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Y2 Child Health > Child Mental Health > Flashcards

Child Mental Health Flashcards

1
Q

What are the three main attachment styles?

A

Secure
Insecure Ambivalent
Insecure Vvoidant

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2
Q

How do type A and type C avoidant attached adolescents differ?

A

Type A - unloved, self reliant, reject others, controlling and intrusive

Type C - low value, dependent on others, insensitive and unpredictable

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3
Q

What are the main characteristics of Avoidant attached Type A adolescents?

A 
Avoid intimacy or dependence 
Hard to engage 
View relationships as unimportant 
Indifferent to other's views 
Linked with higher incidence of physical illness and hard drug use
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4
Q

What are the main characteristics of Avoidant attached type C adolescents?

A

Disruptive and attention seeking
Insecure and coercive
Can alternate with friendly and hostile
Antisocial behaviour, impulsivity and poor concentration
Lots of complaining - feels a growing sense of unfairness and injustice
Overwhelming level of arousal that is difficult to self-regulate
Dysregulated emotions

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5
Q

Define a Secure Base

A

Attachment figure/relationship providing a safe space from which to explore the world

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6
Q

Define a Safe Haven

A

Attachment figure or relationship which is safe to retreat to at times of anxiety and danger

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7
Q

Define attunement

A

Process between caregiver and infant in which they are able to tune into each others emotional states

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8
Q

How can attunement lead to co-dysregulation?

A

Child’s stress is met by stressed adult who is unable to response to the child’s needs –> escalation of distress.

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9
Q

When does the majority of postnatal brain development occur?

A

first 2 years of life - 90% of adult brain by 3 years old.

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10
Q

What are the subtypes of symptoms displayed in disordered attachment?

A 
Behavioural 
Cognitive function 
Emotional function 
Social function 
Physical
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11
Q

What are the behavioural signs of disordered attachment?

A 
Lack of self control/impulsiveness 
Lack of normal fear 
Self destructive behaviours 
Destruction of property 
Aggression 
Irresponsibility 
Inappropriately demanding or clingy - pseduomaturity 
Stealing 
Lying/being deceitful 
Hoarding 
Inappropriate sexual behaviour 
Cruelty to animals 
Sleep disturbance 
Abnormal eating habits
Enuresis and Encopresis 
Defying rules 
Hyperactivity 
Preoccupation with fire or gore 
persistent nonsense questions 
Poor hygiene 
Difficulties with change
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12
Q

What are the cognitive functioning symptoms of disordered attachment?

A

Clear cognitive difficulties displayed du to lack of secure base meaning disruption of exploration and learning -

Lack of cause and effect 
Learning disorders 
Language disorders 
Distorted self image 
Grandiose sense of self importance 
Black and white/all or nothing thinking
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13
Q

What are the emotional functioning symptoms or disordered attachment?

A

Intense core emotions - anger, fear, pain, shame
Disheartened or depressed with mood swings
Struggle to express emotions
Lack of affection
Low self esteem

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14
Q

What are the symptoms of social functioning in disordered attachment?

A 
Superficially engaging - lacks genuine trust/intimacy 
Lack of eye contact 
Indiscriminately affectionate with strangers 
Lack of peer relationships 
Cannot tolerate limits 
Blames others for mistakes 
Victimises 
Lacks trust 
Exploitative and bossy
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15
Q

What are the physical symptoms of disordered attachment?

A 
Poor hygiene
Chronic body tension 
Accident prone 
High pain tolerance or over-reaction to minor injury 
Tactilely defensive
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16
Q

Give examples of causes of disordered attachment?

A 
Unplanned pregnancy, consideration of termination 
Post natal depression
Neglect or abuse (emotional and physical) 
Separation from primary caregiver 
Parental conflict 
Maternal drug addiction 
Frequent moves 
Traumatic experiences 
Unresponsive baby 
Undiagnosed illnesses e.g. colic, ear infections
Lack of attunement 
Poor parenting skills
17
Q

What is Reactive Attachment Disorder (RAD)?

A

disturbed and developmentally inappropriate social relatedness

18
Q

What are the subtypes of RAD?

A

Inhibited -

Disinhibited (aka DSED)

19
Q

Describe Inhibited RAD

A

Refers to children who continually fail to initiate and respond to social interactions in a developmentally appropriate way. They will avoid social interactions, resist comforting, appear to be hypervigilant and ambivalent (have varying views/responses to things)

20
Q

Describe Disinhibited RAD

A

Disinhibited Social Engagement Disorder - these children struggle to distinguish who it is appropriate to become attached to, ie will grow attached to strangers. This is harder to treat than inhibited.

21
Q

What are the suggestive symptoms of RAD in very young children?

A 
Persistent and medically unexplained colic 
Poor eye contact, difficulty tracking 
No reciprocal smile response 
Delayed gross motor development 
Difficulty being comforted 
Resists affection and cuddling from caregiver 
Appears stiff, tactile defensiveness 
Poor sucking response when eating
22
Q

What are common RAD symptoms in older children?

A 
Lack of self control 
Speech and language delays 
Lack of conscience 
Lack of understanding of social boundaries 
Indiscriminately affectionate with strangers or inhibition in social interactions 
Avoidance or seeking physical contact 
Hyperactive 
Aggressive 
Food issues 
Prefers to play alone
23
Q

How does childhood experiences change brain anatomy to influence RAD?

A

Experience –> genetics –> behavioural changes
Experiences –> alter number of neurons, dendritic branches and synapses –> alters how emotional centres of the brain communicate with cortex

24
Q

What are the DDx of RAD?

A

Conduct disorder
Depression
ASD
ADHD

NB: comorbidity is high

25
Q

Tx for RAD?

A 
Family therapy 
Individual Therapy 
Play therapy 
Medication for symptoms of comorbid disorder e.g. ADHD 
Special education interventions
26
Q

What is Conduct Disorder?

A

Repetitive or persistent pattern of behaviour in which the basic rights of others or age appropriated norms or rules are violated.

27
Q

What is ODD?

A

Oppositional Defiant Disorder- Conduct Disorder to a lesser degree in younger children

28
Q

How does Conduct Disorder diagnosed?

A 
The presence of three or more of the following criteria in the space of 6 months: 
1. Aggression to people or animals 
2. Destruction of property 
3. Deceitfulness or theft 
Serious violation of rules
29
Q

What are the different types of Conduct Disorder?

A

Mild to moderate - family environment

Severe Unsocialised - predominantly violent behaviour, most likely dealt with within criminal justice system

Severe Socialised - more covert antisocial acts, better ability to avoid criminal justice system

30
Q

Common comorbidities of Conduct Disorder?

A 
RAD 
ADHD !!! 
Reading and learning difficulties 
Depression 
Substance misuse 
Deviant sexual behaviour
31
Q

What is the triad of difficulties which characterise ADHD?

A

Inattention
Hyperactivity
Impulsivity

32
Q

What are the causes of CD?

A

Not a single cause:
Genetic
Brain injury
Environmental (including family factors)

33
Q

What are familial predictors of antisocial behaviour?

A 
Lack of house rules and routines 
Lack of clarity on behaviour 
Lack of effective contingencies 
Lack of techniques for crisis resolution in family 
Lack of supervision
34
Q

Tx for CD

A 
If no comorbid factors: 
Parental training if child < 11yo 
Child focused programmes for 9-14yo 
Mulitmodal interventions 
Medications may help with impulsivity and aggression
35
Q

What medication is a Tx for impulsivity and aggression in CD?

A

Risperidone (antipsychotic)

36
Q

What Tx may be required for comorbidities in CD?

A

Stimulant medication for ADHD

SSRIs for depression

Y2 Child Health (6 decks)

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