Table of Contents

1. Trauma

  • trauma as a prereq for dx
  • reactive attachment disorder; disinhibited social engagement do; PTSD

1.1. reactive attachment; disinhibited social engagement

  • characterized by aberrant social behaviours that reflect grossly negligent parenting and maltreatment that disrupted the dev of normal attachment behaviour.
  • based on attachment theory
  • reactive attachment: persistent pattern of emotionally withdrawn responses toward adult caregivers, limited positive affect, sadness, and minimal social responsiveness to others, and concomitant neglect, deprivation, and lack of appropriate nurturance from caregivers. + constantly failing to initiate and respond to most social interactions in a normal way
    • due to pathological caregiving received by the child
      • disregard for emotional and physical needs
      • frequent changes (e.g. foster care)
  • disinhibited social engagement
    • actively approaches and interacts with unfamiliar adults in a familiar way, either physically or verbally. diminished checking with or seeking of caregiver. no hesitation.
  • epidemiology
    • <1%, poor data
  • etiology
    • neglectful and abusive parenting
      • risk factors: parental psych d/o, substance, intellectual disability, parent's harsh upbringing, social isolation, premature parenthood
  • dx features
    • DSM: >1y, A+B + evidence of poor parenting
    • documentation of pervasive disturbance leading to inappropriate social behaviours present before age 5
    • non-organic failure to thrive (neglect): listlessness, poverty of spontaneous activity, apathy, dullness, hypokinesis; frightened, watchful.
    • psychological dwarfism
  • ddx: depression, anxiety, ptsd (parent); ASD, language d/o, intellectual disability, metabolic d/o (reactive); ADHD (disinhibited)
  • tx
    • child's safety: hospitalize or home, CPS
    • psychosocial interventions
      • psychotherapy
      • home services
      • educational counselling

1.2. PTSD

  • <6yo: preschool type
    • either persistent avoidance of trauma-evoking stimuli or negative alterations in cognitions suffice as indications for ptsd
  • 6% of youth at some point in their development; lifetime ~10%; fe>male
  • different features
    • re-experiencing through play, recurrent nightmares without remembering, eenactment
    • most children exposed to severe or chronic trauma (abuse) -> disrupted function
  • etiology / risk factors
    • biological
      • preexisting anxiety and depressive
      • <IQ
      • increased excretion of adrenaline and dopamine metabolites, smaller intracranial volume and corpus callosum
    • psychological
      • modeling
      • classic and operant conditioning
    • social
      • family support and reactions to traumatic events in children
  • dx and features
    • reexperience: play that includes part of the trauma or behaviours (e.g. inappropriate sexual behaviours)
    • reexperience: dissociative symptoms
    • avoidance: same
    • negative cognition/mood: <6yo - socially withdrawn behaviour, diminished interest in play; >6yo - psychological amnesia, psychological numbing; older - foreshortened future
    • acute <1mo vs chronic >3mo vs delayed onset >6mo
  • ddx
    • ocd, separation anxiety d/o, social phobia, depressive d/o
  • prognosis
    • mild: persist for 1-2y
    • severe: many years or decades
  • tx
    • trauma-focused CBT
    • CBITS (intervention for trauma in school)
    • SPARCS (structured psychotherapy for adolescents responding to chronic stress
    • TARGET (trauma affect regulation)
    • crisis intervention
    • pharm (symptomatic)
      • comorbidities: depression, anxiety
      • adrenegic modulation: alpha2+ (clonidine - reenactment, guanfacine - nightmares), alpha1- (prazosin), beta- (propranolol - hyperarousal)
      • risperidone and aripiprazole (aggression and behaviour)

Author: Armin

Created: 2022-06-08 Wed 01:10

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