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Child Health > Attachment and Behavioural Disorders > Flashcards

Attachment and Behavioural Disorders Flashcards

1
Q

When does reactive attachment disorder (RAD) usually develop, and when does it usually present?

A

Usually develops before the age of 5

Does not present until teenage years but can be traced back

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2
Q

What disturbance’s in a young child’s upbringing can predispose to an attachment disorder?

A
  • persistent disregard for child’s emotional needs (e.g. comfort, stimulation, and affection)
  • Persistent disregard for child’s physical needs
  • Repeated changes of primary caregivers
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3
Q

What are the main difficulties of an attachment disorder?

A
  • difficulty forming lasting/intimate relationships

Medically:

  • malnutrition, vitamin deficiencies and growth delay
  • evidence of physical abuse
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4
Q

What is the prevalence of attachment disorders in children, and in what environments is this higher?

A

1% for population
20% of children in care
Increased likelihood if child is orphaned

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5
Q

What is the earliest that an attachment disorder can really be noticed?

A

2 months

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6
Q

What are the two subtypes of RAD?

A

Inhibited

Disinhibited

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7
Q

Describe Inhibited RAD

A
  • children continually respond to social interactions in an inappropriate way
  • they use various approaches, avoidance, resist comfort
  • often hypervigilant or highly ambivalent
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8
Q

A child or infant that does not seek comfort from a parent or caregiver during times of threat, alarm or distress is an example of which subtype of RAD?

A

Inhibited

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9
Q

Describe Disinhibited RAD and how its different from inhibited RAD

A 
Disinhibited = child has an inability to display appropriate selective attachments 
Inhibited = disability to form any attachment
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10
Q

Give an example of a child who has Disinhibited RAD

A

child displays excessive familiarity with strangers

=> lack of selectivity in their choices of attachment figure

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11
Q

Why is attachment important?

A

Development of an attachment disorder can affect a healthy personality and result in a personality disorder later in life

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12
Q

What elements are involved in a healthy personality, that are often lost if there is an attachment disorder?

A
  • Development of a conscience
  • Ability to become self-reliant
  • Ability to think logically
  • Ability to cope with frustration and stress
  • Ability to handle fear or a threat to self
  • Development of relationships
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13
Q

What specific causes are related to the development of an attachment disorder?

A
  • Frequent changes in primary caregiver
  • Extended separation from the parent/primary caregiver
  • Frequent moves in foster care/ institutions
  • Parental Neglect
  • Abuse
  • Potential neurodevelopmental difficulties (e.g. Autism = often found in combination with attachment disorders)
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14
Q

What symptoms in young children should raise urgent concerns of an attachment disorder?

A
  • Persistent/medically unexplained severe Colic
  • Poor eye contact
  • No reciprocal smile
  • Delayed gross motor skill development
  • Difficulty being comforted
  • Resists affection
  • Poor sucking response when eating
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15
Q

What symptoms commonly present in older children with attachment disorders?

A
  • impulsive
  • Speech and language delays
  • Lack of conscience / no empathy
  • often in others personal space
  • Indiscriminately affectionate with strangers
  • Avoids/overseeks physical contact
  • Hyperactive
  • Aggressive
  • Destructive towards self/property/others
  • Food issues: gorges, refuses to eat, hides food
  • Prefers to play alone
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16
Q

Why is important to look behind the anger of an aggressive child with an attachment disorder?

A
  • anger has resulted from past experiences of humiliation where they are made to feel worthless
    => the anger is to stop them from feeling this way again and we must understand this when consulting with them
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17
Q

Describe how childhood experiences can change how the brain is developing to cause a change in behaviour

A

Constant stress from difficult childhood experiences = increase in serum cortisol
=> changes the cortical development in the frontal lobe of the brain
=> this area is responsible for sensibility when making decisions etc

18
Q

What are the usual other differential diagnoses when suspecting a child has an attachment disorder?

A

Conduct Disorder (CD)
Depression
Autism Spectrum Disorder
ADHD

19
Q

How is Conduct Disorder different from an attachment disorder?

A

Children with CD are able to form some satisfying relationships with peers and adults unlike those with attachment disorders

20
Q

How is Depression different from an attachment disorder?

A

Depressed children are often able to form appropriate social relations with those who reach out to them, whereas those with attachment disorders will not regardless of who it is.

21
Q

How is Autism Spectrum Disorder different from RAD?

A
  • children with RAD are more able to adapt based on what they get out of certain relationships
  • Children with ASD are much less flexible and will not adapt with each different relationship
22
Q

Children with ADHD are more likely to initiate and maintain a relationship than those with an attachment disorder. TRUE/FALSE?

A

TRUE

23
Q

What are the most common co-morbid disorders that exist with RAD?

A

Emotional disorders
ADHD
Behavioural Disorders

24
Q

What treatments are commonly used for attachment disorders

A
  • Family therapy
  • Individual therapy
  • Play therapy
  • Medication
  • Special education interventions
25
Q

What are the benefits of play therapy?

A
  • child learns appropriate skills for interacting with peers and other social situations
26
Q

Describe the aim of special education interventions

A
  • programs that help the child learn skills required for academic and social success
  • Also addresses behavioral and emotional difficulties
27
Q

In what situation would medication be used to treat an attachment disorder?

A

for symptoms of a comorbid disorder (e.g. anxiety and hyperactivity)

28
Q

What is a conduct disorder?

A

repetitive pattern of behaviour in which the basic rights of others are violated

29
Q

What is conduct disorder also known as?

A

Oppositional Defiant Disorder (ODD)

30
Q

What symptoms do conduct disorders usually present with?

A
  • Aggression to people or animals
  • Destruction of properly
  • Deceitfulness or theft
  • Serious violation of rules
31
Q

What are the consequences of a conduct disorder?

A
  • Difficulty in School
  • Family problems
  • Criminality (Young offender’s involvement)
  • Mental Health co-morbidity
32
Q

What are the different severities of conduct disorder

?

A

1) Mild/Moderate

2) Severe
- Unsocialised (dealt with in criminal justice system)
- Socialised (better at avoiding being caught)

33
Q

What other conditions are often present in behavioural conduct disorders?

A
  • RAD
  • ADHD
  • learning difficulties (30%)
  • Depression
  • Substance misuse
  • Deviant sexual behaviour
34
Q

What triad of difficulties are usually present in ADHD?

A

Inattention
Hyperactivity
Impulsivity

35
Q

There is increased risk of ADHD if the parents of siblings have the condition. TRUE/FALSE?

A

TRUE
60% parents with ADHD pass it on
15% increased risk with siblings

36
Q

If a child is thought to have both CD and ADHD, how do we differentiate the two?

A

Give ADHD meds

Both conditions will react to meds in short term, but long term the meds will only treat the ADHD.

37
Q

What are the main causes of CD?

A
  • Genetic (evidence from twin studies)
  • Brain injury (intrauterine, post natal trauma)
  • Environmental (Clash of temperament between child and parent)
38
Q

What family factors can affect their ability to socialise thier child?

A
  • parents with mental illness/intellectual difficulties
  • drug and alcohol problems
  • domestic violence
  • single parent families
39
Q

Give examples of intra-familiar predictors of antisocial behaviour

A
  • Lack of house rules-
  • Lack of clarity as to how children are to behave
  • Lack of effective contingencies (don’t always get told off for doing same thing wrong)
  • Lack of techniques to deal with crises or resolve conflict
  • Lack of supervision
40
Q

How is CD treated if children do NOT have a co-morbid disorder?

A

Parent /Foster training (<11 years of age)

Child focused programmes (9 and 14 years)
- social and cognitive problem solving programmes

Multimodal interventions (11 and 17 years)
 - multisystemic therapy that provides support to the young person and family
41
Q

What medications can help to treat the impulsivity and aggressive behaviour in CD and associated conditions?

A

Risperidone (atypical antipsychotic)

Treat co-morbid condition:

  • ADHD - stimulant medication
  • Depression – SSRIs

Child Health (21 decks)

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