Mental Health Flashcards
What is the most important predictor of a child’s future personality?
Their relationship with their primary caregiver
Name four different attachment styles
- secure
- insecure ambivalent
- insecure avoidant
- disorganised
What is secure attachment?
Child is distressed when mother leaves, avoids strangers when alone but friendly when mother present - uses mum as ‘safe base’
Describe insecure ambivalent attachment
Infant shows signs of distress when mother leaves, avoids the stranger and shows fear towards them but resists contact from mum when she returns
Describe insecure avoidant attachment
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
What is disorganised attachment?
Very small percentage of infants have no consistency in how they behave
In an child with insecure avoidant attachment how will they feel in adolescence?
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.
How will children with insecure ambivalent feel in adolescence?
Low value, insensitive, unreliable, unpredictable, attention seeking, insecure, friendly vs hostile may come across antisocial
Define a secure base
The attachment figure/relationship provides a safe space from which to explore the world
Define a safe haven
The attachment figure/relationship provides a safe place to retreat at times of danger/anxiety
Define attunement
Process between caregiver and infant whereby they can ‘tune in’ to each other’s physical and emotional states
What are the five key categories of symptoms of disordered attachment?
- behavioural signs
- cognitive functioning
- emotional functioning
- social functioning
- physical aspects
What can cause disrupted attachment?
Pregnancy - unplanned/consideration of termination
Parents - neglect/abuse/conflict/drugs/difficulties
Child - separation from primary caregiver, unresponsive baby, illness, traumatic experience
Define reactive attachment disorder
Disturbed and developmentally inappropriate social relatedness in most contexts that begins before 5 years of age
How may a child with reactive attachment disorder present?
Difficulty forming lasting intimate relationships, may be malnourished, or have evidence of physical abuse/growth delay
How common is RAD?
1% of children under the age of five
Name two types of RAD
Inhibited and Disinhibited
Describe inhibited RAD
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
Describe disinhibited RAD
Child has an inability to display appropriate selective attachments
State some alarming symptoms in a child with suspected attachment disorders
Unexplained severe colic, poor eye contact, no reciprocal smile, delayed gross motor skills, difficulty being comforted, stiff, defensive or poor suckle
Name the common symptoms of RAD
Lack of self control, speech/language delays, lack of social boundaries, indiscriminately affectionate, hyperactive, aggressive, food issues, anxious/wary, prefers to play alone
Describe the neurobiology behind RAD
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
What is the differential diagnosis for RAD? How are they different to RAD?
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
What are the effective treatments for RAD?
Family therapy Individual therapy Play therapy Medication for co-morbidities Special Education Interventions
Define conduct disorder
Repetitive and persistent pattern of behaviour in which the basic rights of others, age appropriate norms or rules are violated
What is conduct disorder called in younger children?
Oppositional defiant disorder
How does conduct disorder present?
Three or more
- aggression to people/animals
- destruction of property
- deceitfulness or theft
- serious violation of rules
What are the types of conduct disorder?
Mild - moderate = restricted to family environment
Severe = unsocialised/socialised
How are socialised and unsocialised conduct disorder different?
Unsocialised - violent and dealt with by the criminal justice system
Socialised - antisocial acts but able to avoid justice system
Name the co-morbidities associated with conduct disorder
Attachment difficulties ADHD Learning difficulties Depression Substance misuse Deviant sexual behaviour
What is ADHD?
Behavioural disorder characterised by inattention, hyperactivity, impulsivity, co-occuring with developmentally inappropriate impairing function, pervasive across setting, longstanding from age 5
What causes ADHD?
Genetic
Brain injury - intrauterine or post natal CNS trauma
Environmental - individual or family problems
How is ADHD treated?
Parent/foster training
Child focussed programmes
Multimodal interventions
Medications
What medications can be given in behavioural disorders?
Risperidone - antipsychotic
Stimulant medication - ADHD
SSRI - depression
