Kk&s Ch.48 Reactive Attachment & Stereotypic

Front 1

reactive attachment disorder onset before?

Back 1

age 5

Front 2

RAD subtypes?

Back 2

inhibited type: fails to initiate and respond socially
disinhibited: socially unselective

Front 3

RAD prev?

Back 3

<1%

Front 4

Factors increasing likelihood of neglect?

Back 4

The likelihood of neglect increases with parental mental retardation; lack of parenting skills because of personal upbringing, social isolation, or deprivation and lack of opportunities to learn about caregiving behavior; and premature parenthood (during early and middle adolescence), in which parents are unable to respond to, and care for, an infant's needs and in which the parents' own needs take precedence over their infant's or child's needs.
Frequent changes of the primary caregiver—as may occur in institutionalization, repeated lengthy hospitalizations, and multiple foster care placement

Front 5

RAD criterion A?

Back 5

Markedly disturbed and developmentally inappropriate social relatedness in most contexts, beginning before age 5 years, as evidenced by either (1) or (2):

1. persistent failure to initiate or respond in a developmentally appropriate fashion to most social interactions, as manifest by excessively inhibited, hypervigilant, or highly ambivalent and contradictory responses (e.g., the child may respond to caregivers with a mixture of approach, avoidance, and resistance to comforting, or may exhibit frozen watchfulness)
2. diffuse attachments as manifest by indiscriminate sociability with marked inability to exhibit appropriate selective attachments (e.g., excessive familiarity with relative strangers or lack of selectivity in choice of attachment figures)

Front 6

RAD must rule out?

Back 6

PDD
not fullly accounted by MR

Front 7

Evidence of pathogenic care?

Back 7

1. persistent disregard of the child's basic emotional needs for comfort, stimulation, and affection
2. persistent disregard of the child's basic physical needs
3. repeated changes of primary caregiver that prevent formation of stable attachments (e.g., frequent changes in foster care)

Front 8

Is it normal to protest hospital stay or not?

Back 8

normal to protest; not protesting = poor attachment

Front 9

RAD ddx?

Back 9

posttraumatic stress disorders, developmental language disorders, and mental retardation syndromes. Metabolic disorders, pervasive developmental disorders, mental retardation, various neurological abnormalities, and psychosocial dwarfism are also considerations in the differential diagnosis.

Front 10

Autism vs RAD?

Back 10

RAD show rapid improvement in hosp;
>IQ impairment in autism
autistic kids appear well nourished

Front 11

RAD tx?

Back 11

1. ensure safety
2. ensure physical health- nutrition
3. encourage positive interaction with caregiver via observation of dyad
4. improve ses - i.e., stabilize $, housing, homemaker
5. pyschotherapy, family tx
6. infant-toddler-mother groups
7. monitor well being
consider placement

Front 12

stereotypic mvmt ds dsm ?

Back 12

1. Repetitive, seemingly driven, and nonfunctional motor behavior (e.g., hand shaking or waving, body rocking, head banging, mouthing of objects, self-biting, picking at skin or bodily orifices, hitting own body).
2. The behavior markedly interferes with normal activities or results in self-inflicted bodily injury that requires medical treatment (or would result in an injury if preventive measures were not used).
3. If mental retardation is present, the stereotypic or self-injurious behavior is of sufficient severity to become a focus of treatment.
4. The behavior is not better accounted for by a compulsion (as in obsessive-compulsive disorder), a tic (as in tic disorder), a stereotypy that is part of a pervasive developmental disorder, or hair pulling (as in trichotillomania).
5. The behavior is not due to the direct physiological effects of a substance or a general medical condition.
6. The behavior persists for 4 weeks or longer.

Front 13

stereotypic m ds seen more in?

Back 13

PDD
MR

Front 14

give egs of Stereotypic m ds

Back 14

body rocking, head rocking, or hand flapping

Front 15

After age ? years, the rates of stereotypic movements in the normal population are unknown, but believed to be negligible

Back 15

6

Front 16

stereotypic movement disorder is more prevalent in gender?

Back 16

boys than in girls

Front 17

Self-injurious behaviors occur in?

Back 17

genetic syndromes, such as Lesch-Nyhan syndrome, and also in some patients with Tourette's disorder. Self-injurious stereotypic behaviors are increasingly common in persons with severe mental retardation. Stereotypic behaviors are also common in children with sensory impairments, such as blindness and deafness.

Front 18

X-linked recessive deficiency of enzymes leading to? syndrome, which has predictable features including mental retardation, hyperuricemia, spasticity, and self-injurious behaviors

Back 18

Lesch-Nyhan

Front 19

Stereotypic movements seem to be associated with ? NT activity.
Anything else?

Back 19

Stereotypic movements seem to be associated with dopamine activity.
Dopamine agonists induce or increase stereotypic behaviors, whereas dopamine antagonists decrease them. In one report, four children with attention-deficit/hyperactivity disorder (ADHD) who were treated with a stimulant medication began to bite their nails and fingertips. The nail-biting ceased when the medication was eliminated.
endogenous opiods

Front 20

head banging and gender?

Back 20

> in males

Front 21

ddx of stereotypica mvmt ds?

Back 21

tics
ocd

Front 22

A recent study of stereotyped movements compared with tics found that ? tended to be longer in duration, and displayed more rhythmic qualities than?
Compare tics vs stereotypies

Back 22

A recent study of stereotyped movements compared with tics found that stereotyped movements tended to be longer in duration, and displayed more rhythmic qualities than tics.
Tics seemed to occur more when a child was in an “alone” condition, rather than when the child was in a play condition, whereas stereotypic movements occurred with the same frequency in these two different conditions.
Stereotypic movements are likely to be self-soothing, whereas tics are often associated with distress.

Front 23

As many as ? percent of normal children show rhythmic activities that seem purposeful and comforting and tend to disappear by 4 years of age

Back 23

80%

Front 24

tx of stereotypies?

Back 24

habit reversal (in which the child is trained to replace the undesired repetitive behavior with a more acceptable behavior
einforcement for reducing the unwanted behavior

Front 25

list agents used to reduce stereotypic mvmt ds?

Back 25

usually atypicals
opiate antagonists
fenfluramine (Pondimin), clomipramine (Anafranil), and fluoxetine (Prozac)