CHILD WITH MENTAL HEALTH PROBLEM Flashcards
What is attachment behaviour?
Behaviour that results in an individual attaining proximity to a preferred other
Whats the secure base effect?
the phenomenon by which children are able to explore their environment without stress because they feel safe knowing that they can return to their caregiver,
Whats the characteristic effects of separation from an attachment figure?
Protest - the child may protest, crying and screaming,protesting angrily, clinging to the attachment figure and try to struggle to escape from those who pick the child up and try to stop the child from reaching the caregiver .
Despair - the child is upset and refuses peoples attempts of comfort.
Detachment - if the separation between the attachment figure and the child continues, the baby may start to play again with others but may also be wary. The child, upon the arrival of the caregiver who has gone, may also reject the caregiver and act angrily towards this attachment figure.
Whats a secure attachment?
Secure attachment is the healthiest form of attachment.
It describes an attachment where a child feels comforted by the presence of their caregiver. Securely attached children feel protected and that they have someone to rely on. Children with secure attachment prefer their caregiver over strangers, seek comfort in their caregiver, and are comfortable exploring their environment with their caregiver present.
Why is a secure attachment important?
By growing up with a sense of stability and care, securely attached children find it easier to investigate and interact with the world around them . Into adulthood, secure attachment translates into higher self-esteem, more long-term healthy relationships, and an increased ability to trust others for social support. Since they grow up with a positive caregiver relationship, securely attached children can replicate a healthy bond with others, in all types of relationships.
What are the 3 types of insecure attachment?
Anxious-ambivalent / anxious-preoccupied
Anxious-avoidant /anxious-dismissive
Fearful avoidant / disorganised
Whats the problem with insecure attachments?
If a child cannot rely on an adult to respond to their needs in times of stress, they are unable to learn how to soothe themselves, manage their emotions and engage in reciprocal relationships
What was the face recognition experiment?
newborn infants will follow a slowly moving schematic face stimulus with their head and eyes further than they will folow scrambled faces or blank stimuli
Despite immature visual systems, babies are still able to recognise primary care givers faces
What is the still face experiment?
where a mother faces her baby, and is asked to hold a ‘still face’, in which she does not react to the baby’s behaviours. The reactions of the baby are then observed. In general, the baby will become agitated by failed attempts to evoke a reaction in the mother.
This should raise awarensss about the importance of social interaction on a baby’s development especially in this world’s use of technology
Whats the most critical period for forming attachments?
First 2 years
An attachment style between child and caregiver will be formed by the end of the first 12 months.
Outline the developmental milestones for attachment?
Pre-Attachment Stage: Newborn to 3 months
Babies show no preference for their caregiver yet.
They are soothed by anyone who takes care of them.
Indiscriminate Attachment: 6 weeks to 7 months
Babies show some preference for their primary caregivers. They are still soothed by those who aren’t their caregiver but are better at differentiating between strangers and those they know.
Discriminate Attachment: 7 months to 11 months
Infants will show a clear preference for one caregiver. They will be upset if separated from their primary caregiver. Babies will now show anxiety around strangers.
Multiple Attachments: from approximately 9 months on
Babies can now bond with people other than their caregiver. They can be soothed by people other than their caregiver who they’ve bonded with, such as grandparents and older siblings.
Whats the internal working models concept?
Bowlby said… The relationship with our primary caregiver becomes internalised and will become a set of unconscious expectations. Once these are formed, the person’s social world will be organised based on these expectations.
What promotes attachment?
Maternal sensitivity
Warmth
Emotional responsiveness
Involvement
Reciprocity
What are insecure attachments usually associated with?
Poor parenting/abuse
What is ambivalent insecure attachment?
When you have negative views of self but positive views of others
When you are dependant on others for self worth and have a fear of losing relationships so are clingy on separation
Children with this insecure attachment are clingy to their caregiver, yet when their caregiver attempts to comfort them, the child remains distressed. This can be hard for the caregiver because they are consistently unable to soothe their child, which can lead to a negative cycle of interaction. The child wants to be close with their caregiver but doesn’t fully trust them for support.
As a child with ambivalent attachment grows, this bonding style will often lead to clinginess and distrust in other types of relationships that develop in their life. people with this attachment style are often anxious and uncertain, lacking in self-esteem. They crave emotional intimacy but worry that others don’t want to be with them
What is disorganised/fearful-avoidant insecure attachment?
Negative views of self and others
Seek and avoid closeness
Fearful of making connections
will show an inconsistent connection with their caregiver and often hold fear towards them. The child must rely on the caregiver for survival, but the caregiver is also a source of fear. This is because their caregiver is sometimes there for support and sometimes unavailable or emotionally damaging, so the child doesn’t know when they can count on their caregiver to meet their needs.
This type of attachment style often occurs in homes with abuse, leading to insecure attachment from trauma. It will often contribute to mental health issues in adulthood, like substance abuse and borderline personality disorder.
In this form of attachment, the child grows up believing that they are unworthy of love.
What is avoidant insecure attachment?
Positive views of self but negative views of others
characterized by a child who avoids their caregiver and does not seek comfort from them. These children will show little to no preference for their caregiver over a stranger. They will not seek out their parents when in times of distress.
Avoidant attachment is formed when a child feels they cannot consistently count on their caregiver to comfort and care for them. An avoidant child sees no preference for their caregiver over a stranger because it’s possible the stranger may be more attuned to their needs than their actual caregiver.
Those who grow up with an avoidant attachment are more likely to have challenges with intimacy later in life and be closed off from social relationships. By not growing up with a close connection to their caregiver, they have trouble finding a healthy connection to others in their life. Instead of craving intimacy, they’re so wary of closeness they try to avoid emotional connection with others. They’d rather not rely on others, or have others rely on them
What are risk factors for attachment diffiuclties?
Poverty
Parental mental health diffiuclties
Exposure to neglect, domestic violence or other forms of abuse
Alcohol/drug taking during pregnancy
Multiple home/school placements
Prem birth
Abandonement
Family bereavement
(Not insecure attachments can also occur in non-vulnerable children)
Whats the strange situation procedure?
- Caregiver (CG) sits with infant on floor for 3 minutes.
- Stranger enters room & engages infant for 3 minutes.
- Caregiver leaves for up to 3 minutes.
- CG returns and spends 3 minutes with infant.
- CG leaves and infant left alone for 3 minutes.
- Stranger returns for 3 minutes.
- CG returns.
As these stages occur the child and mother’;s behaviour is observed.
Outline the child and mother’s behaviour during the strange situation test in a secure attachment?
Mother is seen as available, dependable and warm. They respond to the child’s cues
Child explores room actively and will be distressed if the mother leaves. A positive reunion and accepts comfort easily
Outline the child and mother’s behaviour during the strange situation test in a anxious/avoidant attachment?
Mother is rejecting, angry and hostile if child makes demands in stressful situations
Child is not distressed by mother leaving and will ignore mother on reunion, focussing on the environment
The child had learnt to suppress behaviours normally used to alert mother
Outline the child and mother’s behaviour during the strange situation test in a ambivalent attachment?
Mother is inconsistent with her care and is unresponsive and insensitive to child’s needs and demands
Child is very distressed when mother leaves. Ambivalence on return both seeking comfort then rejecting it on reunion
Outline the child and mother’s behaviour during the strange situation test in a disorganised attachment?
Mother is frightened herself or frightening. Usually abusive or suffering abuse
Child has contradictory behaviours with strong proximity seeking then strong avoidance. Distress, anger, freezing and stereotypes
How do we manage attachment difficulties?
Psychoeducation and formulation of diffiuclties
Systemic work with whole family
Private therapy or via social care if eligible
(Within CAMHS no treatment is offered)
What are behavioural disorders?
involve a pattern of disruptive behaviors in children that last for at least 6 months and cause problems in school, at home and in social situations.
They are a common presentation that may or may not be associated with mental health difficulties
Behaviour should be seen as a form of communication
Whats the difference between conduct disorders and opposition defiant disorder?
ODD affects younger children and involved them being defiant, disobedient and disruptive BUT not aggressive or antisocial behaviour
Conduct disorders continue into adolescence, are more severe and often include aggressive or antisocial behaviour
How are behavioural and conduct disorders managed?
Prevention
Psychotherapy
Family therapy
Parenting support via social care
What are conduct disorders?
Disorders characterized by a repetitive and persistent pattern of dissocial, aggressive, or defiant conduct.
Such behaviour should amount to major violations of age-appropriate social expectations; it should therefore be more severe than ordinary childish mischief or adolescent rebelliousness and should imply an enduring pattern of behaviour (six months or longer).
E.g. cruelty to other people or animals, fire-setting, stealing, repeated lying
Whats the difference between socialised and Unsocialised conduct disorders?
Both have persistent dissociation or aggressive behaviour occurring but the individual either is well integrated into their peer group (socialised) or has significant pervasive abnormalities in their relationships with other children (Unsocialised)
What are mixed disorders of conduct and emotions?
A group of disorders characterized by the combination of persistently aggressive, dissocial or defiant behaviour with overt and marked symptoms of depression, anxiety or other emotional upsets.
What is reactive attachment disorder of childhood?
Starts in the first five years of life and is a rare but serious condition in which an infant or young child doesn’t establish healthy attachments with parents or caregivers.
The syndrome probably occurs as a direct result of severe parental neglect, abuse, or serious mishandling.
What is disinhibited social engagement disorder?
A particular pattern of abnormal social functioning that arises during the first five years of life
those with DSED appear to be extremely friendly and outgoing. They exhibit socially disinhibited behavior. This means they are impulsive and can easily talk to unknown people and random strangers. However, they may have trouble forming stable or meaningful bonds with others.
Causes include an absence of caregiver in first few years of life, lack of emotional support whilst growing up, neglect by caregiver, repeated changing of caregivers, negative experiences, or growing up in foster care or orphanages
What is elective mutism?
a refusal to speak in almost all social situations despite normal ability to do so. often attributed to defiance or the effect of trauma
Now also known as selective mutism
What is separation anxiety disorder of childhood?
differentiated from normal separation anxiety when it is of a severity that is statistically unusual and has an abnormal persistence beyond the usual age period, and when it is associated with significant problems in social functioning.
What is sibling rivalry disorder?
emotional disturbance usually following the birth of an immediately younger sibling is normal but this disorder should only be diagnosed if the degree/persistence of the disturbance is both statistically unusual and associated with abnormalities of social interaction.
The most common symptom of sibling rivalry disorder is frequent or continuous demands for attention
What is a tic?
an involuntary, rapid, recurrent, nonrhythmic motor movement (usually involving circumscribed muscle groups) or vocal production that is of sudden onset and that serves no apparent purpose. Tics tend to be experienced as irresistible but usually they can be suppressed for varying periods of time, are exacerbated by stress, and disappear during sleep.
What are common motor tics?
Simple - eye blinking, neck-jerking, shoulder-shrugging and facial grimacing
Complex - hitting oneself, jumping, hopping
What are common vocal tics?
Simple - throat-clearing, barking, sniffing and hissing
Complex - religion of particular words, often social unacceptable (coprolalia) and the repetition of one’s own sounds or words (palilalia)
What is transient tic disorder?
tics don’t persist for >12 months. Usually eye blinking, facial grimacing or head jerking
Whats a chronic motor or vocal tic disrder?
motor or vocal tics (not both) that last for more than a year
Whats Tourette’s syndrome/Gilles de la Tourette syndrome?
multiple motor tics and 1 or more vocal tics. Disorder worsens during adolescence and tends to persist into adult life.
The vocal tics are often multiple with explosive repetitive vocalizations, throat-clearing, and grunting, and there may be the use of obscene words or phrases.
What is coprolalia?
the involuntary and repetitive use of obscene language, as a symptom of mental illness or organic brain disease.
What is nonorganic enuresis?
A disorder characterized by involuntary voiding of urine, by day and by night, which is abnormal in relation to the individual’s mental age, and which is not a consequence of a lack of bladder control due to any neurological disorder, to epileptic attacks, or to any structural abnormality of the urinary tract. The enuresis may have been present from birth or it may have arisen following a period of acquired bladder control.
What is nonorganic encopresis?
Repeated, voluntary or involuntary passage of faeces, usually of normal or near-normal consistency, in places not appropriate for that purpose in the individual’s own sociocultural setting. The condition may represent an abnormal continuation of normal infantile incontinence, it may involve a loss of continence following the acquisition of bowel control, or it may involve the deliberate deposition of faeces in inappropriate places in spite of normal physiological bowel control
What is feeding disorder of childhood and infancy?
It generally involves food refusal and extreme faddiness in the presence of an adequate food supply, a reasonably competent caregiver, and the absence of organic disease. There may or may not be associated rumination (repeated regurgitation without nausea or gastrointestinal illness).
What is pica of infancy and childhood?
Persistent eating of non-nutritive substances (such as soil, paint chippings, etc.). It may occur as one of many symptoms that are part of a more widespread psychiatric disorder (such as autism), or as a relatively isolated psychopathological behaviour; only the latter is classified here. The phenomenon is most common in mentally retarded children
What are stereotyped movement disorders?
Voluntary, repetitive, stereotyped, nonfunctional movements that do not form part of any recognized psychiatric or neurological condition.
The movements that are of a non self-injurious variety include: body-rocking, head-rocking, hair-plucking, hair-twisting, finger-flicking mannerisms, and hand-flapping.
Stereotyped self-injurious behaviour includes repetitive head-banging, face-slapping, eye-poking, and biting of hands, lips or other body parts.
All the stereotyped movement disorders occur most frequently in association with mental retardation
What is stuttering?
Speech that is characterized by frequent repetition or prolongation of sounds or syllables or words, or by frequent hesitations or pauses that disrupt the rhythmic flow of speech. It should be classified as a disorder only if its severity is such as to markedly disturb the fluency of speech.
