Attachment and Behavioural Disorders Flashcards

1
Q

What is Reactive Attachment Disorder

A

Disturbed and developmentally inappropriate social relatedness that begins before 5 y/o
Associated with pathological care
Individuals struggle to form lasting and intimate relationships

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2
Q

Give examples of ‘pathological’ care that can lead to RAD

A

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

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3
Q

What medical signs can often be seen alongside RAD

A
Malnutrition 
Growth delay 
Evidence of physical abuse 
Vitamin deficiencies 
Infectious diseases
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4
Q

What situation can increase the likelihood of developing RAD

A

Much higher prevalence in looked after children (care or not with parents)
Orphaned at a young age

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5
Q

Is remission possible with RAD

A

Yes

if detected early and the child is given an appropriate, stable and supportive environment

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6
Q

What are the 2 subtypes of RAD

A

Inhibited - more common

Disinhibited

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7
Q

Describe inhibited RAD

A

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

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8
Q

Describe disinhibited RAD

A

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

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9
Q

How can attachment issues affect your personality

A
May lack empathy and self-esteem 
Poor problem solving skills 
Struggle with emotional control 
Lack trust in others 
Be highly impulsive
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10
Q

Attachment issues may precede a personality disorder in adulthood - true or false

A

True

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11
Q

List potential causes of attachment issues

A
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
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12
Q

Describe the healthy vs alien self model

A

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

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13
Q

What symptoms of RAD or neglect should be alarming in young children

A
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
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14
Q

List common symptoms of RAD in older kids

A
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
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15
Q

Why do neglected children often appear angry or aggressive

A

Can be shame based
Past experience of abuse of power can make them feel worthless
Some cope by becoming angry

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16
Q

Describe the neurobiological effects of RAD

A

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

17
Q

List the 4 other conditions apart from RAD that should be considered in the differentials for attachment issues

A

Conduct disorder - CD
Depression
ASD
ADHD

All can occur alongside RAD

18
Q

What is the key difference between RAD and CD

A

Children with CD are able to form some satisfying relationships with peers and adults whereas RAD kids struggle with this

19
Q

What is the key difference between RAD and depression

A

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

20
Q

What is the key difference between RAD and ASD

A

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

21
Q

What is the key difference between RAD and ADHD

A

The difficulties of ADHD are persistent and across different settings, and are more able to initiate and maintain relationships

22
Q

List effective treatments for RAD

A

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

23
Q

What is conduct disorder (CD)

A

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

24
Q

What is conduct disorder called in younger kids

A

Oppositional Defiant Disorder (ODD)

25
Q

How does CD present

A

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

26
Q

Describe the different subtypes of CD

A

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

27
Q

List some co-morbidities associated with CD

A
RAD 
ADHD
Reading and learning difficulty 
Depression 
Substance misuse 
Deviant sexual behaviour - victim or perpetrator
28
Q

What triad of difficulties characterise ADHD

A

Inattention
Hyperactivity
Impulsivity

29
Q

What can cause ADHD

A

Multifactorial condition
Partly genetic - runs in families
Environmental

30
Q

What can cause CD

A

Genetics? - some evidence in twin study
Brain injuries when very young
Environmental - parenting style and family circumstance

31
Q

Which family factors can lead to behavioural issues in the children

A

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

32
Q

What parenting practices can lead to antisocial behaviour

A

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

33
Q

What medications may help with impulsivity and aggressive behaviour

A

Risperidone - atypical antipsychotic
Treat ADHD with stimulant medication
Depression with SSRIs