attachment and behavioural disorders CAMSH

Question 1

reactive attachment disorder (RAD) - what are the 3 components

Answer 1

persistnt disregard for childs emotional needs for comfort, stimulation and affection
Persistent disregard for the child’s physical needs
Repeated changes of primary caregivers

Question 2

impact of RAD later in life

Answer 2

Individuals have difficulty forming lasting, loving and intimate relationships

Question 3

impact of RAD on child at time

Answer 3

: malnutrition, growth delay, evidence of physical abuse, vitamin deficiencies, or infectious diseases.

Question 4

Children orphaned at a young age have an increased likelihood of this disorder
t/f

Answer 4

true

Question 5

2 subtypes of RAD - Inhibited and Disinhibited. outline each

Answer 5

inhibited

• fail to initiate/respond to social interactions
• interactions met with variety of approaches, avoidance, and resisting to comforting, hypervigiilant, highly ambivalent

disinhibited
-unable to display appropriate selective attachments

Question 6

give example of inhibited RAD

Answer 6

does not seek comfort from parent during threat

Question 7

example of disinhibited RAD

Answer 7

A child who displays excessive familiarity with strangers. indiscriminate sociability or lack of selectivity in their choices of attachment figure

Question 8

potential causes of RAD

Answer 8

Frequent changes in primary caregiver
Extended separation from the 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
Potentially, neurodevelopmental difficulties (in particular ASD) can contribute

Question 9

alarming symptoms in very young children 7

Answer 9

persistent medically unexplained severe colic 
poor eye contact
no smile response 
delayed grpss motor skills 
difficulty being comforted 
resists affection and cuddling
stiff, tactile defensiveness

Question 10

common symptoms in older children

Answer 10

lack of self control/impulsive 
speech/language delays 
lack of conscience/remorse
lack of understanding social boundaries 
 indiscriminately affectionate with strangers
avoids/overseeks physical contact
hyperactive
agressive +defensive
food issues (over/undereat, hide foods, hordes, gorges)
plays alone

Question 11

what can anger represent

Answer 11

shame based response
past experiences of humiliating abuses of power (feel worthless, useless,unworthy)
shameful experiences - distorted sense of self

Question 12

neurobiology of RAD

Answer 12

vulnerability to neuroinflammation -> chronic stress/ HPA-axis dysfunction (high cortisol - leads to difficulties developing frontal lobe)
reduced oxytoxcin
oxidative stress damage (teauma)

Question 13

t.f life experiences can alter no. od neurons, dendritic branchs and synapses

Answer 13

true

Question 14

differential diagnoses to consider 4

Answer 14

depression
conduct disorder
ASD
ADHD

Question 15

conduct disorder compared to RAD

Answer 15

able to from satisfying relationships with peers and adults

Question 16

depression compared to RAD

Answer 16

withdrawn, able to form appropriate social relations with those who reach out to them

Question 17

ASD compared to RAD

Answer 17

historical pervasive difficulties, RAD ore able to adapt based on what they get out of relationships

Question 18

ADH compared to RAD

Answer 18

diffiuclties persistent and across different settings, intimate relationships

Question 19

effective treatments for RAD

Answer 19

family therapy (helps understanding) 
individual therapy (helps monitor behaviour/emotion) 
play therapy - younger (helps express themselves) 
medication - helpful for co-morbid disorders (anxity = hyperactivity)
special education interventions (small setting, more sraff to counter)

Question 20

define conduct disorder

Answer 20

persistet/repeitvie pattern of behaviour - basic rights of others/major age appropriate norms/rules are violated
(2nd most common mental health disorder in children/adolescents)

Question 21

nam for conduct disorder in young children

Answer 21

Oppositional defiant disorder (ODD)

Question 22

presentation of CD

Answer 22

3(+) of: 
aggression to people/animals 
property destruction 
deceitfulness or theft
violation of rules

Question 23

CD can be divided into 
mild to moderate
or
severe
how does each differ

Answer 23

mild
-restricted to family environment

sev
unsocialised - predominantly violent behaviour, involved in criminal justice system
socialised - cover antisocial acts, better ability to avoid getting involved with criminal justice system

Question 24

co-morbidites of CD

Answer 24

RAD
ADHD 
reading/learning difficulties (30%)
depression/low mood 
substance misuse 
deviant sexual behaviour (victims, perpetrators)

Question 25

how does CD differ from ADHD

Answer 25

ADHD = inattention, hyperactiivity, impulsivity

co-occurs wiht impaired self-regulation (emotions ect)

Question 26

stimulant medication is same for CD and ADHD

Answer 26

true

Question 27

causes of CD

Answer 27

bio-pstcho-social inflences
genetic (+ usually trigger)
brain injury - intrauterine./post natal CNS trauma
environmental (“difficult to raise”) , clashing temperament

Question 28

intra-familiar predictors for antisocial behaviour

Answer 28

lack of house rules
lack of clarity as to how children are to behave
lack of effective contingencies (inconstistnet responses to undesired behaviour, failure on consequences/rewards)
lack of techniques to deal with crises/family conflict
lack of supervision

Question 29

for children who do not hav co-morbidities, treatment for CD

Answer 29

parent training (if child<11) 
child focused programmes (9-14) 0 social and cognitive problem solving programmes
multimodal inverventions (11-17) (multisystemic therapy that provides intensive support to the young person and their family)

medication in extreme cases
-risperidone (atypical antipsychotic)

Question 30

treating co-morbid conditions

Answer 30

ADHD - stimulant medication

depression - SSRIS