Attachment and Behavioural Disorders Flashcards
What is Reactive Attachment Disorder
Disturbed and developmentally inappropriate social relatedness that begins before 5 y/o
Associated with pathological care
Individuals struggle to form lasting and intimate relationships
Give examples of ‘pathological’ care that can lead to RAD
A persistent disregard for the child’s emotional needs for comfort, stimulation, and affection
Persistent disregard for the child’s physical needs
Repeated changes of primary caregivers
What medical signs can often be seen alongside RAD
Malnutrition Growth delay Evidence of physical abuse Vitamin deficiencies Infectious diseases
What situation can increase the likelihood of developing RAD
Much higher prevalence in looked after children (care or not with parents)
Orphaned at a young age
Is remission possible with RAD
Yes
if detected early and the child is given an appropriate, stable and supportive environment
What are the 2 subtypes of RAD
Inhibited - more common
Disinhibited
Describe inhibited RAD
Children wont communicate in a socially normal way
They fail to initiate and respond to social interaction in a ‘normal’ way for their age
May avoid interactions or be resistant and anxious
Describe disinhibited RAD
Child will not be able to display appropriate selective attachments
So will not form attachments with safe people or engage properly with caregivers
May have excessive familiarity with strangers
How can attachment issues affect your personality
May lack empathy and self-esteem Poor problem solving skills Struggle with emotional control Lack trust in others Be highly impulsive
Attachment issues may precede a personality disorder in adulthood - true or false
True
List potential causes of attachment issues
Frequent changes in primary caregiver Extended separation from caregiver Frequent moves in foster care etc Trauma Young, inexperienced mother Neglect Abuse Neurodevelopmental problems (ASD) can contribute
Describe the healthy vs alien self model
Healthy - parent will respond to the baby’s need or emotion and the baby can mirror this and learn how to cope
Alien - will develop attachment disorder as caregiver doesn’t give them a consistent response or wont respond and they get confused
What symptoms of RAD or neglect should be alarming in young children
Persistent and unexplained colic Poor eye contact No reciprocal smile Delayed gross motor skills Difficulty being comforted Resisting affection from caregiver Stiffness Poor sucking response when eating
List common symptoms of RAD in older kids
Lack of self-control Speech, language delays Lack of conscience Lack of understanding of social boundaries/ personal space Overly affectionate with strangers Hyperactive Aggressive and destructive On guard and anxious
Why do neglected children often appear angry or aggressive
Can be shame based
Past experience of abuse of power can make them feel worthless
Some cope by becoming angry
Describe the neurobiological effects of RAD
Can change structure of the brain
E.g. can alter the number of neurons, increase/decrease the number of branches or synapses
Response to neglect can mimic inflammation and leads to excess cortisol which leads to difficulty in development in the cortical part of the brain
List the 4 other conditions apart from RAD that should be considered in the differentials for attachment issues
Conduct disorder - CD
Depression
ASD
ADHD
All can occur alongside RAD
What is the key difference between RAD and CD
Children with CD are able to form some satisfying relationships with peers and adults whereas RAD kids struggle with this
What is the key difference between RAD and depression
Depressed children are often able to develop social relationships with those who reach out to them
RAD children will struggle to have relationship with anyone
What is the key difference between RAD and ASD
Children with ASD present historical and pervasive difficulties, while children with RAD are more able to adapt based on what they get out of certain relationships
What is the key difference between RAD and ADHD
The difficulties of ADHD are persistent and across different settings, and are more able to initiate and maintain relationships
List effective treatments for RAD
Family therapy - helps other members understand
Individual therapy - helps child monitor emotions and behaviour
Play therapy - helps learn social skill
Medication - for comorbid disorders
Special education intervention - helps at school etc
What is conduct disorder (CD)
A repetitive and persistent pattern of behaviour in which the basic rights of others or major age-appropriate norms or rules are violated
There is an increased risk to the child and others
What is conduct disorder called in younger kids
Oppositional Defiant Disorder (ODD)
How does CD present
Aggression to people or animals
Destruction of properly
Deceitfulness or theft
Serious violation of rules
need at least 3 in past year or one within the last 6 months
Describe the different subtypes of CD
Mild/Moderate - restricted to family environment
Severe unsocialised - more violent behaviour and often dealt with by police
Severe socialised - more covert with antisocial behaviour or better at lying etc
List some co-morbidities associated with CD
RAD ADHD Reading and learning difficulty Depression Substance misuse Deviant sexual behaviour - victim or perpetrator
What triad of difficulties characterise ADHD
Inattention
Hyperactivity
Impulsivity
What can cause ADHD
Multifactorial condition
Partly genetic - runs in families
Environmental
What can cause CD
Genetics? - some evidence in twin study
Brain injuries when very young
Environmental - parenting style and family circumstance
Which family factors can lead to behavioural issues in the children
Families with parents with mental illness and intellectual difficulties
Drug and alcohol problems
Domestic violence - normalises aggression and warps child’s view of relationship
Single parent families - financial and time constraints
What parenting practices can lead to antisocial behaviour
Lack of house rules
Lack of clarity on how to behave - different responses from parents
Lack of techniques to deal with crisis or conflict
Lack of supervision
What medications may help with impulsivity and aggressive behaviour
Risperidone - atypical antipsychotic
Treat ADHD with stimulant medication
Depression with SSRIs
