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child health > attachment disorders and temperament > Flashcards

attachment disorders and temperament Flashcards

1
Q

what is the most important predictor of personality development?

A

child’s early relationship with primary caregiver

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2
Q

what are the stages of development?

A
  • asocial stage
  • indiscriminate attachment
  • specific attachments
  • multiple attachments
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3
Q

when does asocial stage occur and what is it?

A

0-6 weeks

-smiling and crying not directed at specific people

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4
Q

when does indiscriminate attachment occur and what is it?

A

6 weeks to 7 months

attention sought from different individuals

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5
Q

what is specific attachments and when does it occur?

A

7-11 months

-strong attachment to one individual and separation and stranger anxiety

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6
Q

what are the 4 attachment styles?

A
  • secure
  • insecure avoidant
  • insecure ambivalent/resistent
  • disorganized (least common)

everyone falls into one of these attachment styles

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7
Q

what test is used to figure out infants attachment style?

A

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 lives, infant left completely alone
  • stranger returns
  • mother returns and stranger leaves
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8
Q

what is most common type of attachment?

A

secure attachment

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9
Q

how will infant with secure attachment react during strange situation?

A
  • 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
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10
Q

what % of infants have a secure attachment style?

A

70%

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11
Q

what % of infants have an ambivalent attachment style?

A

15%

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12
Q

how do infants with ambivalent attachment style react during the stranger test?

A
  • 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
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13
Q

what % of infants have avoidant attachment?

A

15%

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14
Q

how do infants with avoidant attachment react in the stranger test?

A
  • 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
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15
Q

how do insecure-avoidant attached adolescents- type A view themselves and others?

A

view of self: unloved, self reliant

view of others: rejecting, controlling, intrusive

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16
Q

how do insecure- avoidant attached adolescents- type A present?

A
  • 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
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17
Q

how do insecure- ambivalent attaches adolescents- type C view themselves and others?

A

view of self: low value, ineffective, dependant

view of others: insensitive, unpredictable, unreliable

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18
Q

how do insecure- ambivalent attached adolescents- type C present?

A
  • 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
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19
Q

what is a secure base?

A

-the attachment figure/relationship provides a safe space (literally or symbolically) from which to explore the world

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20
Q

what is a safe haven?

A

-the attachment figure/relationship is a safe place (literally or symbolically) to retreat to at times of danger or anxiety

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21
Q

what is attunement?

A
  • 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
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22
Q

when does co-dysregulation occur?

A

-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

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23
Q

the brain is what % of adult weight at birth?

A

25%

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24
Q

the brain is what % of adult weight at 3 years old?

A

90%

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25
Q

what are some behavioural signs of disordered attachment?

A
  • 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
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26
Q

why may children develop cognitive dysfunction?

A

-due to not having a ‘secure base’ which allows them to explore and learn

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27
Q

what are some examples of cognitive function of someone with disordered attachment?

A
  • 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
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28
Q

what are some examples of emotional function of someone with disordered attachment?

A
  • 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
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29
Q

how may a child with attachment disorder function socially?

A
  • 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
30
Q

how may a child with attachment disorder present physically?

A
  • poor hygiene
  • chronic body tension
  • accident prone
  • high pain tolerance/ over reaction to minor injury
  • tactilely defensive
31
Q

how is disorder attachment managed?

A
  • 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
32
Q

what are the types of temperament ?

A
  • easy temperament
  • difficult temperament
  • slow to warm up temperament
  • no category temperament
33
Q

describe an easy temperament

A
  • easily approach and easily adapt to new situations
  • react madly to things
  • regular in their sleep/wake and eating routines
  • overall positive mood
34
Q

what % of babies have an easy temperament?

A

40%

35
Q

describe a baby with a difficult temperament?

A
  • withdrawn from or are slow to adapt to new situations
  • intense reactions
  • irregular routines
  • negative mood
  • long and recent crying episodes
36
Q

what % of babies have a difficult temperament?

A

10%

37
Q

describe a baby with slow to warm up temperament?

A
  • 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
38
Q

what % of babies have a slow temperament?

A

5-15%

39
Q

what % of babies do not have a category of temperament?

A

40%

40
Q

what is reactive attachment disorder?

A

-markedly disturbed and developmentally inappropriate social relatedness in most contexts that begin before 5 years

41
Q

what effect does RAD have on children forming relationships?

A

-difficulty forming lasting, loving intimate relationships

42
Q

how do patients develop RAD?

A
  • 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
43
Q

what medical effect can RAD have?

A
  • malnutrition
  • growth delay
  • evidence of physical abuse
  • vitamin deficiencies
  • infectious diseases
44
Q

what are the subtypes of RAD?

A
  • inhibited

- disinhibited

45
Q

how do children with inhibited RAD present?

A
  • 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
46
Q

whats another name for disinhibited RAD?

A

Disinhibited social engagement disorder (DSED)

47
Q

what type of child does disinhibited RAD refer to?

A
  • a child who has an inability to make appropriate selective attachements
  • over familiar with strangers
48
Q

what are some signs of RAD?

A
  • 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
49
Q

what increases risk of children developing RAD?

A
  • 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)
50
Q

what are some differentials for RAD?

A
  • 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)
51
Q

True or false

RAD has a high co-morbidity

A

True, about 50% met the criteria for one or more co morbid disorders

52
Q

what’s the nice guidelines for assessing behavioural disorders in ages 1-2?

A

Strange situation

53
Q

what’s the nice guidelines for assessing behavioural disorders in ages 2-4?

A

Modified strange situation procedure

54
Q

what’s the nice guidelines for assessing behavioural disorders in ages 1-4?

A

Attachment Q-sort

children are observed in a number of set environments

55
Q

what’s the nice guidelines for assessing behavioural disorders in ages 4-7?

A

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

56
Q

what’s the nice guidelines for assessing behavioural disorders in ages 7-15?

A

Child attachment interview

-the child is asked to describe their relationship with caregivers in various situations

57
Q

what’s the nice guidelines for assessing behavioural disorders in ages 15 and

A

Adult attachment interview

58
Q

what is the management of RAD in preschool according to NICE?

A
  • 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
59
Q

what is the management of RAD in school age children according to NICE?

A
  • 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
60
Q

what is conduct disorder?

A

-a repetitive and persistent pattern of behaviour in which the basic rights of others or major age appropriate norms or rules are violater

61
Q

what is conduct disorder referred to in children < age of 10?

A

Oppositional Defiant Disorder (ODD)

62
Q

how common is conduct disorder?

A

second most common mental health disorder in children and adolescents

63
Q

how does conduct disorder present?

A

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
64
Q

what types of conduct disorder are there?

A
  • mild to moderate

- severe

65
Q

what types of severe type conduct disorder are there?

A
  • unsocialised

- socialised

66
Q

what is the differene between mild to moderate type and severe type conduct disorder?

A

mild to moderate type is restricted to family environment

67
Q

what is unsocialised severe conduct disorder?

A

-predominantly violent behaviour and more likely to be dealt within the criminal justice system

68
Q

what is socialised severe conduct behavious?

A

-more convert antisocial acts or better ability to avoid getting involved with criminal justice

69
Q

what are some co-morbidities of conduct disorder?

A
  • attachment disorders (RAD)
  • ADHD
  • reading anf other learning difficulties
  • depression
  • substance misuse
  • deviant sexual behaviour
70
Q

how is ADHD characterised?

A
  • inattention
  • hyperactivity
  • impulsivity
71
Q

what is the treatment for conduct disorder?

A

<11 years= treat with paremt/foster training
9-14 years= treat with child focused programmes
11-17 years= treat with multimodal interventions

child health (28 decks)

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