children with RAD are more able to adapt based on what they get out of certain relationships
- Children with ASD are much less flexible and will not adapt with each different relationship
Children with ADHD are more likely to initiate and maintain a relationship than those with an attachment disorder. TRUE/FALSE?
TRUE
What are the most common co-morbid disorders that exist with RAD?
Emotional disorders
ADHD
Behavioural Disorders
What treatments are commonly used for attachment disorders
- Family therapy
- Individual therapy
- Play therapy
- Medication
- Special education interventions
What are the benefits of play therapy?
- child learns appropriate skills for interacting with peers and other social situations
Describe the aim of special education interventions
- programs that help the child learn skills required for academic and social success
- Also addresses behavioral and emotional difficulties
In what situation would medication be used to treat an attachment disorder?
for symptoms of a comorbid disorder (e.g. anxiety and hyperactivity)
What is a conduct disorder?
repetitive pattern of behaviour in which the basic rights of others are violated
What is conduct disorder also known as?
Oppositional Defiant Disorder (ODD)
What symptoms do conduct disorders usually present with?
- Aggression to people or animals
- Destruction of properly
- Deceitfulness or theft
- Serious violation of rules
What are the consequences of a conduct disorder?
- Difficulty in School
- Family problems
- Criminality (Young offender’s involvement)
- Mental Health co-morbidity
What are the different severities of conduct disorder
?
1) Mild/Moderate
2) Severe
- Unsocialised (dealt with in criminal justice system)
- Socialised (better at avoiding being caught)
What other conditions are often present in behavioural conduct disorders?
- RAD
- ADHD
- learning difficulties (30%)
- Depression
- Substance misuse
- Deviant sexual behaviour
What triad of difficulties are usually present in ADHD?
Inattention
Hyperactivity
Impulsivity
There is increased risk of ADHD if the parents of siblings have the condition. TRUE/FALSE?
TRUE
60% parents with ADHD pass it on
15% increased risk with siblings
If a child is thought to have both CD and ADHD, how do we differentiate the two?
Give ADHD meds
Both conditions will react to meds in short term, but long term the meds will only treat the ADHD.
What are the main causes of CD?
- Genetic (evidence from twin studies)
- Brain injury (intrauterine, post natal trauma)
- Environmental (Clash of temperament between child and parent)
What family factors can affect their ability to socialise thier child?
- parents with mental illness/intellectual difficulties
- drug and alcohol problems
- domestic violence
- single parent families
Give examples of intra-familiar predictors of antisocial behaviour
- Lack of house rules-
- Lack of clarity as to how children are to behave
- Lack of effective contingencies (don’t always get told off for doing same thing wrong)
- Lack of techniques to deal with crises or resolve conflict
- Lack of supervision
How is CD treated if children do NOT have a co-morbid disorder?
Parent /Foster training (<11 years of age)
Child focused programmes (9 and 14 years)
- social and cognitive problem solving programmes
Multimodal interventions (11 and 17 years) - multisystemic therapy that provides support to the young person and family
What medications can help to treat the impulsivity and aggressive behaviour in CD and associated conditions?
Risperidone (atypical antipsychotic)
Treat co-morbid condition:
- ADHD - stimulant medication
- Depression – SSRIs
