CAHMS Flashcards
what is the attachment theory
that an infant attends to human voices, recognises human faces and gazes into parent’s eyes when being fed
forming a close bond with primary caregiver
what is the asocial age of attachment
- 0-6 weeks
- smiling and crying not directed at specific people
what is indiscriminate attachment
- 6 weeks to 7 months
- attention sought from different individuals
what is specific attachments stage
7-11 months
- strong attachment to one individual
- separation and stranger anxiety
what is the last stage of attachment
multiple attachments
what are the three main attachment styles
- secure
- insecure avoidant
- insecure ambivalent/resistant
how can separation anxiety be seen for these three styles of attachment
secure - distressed when mother leaves
ambivalent - infant shows signs of distress when mother leaves
avoidant - infant shows no signs of distress when mother leaves
how can stranger anxiety be seen in these styles of attachment
secure - avoidant of stranger when alone but friendly when mother present
ambivalent - infant avoids stranger and shows fear of stranger
avoidant - infant is okay with stranger and plays normally when stranger present
insecure avoidant attached adolescents type A
view of self - unloved, self-reliant view of others - rejecting, controlling, intrusive -avoid intimacy -hard to engage -view relationships as unimportant -dont need other people -cold -assume others dislike them -hard drug use
insecure ambivalent attached adolescents - type C
view of self - low value, ineffective, dependent
view of others - insensitive, unpredictable, unreliable
-disruptive
-attention seeking
-insecure and coercive
-alternate between friendly charm and hostile aggression
-antisocial behaviour
-impulsive
-poor concentration
what does secure base mean
the attachment figure/relationship provides a safe space from which to explore the world
what does safe haven mean
the attachment figure/relationship is a safe place to retreat to at times of danger
what does attunement mean
- process between caregiver and infant in which they are able to tune into each others physical and emotional states
- infant manages stress through coregulation
what does co-dysregulation mean
where the child’s stress is met by a stressed adult who is unable to respond sensitively and effectively to the childs needs which occurs in both care giver and infants stress escalating
how does an infant’s relationship with their caregiver affect their later life
the affective exchanges between infant and caregiver provide a foundation for neurological development and lead to the creation of neural networks that will influence the infants personality and relationships with others throughout life
behavioural signs of disordered attachment
- lack of self control/impulsiveness
- lack of normal fear
- self destructive behaviours
- destruction of property
- aggression towards others
- consistently irresponsible
- inappropriately demanding or clingy
- stealing
- lying
- hoarding
- inappropriate sexual behaviour
- eating problems
- hyperactivity
- difficult with change
cognitive signs of disordered attachment
- lack of cause and effect thinking
- learning disorders
- language disorders
- distorted self image
- grandiose sense of self importance
- black and white style of thinking
emotional signs of disordered attachment
- core emotions are intense
- disheartened and depressed with mood swings
- struggle to express emotions
- lack of affection
- intense displays of rage
- low self esteem
social signs of disordered attachment
- superficially engaging
- lack of eye contact
- indiscriminately affectionate with strangers
- lack of peer relationships
- cannot tolerate limits
- blames others for mistakes
- victimises others
- victimised by others
- lacks trust in others
- bossy
physical aspects of disordered attachment
- poor hygiene
- chronic body tension
- accident prone
- high pain tolerance/over reaction to minor injury
- tactilely defensive
causes of disrupted attachment
- unplanned pregnancy
- consideration of termination
- post natal depression
- neglect or abuse
- separation from primary caregiver
- parental conflict
- maternal addiction to drugs/alcohol
- frequent moves
- trauma
- undiagnosed painful illnesses
management of disordered attachment
- assessment of both attachment and family system and relevance to problems
- young person needs to make sense of their history and current functioning
role of the professional in attachment
- eye contact
- develop trust
- playfulness and empathy
- provide safety
- good role model
signs of easy temperament
- readily approach and easily adapt to new situations
- react mildly to things
- regular in sleep and routine
- positive mood
signs of difficult temperament
- withdraw from or slow to adapt to new situations
- intense reactions
- irregular routines
- negative mood
- lots of crying
signs of ‘slow to warm up’ temperament
- withdraw from or are slow to adapt to new things
- low level of activity
- show a lot of negative mood
- thought of as shy or sensitive
what is reactive attachment disorder
markedly disturbed and developmentally inappropriate social relatedness in most contexts that begins before 5 years old
what can cause RAD
- persistent disregard for the child’s emotional needs for comfort, stimulation, affection
- persistent disregard for the child’s physical needs
- repeated changed of primary caregivers
signs of reactive attachment disorder
- difficulty forming lasting, loving, intimate relationships
- medically can include malnutrition, growth delay, evidence of physical abuse, vitamin deficiencies, or infectious diseases
- noticeable neglectful behaviour from caregiver
- lack of smiling or responsiveness
- lack of distress in stressful situations
- inconsolable crying
- excessive friendliness towards healthcare workers
two subtypes of RAD
inhibited and disinhibited
what is inhibited RAD
- refers to children who continually fail to initiate and respond to social interactions and respond to social interactions in a developmentally appropriate way
- interactions are often met with a variety of approaches - avoidance etc
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
what is the neurobiology of RAD
- childhood experiences interact with genetics to change the structure of the brain and cause behavioural change
- life experiences can dramatically alter the number of neurons, increase or decrease the dendritic branches and the number of synapses
- they can also determine how emotional centres of the brain communicate with the cortex and its higher functioning
differential diagnoses of RAD
- conduct disorder
- depression
- ASD
- ADHD
what additional diagnoses can a lot of children with RAD have
- ADHD
- ODD
- CD
- PTSD
- ASD
- tics
what is the NICE assessment for RAD
- strange situation (1-2 yrs)
- modified strange situation (2-4yrs)
- attachment Q-sort (1-4yrs)
- story stem attachment profile (4-7yrs)
- child attachment interview (7-15yrs)
- adult attachment interview (15yrs and over) and their parents or carers
NICE management for preschool RAD
- video feedback programme for parents and carers
- parental sensitivity and behavioural therapy
- home visiting programmes
- parent-child psychotherapy for those at risk of having maltreatment
NICE management for school age attachment issues
- parental sensitivity and behavioural therapy
- intensive training and support for foster carers, guardians and adoptive parents
- group therapeutic play sessions
- group based educational sessions for caregivers and children/young people
- trauma focused CBT for maltreated
what is conduct disorder
a repetitive and persistent pattern of behaviour in which the basic rights of others of major age-appropriate norms or rules are violated
what is CD called in younger children
oppositional defiant disorder (ODD)
how does CD present
three or more of the following criteria in the past 12 months with at least one criterion present in the past 6 months
- aggression to people or animals
- destruction of property
- deceitfulness or theft
- serious violation of rules
what is mild to moderate CD
restricted to a family environment
what is severe CD
unsocialised - violent behaviour, dealt with in criminal justice potentially
socialised - more covert antisocial acts or better ability to avoid getting involved with criminal justice system
co-morbidities of CD
- RAD
- ADHD
- reading and other learning difficulties
- depression
- substance misuse
- deviant sexual behaviour
what is ADHD characterised by
a triad of difficulties
- inattention
- hyperactivity
- impulsivity
causes of CD
- not one cause
- genetic
- brain injury
- difficult temperament
- parent and family circumstances
- parents with mental illness
- drug and alcohol problems
- domestic violence
- single parent families
what are some predictors of antisocial behaviour
- lack of house rules, no set routine
- lack of clarity of how children are to behave
- inconsistent responsiveness to bad behaviour with failure to follow through on consequences or rewards
- lack of techniques to deal with crises or resolve conflict within family
- lack of supervision
treatment of CD for children who don’t have a complicating factor
- parent/foster training when child is <11yrs
- child focused programmes for 9-14yrs
- multimodal interventions for 11-17yrs
what medications for extreme cases of CD
- risperidone (atypical antipsychotic)
- for ADHD - stimulant medication
- for depression - SSRI’s
