Attachment, Development
Q: 10-month old infant becomes distressed when parets leave child with babysitter without
affection. Which subsequent behavior pattern is likely? - ANS-A: clingy and
Q: 14y/o from juvenile hall, getting aggressive, long history of behavioral problems but no
psych or medical history. In addition to diagnosing behavioral problem, what is the first step
for psychiatrist? (2x) - ANS-A: evaluate patient for additional psychopathology
Q: 18 month old shows a marked awareness of vulnerability to separation and seems to be
constantly concerned about the mother's actual location is exhibiting Mahler's stage of? -
ANS-A: object constancy
+ Object constancy, similar to Jean Piaget's object permanence, describes the phase when
the child understands that the mother has a separate identity and is truly a separate
individual. This leads to the formation of internalization, which is the internal representation
that the child has formed of the mother.
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<Mahler's stages of separation-individuation>
1. normal autism (birth- 2 months): period of sleep outweigh periods of arousal
2. symbiosis (2-5 months): developing perceptual abilities gradually enable infants to
distinguish the inner from outer world; mother-infant is perceived as a single fused entity.
3. Differentiation (5-10 months): draw infant's attention away from self to the outer world.
Physical and psychological distinctiveness from the mother is gradually appreciated.
4. Practicing (10-18 months): ability to move autonomously increases children's exploration
of the outer world.
5. Rapprochement (18-24 months): child realizes their helplessness and dependence, the
need for independence alternates with the need for closeness. Children move away and
come back for reassurance.
6. Object constancy (age 2-5): children gradually comprehend and are reassured by the
permanence of mother and other important people, even when not in their presence.
Q: 18 months old is vulnerable to separation and constantly concerned about mother's actual
location. This representative of Mahler's Stages of? - ANS-A: Rapproachement (18 months-
24 months)
+ add figure
Q: 2y/o clings to mother when introduced to a new child, refusing to join in play during 1st
visit. on 2nd visit, child plays behind mother, and on 3rd visit, she seems to continue her
usual activities while warily eyeing the new child. What temperamental trains or
constellations best describes this child's behavior? (2x) - ANS-A: slow-to-warm-up
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, + Easy* or Flexible** (about 40% of most groups of children): Typically, the easy child is
regular in biological rhythms, adaptable, approachable, and generally positive in mood of
mild to medium intensity.
+ Difficult* or Feisty** (about 10% of children)
The feisty child is the opposite of the easy child. The child may be hard to get to sleep
through the night, her or his feeding and nap schedules may change from day to day, and
the child may be difficult to toilet train because of irregular bowel movements. The feisty
child typically fusses or even cries loudly at anything new and usually adapts slowly.
+The Slow-to-Warm-Up* or Fearful Child** (about 15% of children)
Finally, there is a group of children who are often called shy. The child in this group also has
discomfort with the new and adapts slowly, but unlike the feisty child, this child's negative
mood is often expressed slowly and the child may or may not be irregular in sleep, feeling
and bowel elimination.
Q: 2y/o does not want to let go of wool blanket and resists going anywhere without it.
Attachment type is? - ANS-A: transitional object
Q: 4y/o has developed what language skills? - ANS-A: story telling using words
+ 12-18 months: single words, up to 20 words by 18 months
+ 12-24 months: two word messages, refers self by name
+ 2-3y/o: real sentences, up to 270 words by age 2, and 895 words by age 3
Q: 5y/o child with behavioral problem at school, in and out of foster care for the first 2 years
of his life. Friendly and affectionate with others even with strangers. Parents don't feel
"close" to the child and doesn't seem to have enduring friendships. Dx? - ANS-A: reactive
attachment disorder
+ when child has grossly pathological caregiving, two disorders can occur:
1) reactive attachment disorder: emotionally withdrawn responses toward adult caregiver,
limited positive affect, sadness and minimal social responsiveness to others
2) disinhibited social engagement disorder: undifferentiated, unselective, and inappropriate
social relatedness with familiar and unfamiliar adults
Q: 7y/o with temper tantrums, refuses to go to school. Stomachaches and headaches on
school days. Nightmares about being kidnapped, fears parents will die. Dx? (4x) - ANS-A:
separation anxiety disorder
Q: A female child performs a dance for her mother and basks in the gleam of her mother's
eyes. According to self-psychology, the child is having an experience of: - ANS-A: mirroring
Q: A preschooler misses his long-term nanny who has recently moved away. To help this
child, parents should: (2x) - ANS-A: show pictures of nanny
Q: ability of an infant to utilize symbolic representation at age 18 months allows for: - ANS-A:
using language proficiently
+ 12-18 months: single words, up to 20 words by 18 months
+ 12-24 months: two word messages, refers self by name
+ 2-3y/o: real sentences, up to 270 words by age 2, and 895 words by age 3