Reactive Attachment and Conduct disorders Flashcards
what is reactive attachment disorder
markedly disturbed and developmentally inappropriate social relatedness in most contexts, that begins before the age of five and is associated with grossly pathological care
what constitutes grossly pathological care - causing RAD
persistent disregard for the childs emotional needs for comfort, stimulation and affection
persistent disregard for the childs physical needs
repeated changes of primary care givers
what is the main feature of RAD
difficulty forming lasting, loving and intimate relationships
what are the physical signs of RAD
malnutrition, growth delay, evidence of physical abuse, vitamin deficiencies, infectious diseases
what is the prevelance of RAD
1% of all children, 20% in child in care system
children orphaned young have high chance of getting it
is remission of RAD possible
yes if caught very early and child experiences an appropriately supportive environment
what are the subtypes of RAD
inhibited and disinhibited
what is inhibited RAD
children who continually fail to initiate ans respond to social interaction in a developmentally appropriate way
avoiding interactions, resisting comforting, hypervigilant or highly amivalent
child does no seek comfort in times of threat, stress, or alarm
what are the features of disinhibited RAD
child has inability to display appropriate selective attachments
more enduring than inhibited RAD
e.g. child who displays familiarity with strangers, indiscriminate sociability or lack of selectivity in attachment figure
why is attachment importance
develops conscience- empathy become self reliant- self esteem think logically- solve problems cope with frustration and stress handle fear or threat- makes you less impulsive emotion regulation development of relationships- trust
what must parents do to ensure a secure attachment
imagine what child is going through and respond appropriately
what is attachment disorder commonly the pre-cursor of
personality disorder
what are the potential causes for RAD
frequent changes in primary care giver extended separation frequent moves/ foster placements traumatic experiences young/ inexperienced mother with poor skills neglect abuse Autism spectrum disease
what is the model behind RAD
alien self- When a child has a problem the adult (attachment figure) will create in their mind what the child is feeling, if they can do this can respond to child in appropriate way
Parent is unable to be reciprocal to the child so the child gets incredibly confused, doesn’t know what is going on
Child feels that they are not worth the responses they are not getting, low self esteem, alien self
Their sense of self is their response to repetitive neglect
what symptoms in very young children should raise urgent safeguarding concerns and might suggest RAD
persistent and unexplained colic poor eye contact, difficulty tracking no reciprocal smile response delayed gross motor skill development difficulty being comforted resists affection and cuddling from caregiver/parent appear stiff, display tactile defensiveness poor sucking response when eating
what are the common symptoms of RAD in older children and YP
lack of self control/ impulsive
speech/ language delays (not being stimulated)
lack of conscience/ no remorse
doesn’t understand social boundaries, often personal space
indiscriminately affectionate or inhibition or hesitancy
avoids/ over seeks physical contact
hyperactive, anxious
aggressive- destructive towards self, property and others
food issues- over/ under eat, hordes, gorges, refuses to eat. hides food
often on guard, anxious, wary
prefers to play alone
why are children with RAD often anger
as humiliated throughout childhood, feel worthless and unworthy of respect
shame based anger
what is the neurobiology behind the behavioural changes in RAD
Life experiences can dramatically alter the number of neurons, increase or decrease the dendritic branches and the number synapses
chronic stress mimics chronic inflammation, long term high levels of cortisol in the brain, changes how brain processes emotions
child hyper alert as always been on fight or flight reflex
what are the differntial diagnosis in RAD
conduct disorder
depression
autism spectrum disorder
ADHD
how can you differentiate CD and RAD
Children with CD are able to form some satisfying relationships with peers and adults
how can you differentiate RAD and depression
depressed children are often able to form appropriate social relations with those who reach out to them
how can you differentiate RAD and ASD
child with RAD more able to adapt based on what they get out of certain relationships
how can you differentiate RAD and ADHD
ADHD persistent across different settings, more able to initiate and maintain relationships
what co morbid conditions are common in RAD
(50%)
emotional disorders, ADHD, behavioural disorders
