Reactive Attachment Disorder

Question 1

What is it?

Answer 1

Markedly disturbed and developmentally inappropriate social relatedness in most contents.

Question 2

when does is start?

Answer 2

before 5 years old

Question 3

how does it develop?

Answer 3

persistent disregard for childs emotional or physical needs. constant change in primary care giver.

Question 4

how common is it?

Answer 4

1% of all children under 5

Question 5

how common is it among children in care?

Answer 5

20% of children under 5

also likely with children orphaned at a young age

Question 6

how many sub types are there

Answer 6

2 –> inhibited an disinhibited.

Question 7

what defines inhibited subtype?

Answer 7

continually fail to respond as socially expected
(avoidance, resistance, hypervigilant, or ambivalent (unpredictable))
don’t seek reassurance

Question 8

what defines disinhibited subtype?

Answer 8

can’t display appropriate selective attachments
disinhibited social engagement disorder (DSED)
- less common, more enduring, doesn’t always attach to those who represent safety.

Question 9

why is attachment important? (6)

Answer 9

develop a conscience (empathy) 
self-reliant (low self-esteem) 
logical (low problem solving) 
frustration and stress 
cant handle fear (impulsive) 
develop relationships (lack of trust)

Question 10

what is RAD a precursor to?

Answer 10

personality disorder

Question 11

what are the causes of RAD? (7)

Answer 11

frequent changes in primary caregiver 
extended separation form parent (evacuation) 
frequent moves 
traumatic experiences 
young inexperienced mothers 
neglect/abuse 
neurodevelopmental difficulties (ASD)

Question 12

what is an alien self?

Answer 12

if a childs parent is unable to respond in an appropriate the child gets confused, no one cares how they feel - low self esteem, not a real sense of self but alien.

Question 13

what are the alarming symptoms? (7)

Answer 13

persistently inexplainable colic 
poor eye contact 
no reciprocal smile 
delayed gross motor skills 
difficulty being comfortable 
resists affection 
poor sucking while feeding 

• could suggest abuse or not

Question 14

what are the symptoms shown as an older child?

Answer 14

lack of control 
speech and language delays 
no conscience 
hyperactive 
target for sexual exploitation as can follow anyone 
issues with food (binging or gorging) 

often aggressive and angry but need to look hind as elements of shame and unimportance

Question 15

how does neurobiology relate to this condition?

Answer 15

there is a slight genetic predisposition
but life experiences can dramatically change the number of neurons
determine the emotional centres
if in a constant state of fight or flight, inflammation, frontal lobe changes (higher cortisol)

Question 16

what are the differential diagnoses?

Answer 16

Conduct disorders
       aggressive but respond appropriately,
Depression 
       withdrawn, inhibited type. form relationships 
ASD
       less adaptable
ADHD 
       cannot regulate behaviour at all

Question 17

what % have co-morbidities?

Answer 17

50%

Question 18

what treatments are there? (5)

Answer 18

family therapy (to understand) 
individual therapy (emotion and behaviour) 
play therapy (social interactions) 
medication (co-morbidities) 
special education