attachment disorders and temperament Flashcards
what is the most important predictor of personality development?
child’s early relationship with primary caregiver
what are the stages of development?
- asocial stage
- indiscriminate attachment
- specific attachments
- multiple attachments
when does asocial stage occur and what is it?
0-6 weeks
-smiling and crying not directed at specific people
when does indiscriminate attachment occur and what is it?
6 weeks to 7 months
attention sought from different individuals
what is specific attachments and when does it occur?
7-11 months
-strong attachment to one individual and separation and stranger anxiety
what are the 4 attachment styles?
- secure
- insecure avoidant
- insecure ambivalent/resistent
- disorganized (least common)
everyone falls into one of these attachment styles
what test is used to figure out infants attachment style?
the strange situation
- a mother and infant are left alone
- stranger joins mother and infant
- mother leaves infant and stranger alone
- mother returns, stranger laves
- mother leaves, infant left completely alone
- stranger returns
- mother returns and stranger leaves
what is most common type of attachment?
secure attachment
how will infant with secure attachment react during strange situation?
- distressed when mother leaves
- avoidant of stranger when alone but friendly when mother present
- positive and happy when mother returns
- will use mother as a safe base to explore their environment
what % of infants have a secure attachment style?
70%
what % of infants have an ambivalent attachment style?
15%
how do infants with ambivalent attachment style react during the stranger test?
- infant show some signs of distress when mother leaves
- infant avoids the stranger and shows fear of the stranger
- child approaches mother but resists contact, may even push her away
- infant cries more and explores less than other 2 types
what % of infants have avoidant attachment?
15%
how do infants with avoidant attachment react in the stranger test?
- infant shows no signs of distress when mother leaves
- infant is ok with the stranger and plays normally when stranger is present
- infant shows little interest when mother returns
- mother and stranger able to comfort infant equally
how do insecure-avoidant attached adolescents- type A view themselves and others?
view of self: unloved, self reliant
view of others: rejecting, controlling, intrusive
how do insecure- avoidant attached adolescents- type A present?
- avoid intimacy, dependant, disclosure
- hard to engage
- view relationships as unimportant
- dont feel a huge need of other people
- seen as cold, reported to lack empathy or remorse
- are indifferent to other’s views and assume others dislike them
- linked with higher incidence of somatising illness and hard drug use
how do insecure- ambivalent attaches adolescents- type C view themselves and others?
view of self: low value, ineffective, dependant
view of others: insensitive, unpredictable, unreliable
how do insecure- ambivalent attached adolescents- type C present?
- disruptive ‘attention seeking’, difficult to manage
- insecure and coercive
- can alternate between friendly charm and hostile and agressive
- display antisocial behaviour, impulsivity, poor concentration
- feel a growing sense of unfairness and injustice, complain a lot
- dysregulated emotions
what is a secure base?
-the attachment figure/relationship provides a safe space (literally or symbolically) from which to explore the world
what is a safe haven?
-the attachment figure/relationship is a safe place (literally or symbolically) to retreat to at times of danger or anxiety
what is attunement?
- process between caregiver and infant in which they are able to ‘tune in’ to each other’s physical and emotional states
- through a process of co regulation the infant learns to manage stress and anxiety
when does co-dysregulation occur?
-where the child’s stress is met by a stressed adult who is unable to respond sensitively and effectively to the child’s needs causing both care giver and infant distress to escalate
the brain is what % of adult weight at birth?
25%
the brain is what % of adult weight at 3 years old?
90%
what are some behavioural signs of disordered attachment?
- lack of self control/impulsiveness
- lack normal fear
- self destructive behaviour/ destruct property
- agressive towards others
- coinsistently irresponsible
- inappropriately demanding or clingy or have a pseudo maturity
- stealin/hoarding/lying
- inappropriate sexual behaviour
- cruelty to animals
- sleep disturbances
- abnormal eating habits
- defying rules
- bed wetting, fecal spreading
- hyperactivity
- preoccupation with fire/ gore
- poor hygiene
- persistent nonsense questions and incessant chatter
- difficulties with change
- difficulties with emotional regulation
why may children develop cognitive dysfunction?
-due to not having a ‘secure base’ which allows them to explore and learn
what are some examples of cognitive function of someone with disordered attachment?
- lack of cause and effect thinkinh
- learning disorders
- language disorders
- distorted self imagine
- grandiose sense of self importance
- ‘black and white’ or ‘all or nothing’ styles of thinking
what are some examples of emotional function of someone with disordered attachment?
- core emotions are intense, feelings of anger, fear, pain and shame
- often appear disheartened and depressed with mood swings
- struggle to express emotions
- low self esteem
how may a child with attachment disorder function socially?
- superficially engaging (lack of genuine trust, intimacy and affection)
- lack of eye contact
- indiscriminately affectionate with strangers
- lack of peer relationships
- cannot tolerate limits and external control
- blames others for mistakrs
- victimises other
- victimised by others
- lacks trust in others
how may a child with attachment disorder present physically?
- poor hygiene
- chronic body tension
- accident prone
- high pain tolerance/ over reaction to minor injury
- tactilely defensive
how is disorder attachment managed?
- clear assessment of both attachment and family system and their relevance to current problems and concerns
- the young person needs to be able to make sense of their history and current functioning
what are the types of temperament ?
- easy temperament
- difficult temperament
- slow to warm up temperament
- no category temperament
describe an easy temperament
- easily approach and easily adapt to new situations
- react madly to things
- regular in their sleep/wake and eating routines
- overall positive mood
what % of babies have an easy temperament?
40%
describe a baby with a difficult temperament?
- withdrawn from or are slow to adapt to new situations
- intense reactions
- irregular routines
- negative mood
- long and recent crying episodes
what % of babies have a difficult temperament?
10%
describe a baby with slow to warm up temperament?
- withdrawn from or are slow to adapt to new things
- low level of activity
- show a lot of negative mood
- thought as shy or sensitive
what % of babies have a slow temperament?
5-15%
what % of babies do not have a category of temperament?
40%
what is reactive attachment disorder?
-markedly disturbed and developmentally inappropriate social relatedness in most contexts that begin before 5 years
what effect does RAD have on children forming relationships?
-difficulty forming lasting, loving intimate relationships
how do patients develop RAD?
- it is grossly associated with pathological care
- persistent disregard for child’s emotional needs for comfort, stimulation, affection
- persistent disregard for the child’s physical needs
- repeated changes of primary caregiver
what medical effect can RAD have?
- malnutrition
- growth delay
- evidence of physical abuse
- vitamin deficiencies
- infectious diseases
what are the subtypes of RAD?
- inhibited
- disinhibited
how do children with inhibited RAD present?
- 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, resisting comfort, hypervigilant or highly ambivalent
whats another name for disinhibited RAD?
Disinhibited social engagement disorder (DSED)
what type of child does disinhibited RAD refer to?
- a child who has an inability to make appropriate selective attachements
- over familiar with strangers
what are some signs of RAD?
- primary caregiver not comforting the baby in distress
- primary caregiver not responding to needs such s hunger or dirty nappy
- inappropriate interaction noticed between the baby and primary caregiver
- lack of smiling or responsiveness in baby
- baby rejects demonstrations of comfort
- baby avoids touch or gesture of affection
- baby does not seek attention or comfort
- baby has lack of distress in situations which would be expected to cause distress
- excessive friendlyness towards healtchare workers
- inconsolable crying
- emotional and behvioural difficulties
what increases risk of children developing RAD?
- children orphaned at a young age
- abuse (physical, emotional, exual)
- neglect (physical, emotional)
- household dysfunction (mental illness, incarcerated relative, mother treated violently, substance abuse, divorce)
what are some differentials for RAD?
- conduct disorder (however children with CD are able to form some satisfying relationships with peers and adults)
- depression (depressed children are often able to form appropriate social relations with those who reach out to them)
- ASD
- ADHD (children with ADHD are more able to initiate and maintain relationships)
True or false
RAD has a high co-morbidity
True, about 50% met the criteria for one or more co morbid disorders
what’s the nice guidelines for assessing behavioural disorders in ages 1-2?
Strange situation
what’s the nice guidelines for assessing behavioural disorders in ages 2-4?
Modified strange situation procedure
what’s the nice guidelines for assessing behavioural disorders in ages 1-4?
Attachment Q-sort
children are observed in a number of set environments
what’s the nice guidelines for assessing behavioural disorders in ages 4-7?
story stem attachment profile
-stories with stressful scenarios involving a child and their parent are started and the children complete them verbally using toys to interact the story
what’s the nice guidelines for assessing behavioural disorders in ages 7-15?
Child attachment interview
-the child is asked to describe their relationship with caregivers in various situations
what’s the nice guidelines for assessing behavioural disorders in ages 15 and
Adult attachment interview
what is the management of RAD in preschool according to NICE?
- a video feedback programme for parents, foster carers, guardians or adoptive parents
- parental sensitivity and behavioural therapy
- home visiting programmes
- parent child psychotherapy for those who have been or at risk of maltreatment
what is the management of RAD in school age children according to NICE?
- parental sensitivity and behavioural therapy
- intense training and support for foster carers, guardians and adoptive parents
- group therapeutic play sessions
- group based educational sessions for caregivers and children/young people (late primary school or early secondary school)
- trauma focused CBT for those who have been maltreated
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 violater
what is conduct disorder referred to in children < age of 10?
Oppositional Defiant Disorder (ODD)
how common is conduct disorder?
second most common mental health disorder in children and adolescents
how does conduct disorder present?
the presence of 3 or more of the following criteria in the past 12 months with at least one criteria present in the past 6 months
- agression to people or animals
- destruction of property
- deceitfulness or theft
- serious violation of rules
what types of conduct disorder are there?
- mild to moderate
- severe
what types of severe type conduct disorder are there?
- unsocialised
- socialised
what is the differene between mild to moderate type and severe type conduct disorder?
mild to moderate type is 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 behavious?
-more convert antisocial acts or better ability to avoid getting involved with criminal justice
what are some co-morbidities of conduct disorder?
- attachment disorders (RAD)
- ADHD
- reading anf other learning difficulties
- depression
- substance misuse
- deviant sexual behaviour
how is ADHD characterised?
- inattention
- hyperactivity
- impulsivity
what is the treatment for conduct disorder?
<11 years= treat with paremt/foster training
9-14 years= treat with child focused programmes
11-17 years= treat with multimodal interventions
