CAMHS

Question 1

what are the stages of attachment?

Answer 1

asocial stage 0-6 weeks
indiscriminate attachment 6 weeks - 7 months
specific attachments 7-11 months
multiple attachments

Question 2

what are the 3 main attachment styles?

Answer 2

secure
insecure avoidant
insecure ambivalent / resistant
(disorgansied is a rare 4th type)

Question 3

how does avoidant attachment present in adolescents?

Answer 3

type a
view themselves as unloved, self-reliant, avoids intimacy & dependence, higher incidence of somatising illness

Question 4

how does ambivalent attachment present in adolescents?

Answer 4

type b
low self value, dependent, disruptive, insecure, can display antisocial behaviour, dysregulated emotions

Question 5

what is the definition of attunement

Answer 5

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

Question 6

how much of adult size does the brain grow from age 0-3?

Answer 6

25% of full size at birth, 90% at 3

Question 7

what is the emotional functioning of attachment disorders

Answer 7

Core emotions are intense, feelings of anger, fear, pain and shame.
Often appear disheartened and depressed with mood swings.
Struggle to express emotions.

Question 8

how do attachment disorders present?

Answer 8

cognitive functioning -difficulties due to lack of secure base
emotional functioning- strong or lack of emotions
social functioning - superficial engagement, lack of eye contact etc.
physical- poor hygiene, chronic body tension, very high or low pain tolerance

Question 9

what are some causes of disrupted attachment?

Answer 9

poor parenting skills, unplanned pregnancy, periods of separation, neglect or abuse

Question 10

what is the management of disordered attachment?

Answer 10

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

Question 11

what are the 4 types of temperament in babies?

Answer 11

-easy- readily approaches new situations, positive mood
-difficult- withdrawn, slow to adapt, long frequent crying episodes
-slow to warm up
-no category

Question 12

what is reactive attachment disorder?

Answer 12

Markedly disturbed and developmentally inappropriate social relatedness in most contexts that begins before 5yrs
Associated with grossly pathological care
difficulty forming good lasting relationships
associated symptoms- malnutrition, physical abuse symptoms, infectious diseases

Question 13

what is an example of inhibited RAD?

Answer 13

A child or infant that does not seek comfort from a parent or caregiver during times of threat, alarm or distress

Question 14

what is an example of disinhibited RAD?

Answer 14

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

Question 15

what are the signs of RAD?

Answer 15

inappropriate interaction between child and primary caregiver
lack or smiling or responsiveness
lack of distress when it would be expected
excessive friendliness towards strangers
inconsolable crying
emotional & behavioural difficulties

Question 16

describe the neurobiology of RAD

Answer 16

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 synapses
In particular, they can determine how emotional centres of the brain communicate with the cortex and its higher functioning

Question 17

what are the differential diagnoses for RAD?

Answer 17

50% have at least 1 co-morbid disorder
-conduct disorder (CD)
-depression
-ASD
-ADHD

Question 18

what assessments do you do for RAD?

Answer 18

strange situation / modified version or attachment Q-sort for age 1-4
story stem attachment profile 4-7 years
child attachment interview 7-15 years
adult attachment interview 15+

Question 19

what is the management for school age children with RAD?

Answer 19

parental sensitivity and behavioural therapy
intensive training and support for carers
group therapies
trauma focused CBT

Question 20

what is the prognosis of RAD?

Answer 20

Developmental delay
Reduction in academic achievement
Withdrawal
Disruptive behaviour
Difficulties with relationships
Increased risk of contact with youth justice

Question 21

what is a conduct disorder?

Answer 21

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

Question 22

how do you diagnose a CD?

Answer 22

The presence of 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 properly
Deceitfulness or theft
Serious violation of rules

Question 23

what are the types of CD?

Answer 23

mild to moderate- only in family environment

severe- unsocialised (violent, more likely criminal behaviour)
socialised (covert antisocial acts, can still maintain relationships)

Question 24

what are the comorbidities seen in CD?

Answer 24

Attachment difficulties (RAD)
ADHD
Reading and other learning difficulties
Depression
Substance misuse
Deviant sexual behaviour

Question 25

what causes CD?

Answer 25

genetic, brain injury, neurological conditions
environmental- parental and family circumstances

Question 26

how do you manage CD?

Answer 26

for no comorbidities:
training for carers for children <11
child focused programmes in age 9-14
multimodal interventions in age 11-17

in severe cases- risperidone (antipsychotic)
if ADHD give stimulant medications
if depression give SSRIs