Childhood Disorders

1. Childhood Disorders Reactive Attachment Disorder of Infancy & Early Childhood Carolyn R. Fallahi, Ph. D.

2. Common Associated Diagnoses Axis I: Reactive Attachment disorder of infancy & early childhood. Attention Deficit Hyperactivity Disorder Major Depressive Disorder Dysthmic Disorder Adjustment Disorder Posttraumatic Stress Disorder Obsessive-Compulsive Disorder Oppositional Defiant Disorder Conduct Disorder Antisocial Personality Disorder

3. Behavioral Definitions • Brought into family through adoption after coming from an abusive, neglectful biological family. • Consistent pattern of failing to initiate or respond to social interactions. • Pattern of becoming too friendly too quickly with strangers. • Pattern of showing indiscriminate affection to strangers.

4. Behavioral Definitions • Resists accepting care from others. • Hoarding or gorging food. • Aggressive behavior. • Frequent lying. • Stealing. • No signs of a conscience.

5. Behavioral Definitions • Excessive clinginess. • Persistent disregard for emotional or physical needs. • Subjected to frequent changes in caregivers.

6. History of Attachment • History of Attachment • John Bowlby • Stages: Protest, Despair, Detachment • Mother-child bond adaptive & important for survival • Karl Lorenz & imprinting

7. Critical period for the development of attachment • Age range? • Model for future relationships.

8. Mary Ainsworth’s Research Model • The Strange Situation • 8 episodes measuring 4 behaviors • Willingness to explore • Separation anxiety • Stranger anxiety • Reunion behavior

9. Infant Characteristics that promote attachment • “kewpie doll” appearance • Rooting, sucking, grasping reflexes • Cooing, babbling • Smiling • Crying • Responsiveness to social overtures

10. Infant & Mother characteristics that hinder attachment • Physically unattractive • Reflexes weak • Irritable • Little pleasant vocalization • Easily over stimulated • Maternal depression • Abused mother • Mother insensitive to baby’s cues • Several children in family • Marital problems

11. Schaffer & Emerson Stages in Social Attachment • Asocial stage – 0-6 weeks • Indiscriminate attachment stage – 6 weeks to 6-7 months • Specific attachment stage – 7-9 months • Multiple attachment stage – shortly after stage 3

12. Theories of Attachment • Psychoanalytical • Learning • Ethological

13. Types of Attachment • Secure attachment • Insecure attachment (anxious/resistant) • Insecure attachment (anxious/avoidant) • Insecure attachment (disorganized/disoriented)

14. Ainsworth’s Caregiving Hypothesis • Quality of attachment • Inconsistent caregiving • Impatient caregiving • Abusive caregiving

15. Kagan’s Temperament Hypothesis • Easy temperment • Difficult temperment • Slow to warm up temperment

16. Reactive Attachment Disorder • Infancy & early childhood • Older children & adolescents • adults

17. Therapy • Holding therapy – controversial. • Failure-to-thrive cases. • Therapy techniques. • Adolescents & adults.

18. Long-term goals • Establish & maintain bond. • Form healthy connections with others. • Has a desire for & initiates connections with others. • Tolerates reasonable absence from caregiver.