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child and family > CAHMS > Flashcards

CAHMS Flashcards

1
Q

what is the attachment theory

A

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

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2
Q

what is the asocial age of attachment

A
  • 0-6 weeks

- smiling and crying not directed at specific people

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3
Q

what is indiscriminate attachment

A
  • 6 weeks to 7 months

- attention sought from different individuals

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4
Q

what is specific attachments stage

A

7-11 months

  • strong attachment to one individual
  • separation and stranger anxiety
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5
Q

what is the last stage of attachment

A

multiple attachments

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6
Q

what are the three main attachment styles

A
  • secure
  • insecure avoidant
  • insecure ambivalent/resistant
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7
Q

how can separation anxiety be seen for these three styles of attachment

A

secure - distressed when mother leaves
ambivalent - infant shows signs of distress when mother leaves
avoidant - infant shows no signs of distress when mother leaves

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8
Q

how can stranger anxiety be seen in these styles of attachment

A

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

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9
Q

insecure avoidant attached adolescents type A

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
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10
Q

insecure ambivalent attached adolescents - type C

A

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

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11
Q

what does secure base mean

A

the attachment figure/relationship provides a safe space from which to explore the world

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12
Q

what does safe haven mean

A

the attachment figure/relationship is a safe place to retreat to at times of danger

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13
Q

what does attunement mean

A
  • process between caregiver and infant in which they are able to tune into each others physical and emotional states
  • infant manages stress through coregulation
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14
Q

what does co-dysregulation mean

A

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

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15
Q

how does an infant’s relationship with their caregiver affect their later life

A

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

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16
Q

behavioural signs of disordered attachment

A
  • 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
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17
Q

cognitive signs of disordered attachment

A
  • lack of cause and effect thinking
  • learning disorders
  • language disorders
  • distorted self image
  • grandiose sense of self importance
  • black and white style of thinking
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18
Q

emotional signs of disordered attachment

A
  • core emotions are intense
  • disheartened and depressed with mood swings
  • struggle to express emotions
  • lack of affection
  • intense displays of rage
  • low self esteem
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19
Q

social signs of disordered attachment

A
  • 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
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20
Q

physical aspects of disordered attachment

A
  • poor hygiene
  • chronic body tension
  • accident prone
  • high pain tolerance/over reaction to minor injury
  • tactilely defensive
21
Q

causes of disrupted attachment

A
  • 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
22
Q

management of disordered attachment

A
  • assessment of both attachment and family system and relevance to problems
  • young person needs to make sense of their history and current functioning
23
Q

role of the professional in attachment

A
  • eye contact
  • develop trust
  • playfulness and empathy
  • provide safety
  • good role model
24
Q

signs of easy temperament

A
  • readily approach and easily adapt to new situations
  • react mildly to things
  • regular in sleep and routine
  • positive mood
25
Q

signs of difficult temperament

A
  • withdraw from or slow to adapt to new situations
  • intense reactions
  • irregular routines
  • negative mood
  • lots of crying
26
Q

signs of ‘slow to warm up’ temperament

A
  • 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
27
Q

what is reactive attachment disorder

A

markedly disturbed and developmentally inappropriate social relatedness in most contexts that begins before 5 years old

28
Q

what can cause RAD

A
  • 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
29
Q

signs of reactive attachment disorder

A
  • 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
30
Q

two subtypes of RAD

A

inhibited and disinhibited

31
Q

what is inhibited RAD

A
  • 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
32
Q

what is disinhibited RAD

A
  • refers to a child who has an inability to display appropriate selective attachments
  • also known as disinhibited social engagement disorder
  • more enduring over time
33
Q

what is the neurobiology of RAD

A
  • 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
34
Q

differential diagnoses of RAD

A
  • conduct disorder
  • depression
  • ASD
  • ADHD
35
Q

what additional diagnoses can a lot of children with RAD have

A
  • ADHD
  • ODD
  • CD
  • PTSD
  • ASD
  • tics
36
Q

what is the NICE assessment for RAD

A
  • 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
37
Q

NICE management for preschool RAD

A
  • 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
38
Q

NICE management for school age attachment issues

A
  • 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
39
Q

what is conduct disorder

A

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

40
Q

what is CD called in younger children

A

oppositional defiant disorder (ODD)

41
Q

how does CD present

A

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
42
Q

what is mild to moderate CD

A

restricted to a family environment

43
Q

what is severe CD

A

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

44
Q

co-morbidities of CD

A
  • RAD
  • ADHD
  • reading and other learning difficulties
  • depression
  • substance misuse
  • deviant sexual behaviour
45
Q

what is ADHD characterised by

A

a triad of difficulties

  • inattention
  • hyperactivity
  • impulsivity
46
Q

causes of CD

A
  • 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
47
Q

what are some predictors of antisocial behaviour

A
  • 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
48
Q

treatment of CD for children who don’t have a complicating factor

A
  • parent/foster training when child is <11yrs
  • child focused programmes for 9-14yrs
  • multimodal interventions for 11-17yrs
49
Q

what medications for extreme cases of CD

A
  • risperidone (atypical antipsychotic)
  • for ADHD - stimulant medication
  • for depression - SSRI’s

child and family (20 decks)

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