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Flashcards in Reactive Attachment and Conduct disorders Deck (35):
1

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

2

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

3

what is the main feature of RAD

difficulty forming lasting, loving and intimate relationships

4

what are the physical signs of RAD

malnutrition, growth delay, evidence of physical abuse, vitamin deficiencies, infectious diseases

5

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

6

is remission of RAD possible

yes if caught very early and child experiences an appropriately supportive environment

7

what are the subtypes of RAD

inhibited and disinhibited

8

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

9

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

10

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

11

what must parents do to ensure a secure attachment

imagine what child is going through and respond appropriately

12

what is attachment disorder commonly the pre-cursor of

personality disorder

13

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

14

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

15

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

16

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

17

why are children with RAD often anger

as humiliated throughout childhood, feel worthless and unworthy of respect
shame based anger

18

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

19

what are the differntial diagnosis in RAD

conduct disorder
depression
autism spectrum disorder
ADHD

20

how can you differentiate CD and RAD

Children with CD are able to form some satisfying relationships with peers and adults

21

how can you differentiate RAD and depression

depressed children are often able to form appropriate social relations with those who reach out to them

22

how can you differentiate RAD and ASD

child with RAD more able to adapt based on what they get out of certain relationships

23

how can you differentiate RAD and ADHD

ADHD persistent across different settings, more able to initiate and maintain relationships

24

what co morbid conditions are common in RAD

(50%)
emotional disorders, ADHD, behavioural disorders

25

what are the treatments for RAD

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

26

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

27

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

28

how does CD present

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

29

what are the consequences of CD

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

30

what are the types of CD

mild to moderate (restricted to family)

severe (unsocialised and socialised)

31

what are the co morbidities of DD

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

32

what is ADHD characterised

inattention
hyperactivity
impulsivity

pervasive across settings

33

is CD or ADHD more likely to be genetic

ADHD

34

what can cause CD

genetic
brain injury
environmental

35

what medication can help with impulsivity and aggressive behaviour

risperidone