Neurodevelopmental problems in maltreated children referred with indiscriminate friendliness

We aimed to explore the extent of neurodevelopmental difficulties in severely maltreated adopted children. We recruited 34 adopted children, referred with symptoms of indiscriminate friendliness and a history of severe maltreatment in their early childhood and 32 typically developing comparison children without such a history, living in biological families. All 66 children, aged 5–12 years, underwent a detailed neuropsychiatric assessment. The overwhelming majority of the adopted/indiscriminately friendly group had a range of psychiatric diagnoses, including Attention Deficit Hyperactivity Disorder (ADHD), Post-Traumatic Stress Disorder (PTSD) and Reactive Attachment Disorder (RAD) and one third exhibited the disorganised pattern of attachment. The mean IQ was 15 points lower than the comparison group and the majority of the adopted group had suspected language disorder and/or delay. Our findings show that school-aged adopted children with a history of severe maltreatment can have very complex and sometimes disabling neuropsychiatric prob

Triad 6 - Video files

File 0239 is Stacey File 0240 is Caroline File 0241 is Sacha File 0242(1) is Lis

Physical health assessment and care management in community addiction settings

Individuals with addiction problems often experience challenges accessing or engaging with general health services. Addiction services may be the only service attended by these individuals and as such mental health nurses (MHN) working in these settings are in a position to assess and manage their physical health needs. This study investigated the views and confidence levels of MHN working in community addiction settings towards undertaking physical health assessment, and management, and found that there were variable attitudes and confidence levels among the participants, dependent on the physical assessment tasks discussed. In contrast to previous studies, medication side effect monitoring was seen by fewer participants as an important part of their role. On the whole participants felt positive about incorporating physical health into their practice, however, they reported requiring more training to develop and maintain competence in their physical assessment and care skills. There remained ambiguity among some of the participants as to whether some physical health assessments should be undertaken by MHNS and more detailed research is required to identify key skills clusters for this clinical area. </jats:p

A fragile bond: adoptive parents' experiences of caring for children with a diagnosis of reactive attachment disorder

Aims and objectives. To understand how adoptive parents caring for children with a diagnosis of reactive attachment disorder (RAD) make sense of their life-worlds by establishing the meanings that underlie and structure their experiences of their everyday lives.Background. Reactive attachment disorder is a serious psychosocial disorder of childhood that causes short- and long-term relationship, health and social consequences for children. It is more likely to be observed in children being cared for by foster carers, kinship carers or adoptive parents. Exploration of adoption from parents' perspectives is not well documented, and no previous work has been undertaken to understand the challenges of caring for children with a diagnosis of reactive attachment disorder.Design. The study was guided by Husserl's phenomenology, which aims to uncover the underlying essential meanings intrinsic to a phenomenon. Three concepts are central to this approach: essences, intuiting and eidetic reduction.Methods. Semi-structured interviews were conducted with eight adoptive parents. Data were analysed using an adaptation of Colaizzi's method.Results. Four essential elements fundamental to participants' lived experiences of caring for a child with a diagnosis of RAD were uncovered: being profoundly unprepared, being insecure, being assailed by unexpected emotions and being committed.Conclusions. The parent-child relationship is a fragile bond developed at an unexpectedly high personal cost; it is a committed relationship but vulnerable to continual destabilisation. The involvement in the preparation of adoptive parents of child and adolescent mental health (CAMH) staff with expertise in the impact of early neglect or separation on children should be considered.Relevance to clinical practice. The development of systems to prepare, screen and identify potential challenges and problems prior to adoption might help adoptive parents. Access to a CAMH professional in the pre and postadoption phases might assist potential adoptive parents in making informed decisions around the choice of a child for adoption

Discrimination between attention deficit hyperactivity disorder and reactive attachment disorder in school aged children

We aimed to determine whether it is possible to discriminate between children with attention deficit hyperactivity disorder (ADHD) and children with reactive attachment disorder (RAD) using standardized assessment tools for RAD. The study involved 107 children: 38 with a diagnosis of RAD and 30 with ADHD were recruited through community child and adolescent mental health services (CAMHS) and specialist ADHD clinics. In addition, 39 typically developing children were recruited through family practice. Clinicians were trained to use a standardized assessment package for RAD using a DVD with brief follow-up support. Discriminant function analysis was used to identify the items in the standardized assessment package that best discriminated between children with ADHD and children with RAD. Clinicians' ratings of RAD symptoms were reliable, particularly when focusing on eight core DSM-IV symptoms of RAD. Certain parent-report symptoms were highly discriminatory between children with ADHD and children with RAD. These symptoms included "cuddliness with strangers" and "comfort-seeking with strangers". A semi-structured interview with parents, observation of the child in the waiting room and teacher report of RAD symptoms aided diagnostic discrimination between the groups. Clinical diagnosis of RAD can be made reliably by clinicians, especially when focusing on eight core RAD symptoms. Clear discrimination can be made between children with RAD and children with ADHD