Mental Health

Question 1

What is the most important predictor of a child’s future personality?

Answer 1

Their relationship with their primary caregiver

Question 2

Name four different attachment styles

Answer 2

• secure
• insecure ambivalent
• insecure avoidant
• disorganised

Question 3

What is secure attachment?

Answer 3

Child is distressed when mother leaves, avoids strangers when alone but friendly when mother present - uses mum as ‘safe base’

Question 4

Describe insecure ambivalent attachment

Answer 4

Infant shows signs of distress when mother leaves, avoids the stranger and shows fear towards them but resists contact from mum when she returns

Question 5

Describe insecure avoidant attachment

Answer 5

Child shows no signs of distress when mum leaves and is ok with stranger, shows little interest when mother returns - equal comfort from both mum and stranger

Question 6

What is disorganised attachment?

Answer 6

Very small percentage of infants have no consistency in how they behave

Question 7

In an child with insecure avoidant attachment how will they feel in adolescence?

Answer 7

Unloved, self reliant, reject or control others, very intrusive. Hard to engage, avoid intimacy and view relationships as unimportant. Assume others don’t like them and come across cold.

Question 8

How will children with insecure ambivalent feel in adolescence?

Answer 8

Low value, insensitive, unreliable, unpredictable, attention seeking, insecure, friendly vs hostile may come across antisocial

Question 9

Define a secure base

Answer 9

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

Question 10

Define a safe haven

Answer 10

The attachment figure/relationship provides a safe place to retreat at times of danger/anxiety

Question 11

Define attunement

Answer 11

Process between caregiver and infant whereby they can ‘tune in’ to each other’s physical and emotional states

Question 12

What are the five key categories of symptoms of disordered attachment?

Answer 12

• behavioural signs
• cognitive functioning
• emotional functioning
• social functioning
• physical aspects

Question 13

What can cause disrupted attachment?

Answer 13

Pregnancy - unplanned/consideration of termination
Parents - neglect/abuse/conflict/drugs/difficulties
Child - separation from primary caregiver, unresponsive baby, illness, traumatic experience

Question 14

Define reactive attachment disorder

Answer 14

Disturbed and developmentally inappropriate social relatedness in most contexts that begins before 5 years of age

Question 15

How may a child with reactive attachment disorder present?

Answer 15

Difficulty forming lasting intimate relationships, may be malnourished, or have evidence of physical abuse/growth delay

Question 16

How common is RAD?

Answer 16

1% of children under the age of five

Question 17

Name two types of RAD

Answer 17

Inhibited and Disinhibited

Question 18

Describe inhibited RAD

Answer 18

Children who continually fail to initiate and respond to social interactions in a developmentally appropriate way. Interactions are often met with a variety of approaches - avoidance, resisting comfort, hyper vigilant or highly ambivalent

Question 19

Describe disinhibited RAD

Answer 19

Child has an inability to display appropriate selective attachments

Question 20

State some alarming symptoms in a child with suspected attachment disorders

Answer 20

Unexplained severe colic, poor eye contact, no reciprocal smile, delayed gross motor skills, difficulty being comforted, stiff, defensive or poor suckle

Question 21

Name the common symptoms of RAD

Answer 21

Lack of self control, speech/language delays, lack of social boundaries, indiscriminately affectionate, hyperactive, aggressive, food issues, anxious/wary, prefers to play alone

Question 22

Describe the neurobiology behind RAD

Answer 22

Experiences interact with genetics to change the structure of the brain leading to behavioural changes. Life experiences alter the number of neurones and can increase/decrease the dendritic branches/number of synapse which can determine how the brain communicates with the cortex and higher functioning

Question 23

What is the differential diagnosis for RAD? How are they different to RAD?

Answer 23

Conduct disorder - children are able to form some satisfying relationships
Depression - often children with inhibited type but children with depression can form appropriate relationships with those who reach out
ASD - historical and pervasive difficulties
ADHD - more able to initiate and maintain relationships

Question 24

What are the effective treatments for RAD?

Answer 24

Family therapy 
Individual therapy 
Play therapy 
Medication for co-morbidities 
Special Education Interventions

Question 25

Define conduct disorder

Answer 25

Repetitive and persistent pattern of behaviour in which the basic rights of others, age appropriate norms or rules are violated

Question 26

What is conduct disorder called in younger children?

Answer 26

Oppositional defiant disorder

Question 27

How does conduct disorder present?

Answer 27

Three or more

• aggression to people/animals
• destruction of property
• deceitfulness or theft
• serious violation of rules

Question 28

What are the types of conduct disorder?

Answer 28

Mild - moderate = restricted to family environment

Severe = unsocialised/socialised

Question 29

How are socialised and unsocialised conduct disorder different?

Answer 29

Unsocialised - violent and dealt with by the criminal justice system
Socialised - antisocial acts but able to avoid justice system

Question 30

Name the co-morbidities associated with conduct disorder

Answer 30

Attachment difficulties 
ADHD
Learning difficulties 
Depression 
Substance misuse
Deviant sexual behaviour

Question 31

What is ADHD?

Answer 31

Behavioural disorder characterised by inattention, hyperactivity, impulsivity, co-occuring with developmentally inappropriate impairing function, pervasive across setting, longstanding from age 5

Question 32

What causes ADHD?

Answer 32

Genetic
Brain injury - intrauterine or post natal CNS trauma
Environmental - individual or family problems

Question 33

How is ADHD treated?

Answer 33

Parent/foster training
Child focussed programmes
Multimodal interventions
Medications

Question 34

What medications can be given in behavioural disorders?

Answer 34

Risperidone - antipsychotic
Stimulant medication - ADHD
SSRI - depression