Attachment and behavioural disorders

Question 1

what is reactive attachment disorder?

Answer 1

Markedly disturbed and developmentally inappropriate social relatedness in most contexts that begins before 5yrs

Question 2

what is RAD associated with?

Answer 2

grossly pathological care eg abuse/neglect

Question 3

what are the symptoms of RAD?

Answer 3

Difficulty forming lasting, loving intimate relationships
Medically can include: malnutrition, growth delay, evidence of physical abuse, vitamin deficiencies, or infectious diseases

Question 4

what is inhibited RAD?

Answer 4

Refers to 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, hypervigilant or highly ambivalent

Question 5

what is disinhibited RAD?

Answer 5

Refers to a child who has an inability to display appropriate selective attachments

More enduring over time than the inhibited type

Question 6

what are some signs of RAD?

Answer 6

Noticeable neglectful behaviour by the primary caregiver
Inappropriate interaction noticed between the baby or child and the primary caregiver
Lack of smiling or responsiveness in the baby or child
Lack of distress in situations which would be expected to cause distress
Indiscriminate, excessive friendliness towards healthcare workers
Inconsolable crying
Emotional and behavioural difficulties

Question 7

are ACEs a risk factor for RAD?

Answer 7

yes

Question 8

does RAD exist alongside other disorders?

Answer 8

yes
About 50% met the criteria for one or more co-morbid disorders
Emotional disorders (24.0%)
ADHD (19.0%)
Behavioural disorders (21%)
13.0% of children with RAD have disorders in all of the above groups of disorders

Question 9

how is an assessment for RAD done?

Answer 9

Strange Situation (1-2 years)
Modified Strange Situation Procedure (2-4 years)
Attachment Q‑sort (1-4 years)
-Children are observed in a number of set environments
Story Stem Attachment Profile (4-7 years)
-Stories with stressful scenarios involving a child and their parents are started and the children complete them verbally or using toys to enact the story
Child Attachment Interview (7-15 years)
-The child is asked to describe their relationship with caregivers in various situations.
Adult Attachment Interview (15 years and over) and their parents or carers

Question 10

how is RAD managed at preschool level?

Answer 10

A video feedback programme for parents, foster carers, guardians or adoptive parents
Parental sensitivity and behavioural therapy
Home visiting programmes
Parent-child psychotherapy for those who have been or at risk of maltreatment

Question 11

how is RAD managed at school aged level?

Answer 11

Parental sensitivity and behavioural therapy
Intensive training and support for foster carers, guardians and adoptive parents
Group therapeutic play sessions (children of primary school age)
Group-based educational sessions for caregivers and children/young people (late primary school or early secondary school stage)
Trauma-focused CBT for those who have been maltreated

Question 12

what is the prognosis in RAD?

Answer 12

Developmental delay
Reduction in academic achievement
-Withdrawal
-Disruptive behaviour
-Difficulties with relationships
Increased risk of contact with youth justice

Question 13

what is conduct disorder?

Answer 13

A repetitive and persistent pattern of behaviour in which the basic rights of others or major age-appropriate norms or rules are violated

Question 14

how does CD present?

Answer 14

The presence of three or more of the following criteria in the past 12 months with at least one criterion present in the past 6 months
-Aggression to people or animals
-Destruction of properly
-Deceitfulness or theft
-Serious violation of rules

Question 15

what are some of the aggressive characteristics in CD?

Answer 15

Often threatens, bullies, or intimidates others
Often initiates fights
Has used a physical weapon that can cause serious physical harm to others
Has been physically cruel to others
Has been physically cruel to animals
Has stolen while confronting a victim
Has forced someone into sexual activity

Question 16

what are the consequences of CD?

Answer 16

Serious impairment in social academic or occupational function, including:
-School
-Family
-Criminality
-Health, Social Services and Criminal Justice
system involvement (Youth Offending
Services)
-Mental Health co-morbidity

Question 17

what are the comorbidities associated with CD?

Answer 17

Attachment difficulties (RAD)
ADHD
Reading and other learning difficulties
Depression
Substance misuse
Deviant sexual behaviour

Question 18

what are some of the family factors associated with CD?

Answer 18

Some families are vulnerable to problems meeting the needs of the child to be socialised
-Families with parents with mental illness and
intellectual difficulties
-Drug and alcohol problems
-Domestic violence
-Single parent families

Question 19

what are some predictors of antisocial behaviour?

Answer 19

Lack of house rules - no set routine
Lack of clarity as to how children are to behave
Inconsistent responses to undesired behaviour with failure to follow through on consequences or with rewards
Lack of techniques to deal with crises or resolve conflict within family
Lack of supervision

Question 20

what is the treatment of CD?

Answer 20

For children who do not have a complicating factor (i.e. co-morbid mental health issues):
-Parent /Foster training is suitable where the child is younger than 11 years of age
-Child focused programmeswhere child is aged between 9 and 14 years (social and cognitive problem solving programmes)
-Multimodal interventionsto young people aged between 11 and 17 years (multisystemic therapy that provides intensive support to the young person and their family)