Attachment and Behavioural Disorders

Question 1

what is reactive attachment disorder

Answer 1

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

Question 2

some common causes of RAD

Answer 2

Persistent disregard for child’s emotional needs

persistent disregard for child’s physical needs

repeated changes of primary care giver

Question 3

who is more likely to have RAD

Answer 3

children orphaned at young age

those who move through foster parents but don’t have one primary care giver

Question 4

what are the two subtypes of RAD

Answer 4

Inhibited

Disinhibited

Question 5

what are the symptoms/signs of inhibited RAD

Answer 5

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

Question 6

What are some symptoms/signs of disinhibited RAD

Answer 6

Child has inability to display appropriate selective attachments

eg. has excessive familiarity with strangers

Question 7

what is an ‘alien self’

Answer 7

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

Question 8

what are some alarming symptoms in young children that would raise safeguarding concerns

Answer 8

• 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

Question 9

RAD symptoms in older kids

Answer 9

• 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

Question 10

where does anger tend to stem from in difficult children

Answer 10

shame-based
originated from past experiences of humiliating abuses of power where they were made to feel worthless, useless and unworthy of respect

Question 11

what effect do childhood experiences have on the emotional centres of the brain

Answer 11

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

Question 12

Differentials which are often either mistaken for, or a co-morbidity of RAD

Answer 12

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

Question 13

what percentage of those with RAD also have a co-morbid disorder

Answer 13

50%

Question 14

what are some effective treatments for RAD

Answer 14

• Family therapy
• Individual therapy
• Play therapy
• Medication (for symptoms of co-morbid disorder)
• Special education interventions

Question 15

how does family therapy help RAD

Answer 15

helps parents or other children understand symptoms of disorder and effective interventions

Question 16

how does individual therapy help RAD

Answer 16

Helps child directly with monitoring of emotions and behaviour

Question 17

how does play therapy help RAD

Answer 17

helps child learn skills for interacting with peers and other social situations

Question 18

What is Conduct Disorder

Answer 18

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

Question 19

What is Oppositional Defiant Disorder

Answer 19

lesser degree of conduct disorder seen in younger children

Question 20

what are the criteria for Conduct Disorder

Answer 20

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

Question 21

what are some consequences of Conduct Disorder

Answer 21

serious impairment in social, academic or occupational function

• school
• family
• criminality
• health, social services, criminal justice system
• mental health co-morbidity

Question 22

what is mild-moderate Conduct Disorder

Answer 22

restricted to family environment

Question 23

what are the 2 types of severe conduct disorder

Answer 23

Unsocialised

Socialised

Question 24

what is unsocialised conduct disorder characterised with

Answer 24

violent behaviour, more likely to be dealt with my criminal justice system

Question 25

what is socialised conduct disorder characterised with

Answer 25

better ability to avoid getting involved with criminal justice system

Question 26

what are common Conduct Disorder co-morbidities

Answer 26

RAD
ADHD!! (common)
Learning difficulties 
Depression 
Substance misuse 
Deviant sexual behaviour

Question 27

what are the triad of ADHD difficulties

Answer 27

Inattention
Hyperactivity
Impulsivity

Question 28

symptoms of co-occuring ADHD and Conduct Disorder

Answer 28

Developmentally inappropriate
Impairing functioning
Pervasive across settings
Longstanding from age 5

Question 29

what are the causes of ADHD

Answer 29

genetic + environment

runs in families

Question 30

whats the difference between children with ADHD and children with both CD and ADHD

Answer 30

Children with both have higher rates of antisocial personality as adults

Question 31

what are some causes of Conduct Disorders

Answer 31

Genetic
Brain injury
Environmental

Question 32

what factors may make a family vulnerable to not meeting the needs of their children

Answer 32

• families with parents with mental illness and intellectual difficulties
• drug and alcohol problems
• domestic violence
• single parent families

Question 33

what are some predictors of antisocial behaviour within the family

Answer 33

• 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

Question 34

Treatment for Conduct disorder (in those without co-morbid disease)

Answer 34

parent/foster training if child is under 11

Child focused programmes

multimodal interventions for ages 11-17

medication - used for extreme aggression

Question 35

what medications are used to treat CD

Answer 35

Risperidone (antipsychotic)