Attachment and Behavioural Disorders Flashcards
what is reactive attachment disorder
disturbed and developmentally inappropriate social relatedness beginning before the age of 5 and associated with pathological care
individuals have difficulties forming lasting, loving and intimate relationships
some common causes of RAD
Persistent disregard for child’s emotional needs
persistent disregard for child’s physical needs
repeated changes of primary care giver
who is more likely to have RAD
children orphaned at young age
those who move through foster parents but don’t have one primary care giver
what are the two subtypes of RAD
Inhibited
Disinhibited
what are the symptoms/signs of inhibited RAD
children continually fail to initiate and respond to social interactions
child does not seek comfort from care giver
if child is left alone, then mother comes back to comfort them they can’t be comforted
What are some symptoms/signs of disinhibited RAD
Child has inability to display appropriate selective attachments
eg. has excessive familiarity with strangers
what is an ‘alien self’
when the mother does not respond to the emotional/physical needs of the child the child develops an altered sense of self, not feeling worth of being looked after
what are some alarming symptoms in young children that would raise safeguarding concerns
- Persistent colic
- poor eye contact, difficulty tracking
- no reciprocal smile
- delayed gross motor skills
- difficulty being comforted
- resists affection and cuddling
- appears stiff, defensive
- poor sucking response when eating
RAD symptoms in older kids
- lack of self control/impulsive
- speech and language delays
- lack of conscience/no remorse
- lack social boundaries
- indiscriminately affectionate with strangers or hesitancy in social interactions
- avoids/over seeks physical contact
- hyperactive
- aggressive
- food issues:hordes, gorges, hides food, refused to eat
- anxious, wary
- prefers to play alone
where does anger tend to stem from in difficult children
shame-based
originated from past experiences of humiliating abuses of power where they were made to feel worthless, useless and unworthy of respect
what effect do childhood experiences have on the emotional centres of the brain
they dramatically change the number for neurons and the number of axons connecting them so affect how the emotional centres of the brain communicate with the cortex
Differentials which are often either mistaken for, or a co-morbidity of RAD
Conduct disorder
-these children are able to form some satisfying relationships
Depression
-often able to form appropriate relationships with those who reach out to them
ASD
-more able to adapt based on what they get out of different relationships
ADHD
-difficulties are persistent - more able to initiate and maintain relationships
what percentage of those with RAD also have a co-morbid disorder
50%
what are some effective treatments for RAD
- Family therapy
- Individual therapy
- Play therapy
- Medication (for symptoms of co-morbid disorder)
- Special education interventions
how does family therapy help RAD
helps parents or other children understand symptoms of disorder and effective interventions
how does individual therapy help RAD
Helps child directly with monitoring of emotions and behaviour
how does play therapy help RAD
helps child learn skills for interacting with peers and other social situations
What is Conduct Disorder
a repetitive and persistent pattern of behaviour where the basic rights of others or major age appropriate norms/rules are violated
type of behaviour disorder
What is Oppositional Defiant Disorder
lesser degree of conduct disorder seen in younger children
what are the criteria for Conduct Disorder
presence of 3 or more in the last 2 months and at least 1 in the last 6 months:
- aggression to people or animals
- destruction of property
- deceitfulness or theft
- serious violation of rules
what are some consequences of Conduct Disorder
serious impairment in social, academic or occupational function
- school
- family
- criminality
- health, social services, criminal justice system
- mental health co-morbidity
what is mild-moderate Conduct Disorder
restricted to family environment
what are the 2 types of severe conduct disorder
Unsocialised
Socialised
what is unsocialised conduct disorder characterised with
violent behaviour, more likely to be dealt with my criminal justice system
what is socialised conduct disorder characterised with
better ability to avoid getting involved with criminal justice system
what are common Conduct Disorder co-morbidities
RAD ADHD!! (common) Learning difficulties Depression Substance misuse Deviant sexual behaviour
what are the triad of ADHD difficulties
Inattention
Hyperactivity
Impulsivity
symptoms of co-occuring ADHD and Conduct Disorder
Developmentally inappropriate
Impairing functioning
Pervasive across settings
Longstanding from age 5
what are the causes of ADHD
genetic + environment
runs in families
whats the difference between children with ADHD and children with both CD and ADHD
Children with both have higher rates of antisocial personality as adults
what are some causes of Conduct Disorders
Genetic
Brain injury
Environmental
what factors may make a family vulnerable to not meeting the needs of their children
- families with parents with mental illness and intellectual difficulties
- drug and alcohol problems
- domestic violence
- single parent families
what are some predictors of antisocial behaviour within the family
- Lack of house rules
- lack of clarity as to how children should behave
- Lack of effective contingencies (inconsistent responses to behaviour)
- lack of techniques to deal with family crisis
- lack of supervision
Treatment for Conduct disorder (in those without co-morbid disease)
parent/foster training if child is under 11
Child focused programmes
multimodal interventions for ages 11-17
medication - used for extreme aggression
what medications are used to treat CD
Risperidone (antipsychotic)
