Attachment and behavioural disorders Flashcards
What is reactive attachment disorder?
Markedly disturbed and developmentally inappropriate social retardedness in most contexts that begins before the age of 5 and is associated with grossly pathological care
What type of care can lead to RAD?
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 are the consequences of RAD?
Individuals can have difficulty forming lasting, loving and intimate relationships
Can cause malnutrition, growth delay, evidence of physical abuse, vitamin deficiencies or infectious diseases
What children have an increased likelihood of developing RAD?
20% of children in care system will develop RAD
Children orphaned at a young age
What is inhibited RAD?
Refers to children who continually fail to initiate and respond to social interactions in a developmentally appropriate way
Interactions are often met with a variety of approaches, avoidance and resisting to comfort, often hypervigilant or highly ambivalent
What is an example of a child who has inhibited RAD?
A child or infant that does not seek comfort from a parent or caregiver during times or threat, alarm or disterss
What is disinhibited RAD?
Refers to a child who has an inability to display appropriate selective attachments
Also known as disinhibited social engagement disorder
More enduring over time than the inhibited type
What is an example of a child who has disinhibited RAD?
A child who displays excessive familiarity with strangers. Indiscriminate sociability or lack of selectivity in their choices of attachment figure
Why is attachment important?
Development of a conscience
Ability to become self reliant
Ability to think logically
Ability to cope with frustration and stress
Ability to handle the fear or threat to self
Development of relationships
What can occur if attachment does not occur?
Lack of empathy Poor self esteem Poor problem solving abilities Difficulties with emotional regulation Highly impulsive Lack of trust in others
What can cause RAD?
Frequent changes in primary caregiver
Extended separation from parent/primary caregiver
Frequent moves and/or placements in foster care or institutions
Traumatic experiences
Young or inexperienced mother with poor parenting skills
Neglect
Abuse
Neurodevelopmental difficulties e.g. ASD
What are alarming symptoms in young children that should raised urgent safeguarding concerns?
Persistent and medically unexplained severe colic
Poor eye contact, difficulty tracking
No reciprocal smile response
Delayed gross motor skill development
Difficulty being comforted
Resists affection and cuddling from caregiver
Appears stiff, displays tactile defensiveness
Poor sucking response when eating
What are common symptoms in older children of RAD?
Lack of self control Speech and language delays Lack of conscience Lack of understanding of social boundaries Indiscriminately affectionate with strangers or hesitancy in social interactions Avoids/over seeks physical contact Hyperactivity Aggressiveness Food issues Prefers to play alone Often on guard, anxious, wary
What are differential diagnoses when thinking about RAD?
Conduct disorder -children with CD are able to form satisfying relationships with peers and adults
Depression - can mimic inhibited RAD
ASD - historical and pervasive difficulties while children with RAD are more able to adapt based on what they get out of certain relationships
ADHD - difficulties are persistent and across different settings, RAD will be worst at home
What are the treatments for RAD?
Family therapy - help parents or caregivers understand the symptoms
Individual therapy - helps the child directly with monitoring emotions and behavioral
Play therapy - helps child learn appropriate skills for interacting with peers
Medication - symptoms of comorb disorder
Special education interventions - specifically designed programs that can help the child learn skills required for academic and social success
What is conduct disorder?
A repetitive and persistent pattern of behaviour in which the basic rights of others or major age-appropriate norms or rules are violated
How will conduct disorder present?
3 or more of the following criteria in the part 12 months with at lead one in the last 6 months: Aggression to people or animals Destruction of property Deceitfulness or theft Serious violation of rules
What comes under aggression in CD?
Often threats, bullies or intimidates others
Initiates fights
Physical weapon that can cause serious physical harm
Physically cruel to others
Physically cruel to animals
Stolen while confronting a victim
Forced somoen into secual actiivty
What comes under destruction of property in CD?
Deliberately destroyed other peoples property
Deliberately engaged in fire setting
What comes under deceitfulness or theft in CD?
Broken into someone’s house, building or car
Often lies to obtain goods or favours or avoids obligations
What are the consequences of CD?
Serious impairment in social, academic or occupational function:
School, family, criminality, young offending services, mental health co-morb
What is mild to moderate CD?
Restricted to family environment
What is unsocialised severe conduct disorder?
Predominantly violent behaviour and more likely to be dealt within the criminal justice system
What is socialised severe conduct disorder?
More covert antisocial acts or better ability to avoid getting involved with the criminal justice system. More ability to lie about it or hide it, better cognitive ability. Can manipulate the system more efficiently
What other conditions can occur with CD?
RAD ADHD Reading and other learning difficulties Depression or low mood Substance misuse Deviant sexual behaviour - victims or perpetrators of sexual abuse or rape
What is the triad of ADHD?
Inattention
Hyperactivity
Impulsivity
What causes ADHD?
Multifactorial and involve genetic and environmental factors
What is the difference between ADHD and CD?
ADHD - unintentionally make mistakes and are hyperactive
CD - purpose and intention is to be disruptive
What causes CD?
Bio-psycho-social influences
Genetic - evidence with twin studies
Brain injury (intrauterine, post natal CNS trauma): antisocial behaviour is more common in children with neurological conditions
Environmental - child problem family chaos
What can lead to family problems with socialising the children?
Families with parents with mental illness and intellectual difficulties
Drug and alcohol problems
Domestic violence - alters how children view relationships
Single parent families
What are some intra-familial predictors of antisocial behaviour?
Lack of house rules - not set routine for meals and other activities
Lack of clarity of acceptable behaviours
Lack of effective contingencies that is inconsistent responses to undesired behaviour with failure to follow through on consequences or rewards - good cop bad cop
Lack of techniques to deal with crises or resolve conflict within the family
Lack of supervision is strongly associated with delinquency
What is the treatment for CD?
Parent/foster training is suitable when the child is below 11 years
Child focused programme where child is ages between 9 and 14
Multimodal interventional to young people between 11 and 17
When is medication prescribed in CD?
Extreme cases of impusivity or aggressive beaviour:
Risperiodone (atypical antipsychotic)
ADHD - stimulants
Depression - SSRIs
