Reactive Attachment and Conduct disorders Flashcards Preview

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Flashcards in Reactive Attachment and Conduct disorders Deck (35):

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
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
autism spectrum disorder


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

emotional disorders, ADHD, behavioural disorders


what are the treatments for RAD

family therapy (best option usually)
individual therapy
play therapy
medication (for co morbid disorder)
special education interventions


what is the prognosis for RAD

can be improved if caught early but many children missed by system and present when already in criminal justice system


what is conduct disorder

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


how does CD present

aggression to people or animals
destruction to people or animals
deceitfulness or theft
serious violations of rules


what are the consequences of CD

poor school attendance
chaotic family relationships
health (self harm), social services and criminal justice system involvement
mental health co-morbidity


what are the types of CD

mild to moderate (restricted to family)

severe (unsocialised and socialised)


what are the co morbidities of DD

RAD, ADHD, learning difficulties, depression, substance abuse, deviant sexual behaviour (victim and perpetrators)


what is ADHD characterised


pervasive across settings


is CD or ADHD more likely to be genetic



what can cause CD

brain injury


what medication can help with impulsivity and aggressive behaviour