Trauma and Stressor Related Disorder DSM (all except PTSD) Flashcards
social neglect (absence of adequate caregiving during childhood) is a requirement in diagnosis of which disorders
reactive attachment disorder
disinhibited social engagement disorder
what distinguished reactive attachment disorder and disinhibited social engagement disorder
share common etiology (social neglect), differ in manifestation of distress
RAD–> internalizing disorder with depressive symptoms and withdrawn behaviour
DSED–> marked by disinhibition and externalizing behaviour
what is the “consistent pattern” of behaviour that characterizes criterion A of reactive attachment disorder
inhibited, emotionally withdrawn behaviour toward adult caregivers
there is a pattern of “markedly disturbed and developmentally inappropriate attachment behaviours”
criterion A for reactive attachment disorder
a consistent pattern of INHIBITED, emotionally WITHDRAWN behaviour towards adult caregivers manifested by BOTH of the following:
- child rarely or minimally SEEKS comfort when distressed
- child rarely or minimally RESPONDS to comfort when distressed
criterion B for reactive attachment disorder
a persistent social and emotional disturbance characterized by at least TWO of the following:
- minimal social and emotional responsiveness to others
- limited positive affect
- episodes of unexplained IRRITABILITY, SADNESS or FEARFULNESS that are evident even during nonthreatening interactions with adult caregivers
criterion C for reactive attachment disorder
child has experienced a pattern of EXTREMES of insufficient care as evidenced by at least ONE of the following:
- social NEGLECT or deprivation in the form of persistent lack of having basic emotional needs for comfort, stimulation, and affection met by caregiving adults
- repeated CHANGES of primary caregivers that limit opportunities to form stable attachments (i.e frequent changes in foster care)
- rearing in UNUSUAL SETTINGS that severely limit opportunities to form selective attachments (i.e institutions with high child-to-caregiver ratio)
criterion D for reactive attachment disorder
the care in criterion C is presumed to be responsible for the disturbed behaviour in criterion A (i.e disturbance in criterion A began after the lack of adequate care in criterion C)
criterion E for reactive attachment disorder
criteria not met for autism spectrum disorder
criterion F for reactive attachment disorder
disturbance is evident BEFORE age 5 years
criterion G for reactive attachment disorder
child has developmental age of at least 9 months
what specifiers exist for reactive attachment disorder
- “persistent”–> present for more than 12 months
- severity
describe what would be considered “severe” reactive attachment disorder
when a child exhibits ALL the symptoms of the disorder, with each symptom manifesting at relatively high levels
reactive attachment disorder symptoms must be present before what age
5
developmental age of a child must be above what age to diagnose reactive attachment disorder
at least 9 months
how do summarize the criteria for reactive attachment disorder
a–> must have both, around seeking and responding to comfort
B–> social and emotional disturbances associated (must have 2)
C–> pattern of etiological neglect (must have experienced at least 1)
cant have ASD diagnosis
what is the essential feature of reactive attachment disorder
absent or grossly underdeveloped attachment between the child and putative caregiving adults
are children with reactive attachment disorder believed to have the capacity to form selective attachments
yes
however, because of limited opportunities during early development, they fail to show the behavioural manifestations of selective attachments
reactive attachment disorder often occurs with what other features
developmental delays–> especially cognition and language (due to severe neglect)
may have stereotypies
may have other signs of severe neglect ie malnutrition
how prevalent is reactive attachment disorder even in populations of severely neglected children
less than 10% of such children
*thus considered relatively rare though actual prevalence is unknown
does reactive attachment disorder occur in older children
per DSM it is “unclear” if it occurs in children older than 5 and thus the dx should be made with caution in kids older than 5–> unclear how this presentation would differ in older kids compared to younger
name risk factors for reactive attachment disorder
social neglect is both a requirement or dx and the only known risk factor
name a factor that determines prognosis of reactive attachment disorder
quality of the caregiving environment following serious neglect
**the majority of severely neglected kids do not develop the disorder
ddx reactive attachment disorder
autism spectrum disorder
intellectual disability
depressive disorders
list some of the features that overlap between reactive attachment disorder and autism
both may show:
dampened expression of positive emotions
cognitive and language delays
impairments in social reciprocity
stereotypies
how do you distinguish between reactive attachment disorder and autism spectrum disorder
- differential histories of neglect (+RAD)
- presence of restricted interests or ritualized behaviours (+ASD)
- specific deficit in social communication (+ASD)
- specific deficit in selective attachment behaviours (+RAD)
do kids with reactive attachment disorder show deficits in social communicative functioning
no–> its generally comparable to their overall intellectual level
how do you distinguish reactive attachment disorder from intellectual disability
kids with ID would not show the profound reduction in positive affect and emotion regulation difficulties seen in reactive attachment disorder
kids with ID (if have intellectual age of 7-9 months) should still show selective attachments regardless of chronological age
list conditions associated with neglect
cognitive delays
language delays
stereotypies