Center for Family Development Blog

Training in Complex Trauma for Value Behavioral Health Providers

2011-11-17T16:45:00.000-05:00

I'm in Pittsburgh now, November 17, 2011. I'll be doing a presentation for Value Behavioral Health about evaluating and treatment Complex Trauma tomorrow. VBH manages the Medicaid contract for the State of PA for Western PA, so there will be about 350 providers at the training.

Attachment Therapy Companion

2011-11-12T08:48:00.002-05:00

I've just heard that a book I wrote with two colleagues,
The Attachment Therapy Companion: Key Practices for Treating Children
& Families
is now in production and should be out in early 2012. The book
describes what are the standards of care for this treatment.
From the Introduction:

This book is an important contribution to the field of trauma
treatment and attachment-focused the therapy. It provides the
clinician with a framework to assess, develop treatment plans, and
provide treatment in a comprehensive and integrated manner. College
professors are afforded a guide for classroom instruction. The book
will provide consumers with the necessary tools and information to
make better informed decisions regarding the adequacy of care they are
getting. College professors will find this book a useful adjunct for
family therapy, treatment, and ethics classes and the study guide will
assist in classroom instruction. Finally the book will provide judges,
child welfare professionals, insurance companies, and others with a
framework for evaluating proposed plans of care. It is my belief that
this book will mark a new stage in the development of attachment-
focused therapy by delineating what are the standards of care for the
treatment of attachment and trauma disorders.

Tips for parents

2011-10-23T16:25:00.002-04:00

Tips for parents on Halloween safety:

http://www.huffingtonpost.com/mary-l-pulido-phd/protecting-kids-first-a-s_b_991354.html

New Book on the Practice of Attachment-Focused Therapy

2011-10-23T15:29:00.000-04:00

Dr. Becker-Weidman is one of the editors of a new book to be published early in 2012 on the professional practice of attachment-focused therapy. The two other editors are Lois Ehrmann and Denise LeBow. The book will serve as a practice manual defining standards of care. The book will be a valuable resource for social workers, psychologists, mental health practitioners, departments of social services, child welfare organizations, judges, and attorneys. The book's table of contents will be:
Chapter 1: Terminology and Diagnosis
Chapter 2: Purposes and Scope of Guide
Chapter 3: Overview of Attachment Theory: Synopsis of Key Concepts
CHAPTER 4: Overview of Attachment-Focused Therapy
CHAPTER 5: Core Concepts of Trauma and Trauma Focused Therapy
CHAPTER 6: Intake, Screening, & Referral
CHAPTER 7: Assessment of Children With Attachment Issues
CHAPTER 8: Treatment Planning
CHAPTER 9: Considerations in Behavior Management
CHAPTER 10: Training, Consultation, and Competency
CHAPTER 11: Ethical Considerations in Attachment Focused Therapy
CHAPTER 12: Vicarious Trauma and the Clinician’s Responsibility for Self Care
References
Glossary
Appendix A: Paper on Coercion in Treatment
Appendix B: Screening and Assessment Tools
Appendix C: Out-of Home Placements
Appendix D: Study Guide

Dr. Becker-Weidman to present two days in Northern California

2011-09-25T16:41:00.000-04:00

Dr. Becker-Weidman will be presenting a workshop, "Healing Trauma and Attachment Disorders" at two locations in Northern California Oct 14 & 15.

Dr. Becker-Weidman in Saratoga Springs

2011-09-25T16:39:00.000-04:00

Dr. Becker-Weidman will be presenting a community workshop, "Complex Trauma: A Community Approach"- Implications for Treatment, Parenting, Child Welfare, Family Court and Education"
in Saratoga Springs on October 20, 2011.

Dr. Becker-Weidman @ Justice For Children in Syracuse

2011-09-25T16:33:00.000-04:00

Dr. Becker-Weidman will be presenting at the 2011 Building Justice for Children Conference in Syracuse October 25-27. He will be talking about Assessing Children's mental health and trauma issues.

A cool website for 3D images of the Brain

2011-09-20T15:40:00.000-04:00

I found this cool website and thought you'd be interested in it.

3D Brain images

http://www.g2conline.org/2022

What is Attachment?

2011-09-12T17:29:00.000-04:00

The attachment system, is a biologically based system that evolved to ensure the survival of the human infant. In simple terms, it is a proximity seeking system. When a child is threatened, the child will seek its primary caregiver who provides a sense of safety and security.

The organization ATTACh (Association for the Treatment and Training of Attachment in Children) gives the following lengthier definition of attachment:
“Attachment is a reciprocal process by which an emotional connection develops between an infant and his/her primary caregiver. It influences the child’s physical, neurological, cognitive, and psychological development. It becomes the basis for development of basic trust or mistrust, and shapes how the child will relate to the world, learn, and form relationships throughout life.”

Complex Trauma: A community Approach

2011-09-09T09:27:00.002-04:00

Dr. Becker-Weidman will be presenting two day-long workshops in California:

Arthur Becker -Weidman, Ph.D.
Friday, October 14, 2011
9:00 AM—4:00 PM
Chi co Masonic Fami ly Cente r
1110 W. East Avenue , Chi co CA
Please RSVP to (530) 879-3861 or ldamschroder@sierraff.org
This FREE training is made available through the collaborative efforts of
Sierra Forever Families & California Department of Social Services
Childcare Reimbursement Available call Leslie 879-3861 for more information
Arthur Becker-Weidman, Ph.D. is a Diplomat in Child Psychology and Forensic Psychology, the American Board of Psychological Specialties. He is a Registered Clinician with the Association for the Treatment and Training in the Attachment of Children and is a Certified Therapist, Consultant, and Trainer of Dyadic Developmental treatment®. Dr.
Becker-Weidman has edited and authored four books: Creating Capacity for Attachment (2005/2008), Attachment Parenting (2010), Dyadic Developmental Psychotherapy: Essential Practices & Methods (2010), and The Dyadic Developmental Psychotherapy Casebook (2011). He has four DVD's. Dr. Becker-Weidman is on the Board of Directors of the Association for the Treatment and Training in the Attachment of Children where he serves on several committees. Dr. Becker-Weidman provides training and workshops to parents, professionals, and governments across the U.S. and internationally.
These learning objectives will be addressed:
Participants will be able to describe how parent-child attachment normally develops
Participants will identify the seven domains of impairment caused by Complex Trauma
Participants will be able to identify three general principles of parenting & treatment grounded in attachment-theory & Dyadic Developmental Psychotherapy
Participants will be able to use two new interventions to help parents with children with trauma and attachment disorders
Participants will be able to describe one key element of Dyadic Developmental Psychotherapy and be able to use it in their practice
Parents will be be able to describe the fundamental principles of attachment-facilitating parenting.
Parents will be able to implement at least two attachment facilitating interventions
Course meets qualifications for 6 hours continuing
education credit for MFT’s & LCSW’s as required by the Board of Behavioral Sciences

Complex Trauma: A community Approach

2011-09-09T08:50:00.000-04:00

Dr. Becker-Weidman will be presenting an all day workshop on October 20, 2011 in Saratoga Springs.

“Complex Trauma: A Community Approach”- Implications for Treatment, Parenting, Child Welfare, Family Court and Education.”

With Dr. Arthur Becker-Weidman

October 20, 2011

8:30- 5 pm.

8:00am Registration

Knights of Columbus Hall
50 Pine Road
Saratoga Springs, New York

CONFERENCE FEE
PROFESSIONALS: $95.00
All purchase orders add $15.00
PARENTS & GUARDIANS: $25.00
Due to Co-Sponsorship by the Theraplay Institute 6 CEUs are available for psychologists and play therapists

Coffee & Lunch Included

MAKE YOUR CHECK PAYABLE TO:
CCMH YOUTH CONFERENCE

MAIL TO:
Tammy Horan
Saratoga County Mental Health Center
211 Church Street
Saratoga Springs, NY 12866
518-584-9030
e-mail: ythserv@yahoo.com

Name:___________________________

Agency:__________________________

Address:_________________________

________________________________

Phone:___________________________

E-Mail:__________________________

Children in the Child Welfare system have often experienced Complex Trauma and require specialized treatment, parenting and educational approaches. For over twenty-five years Dr. Becker Weidman has specialized in the treatment of families with children who have complex trauma and disorders of attachment and on training therapists, parents, children welfare workers, educators and courts
Dr. Becker- Weidman will describe Complex Trauma and Dyadic Developmental Psychotherapy (DDP), which is an evidence-based, effective, and empirically validated treatment, and how these approaches and concepts can integrate the community response system. Dr. Becker-Weidman will explain the effects of complex trauma on child development as well as factors affecting placement stability. The ways that teachers, child welfare professionals, parents, and therapists respond are often the key to lessening the ill effects of trauma. The community system of care must embody the principles of safety, security, support, acceptance, curiosity so that the child and family can heal. Through the use of presentations and tapes of actual sessions, Dr. Becker-Weidman will explain his approach.

Children in the Child Welfare system have often experienced Complex trauma and require specialized treatment, parenting and educational approaches. For over twenty-five years Dr. Becker Weidman has specialized in the treatment of families with children who have complex trauma and disorders of attachment and on training therapists, parents, children welfare workers, educators and courts. The material presented by Dr. Becker-Weidman will build on the presentation of Dr. Daniel Hughes her in 2009. Dr. Becker-Weidman and Dr. Hughes are close colleagues, haven written articles together and collaborate as trainers and Board members of the Dyadic Developmental Psychotherapy Institute.
Dr. Becker- Weidman will describe Complex Trauma and dyadic Developmental Psychotherapy, which is an evidence-based, effective, and empirically validated treatment,how these approaches and concepts can integrate the systems of care that are involved with foster and adoptive families and their children, as well as will children with histories of abuse and neglect and attachment disorganization. Dr. Becker-Weidman will explain what Complex Trauma is, its effects on child development, factors affecting placement stability and the implications of this for teachers, child welfare professionals, parents, and therapists. The framework for this presentation will be Dyadic Developmental Psychotherapy, an approach grounded in Attachment Theory. Dr. Becker-Weidman’s approach within all systems of care is to provide safety, security and the necessary support so that the positive and emotionally meaningful relationships can develop. He actively communicates acceptance, curiosity and empathy. The system of care must embody these principles so that the child and family can heal. Through the use of presentations and tapes of actual sessions, Dr. Becker-Weidman will explain his approach.

About the Presenter
Dr. Arthur Becker-Weidman has been training professionals, evaluating and treating families and children with trauma-attachment disorders for over thirty years. He has a PhD from the University of Maryland’s Institute for Child Study and is a Diplomat of the American Board of Psychological Specialties in Child Psychology and Forensic Psychology. He is recognized as an expert witness and frequently provides testimony in court proceedings.
Art lives in Williamsville, NY with his family and is the Director of The Center for Family Development, an internationally recognized training and treatment center. He is the author of four books: Creating Capacity for Attachment (2005/2008), Attachment Facilitating Parenting (2010), Dyadic Developmental Psychotherapy Casebook (2011). He is the author of many articles in professional peer-reviewed journals and empirical studies. He has published research demonstrating the efficacy and evidence-base of DDP. Dr. Becker-Weidman provides training and consultation to therapists, psychologists, social workers, and parents throughout the US, Australia, Canada, Finland, Singapore, Slovakia and the Czech Republic.

Who Should Attend?
This program is designed for anyone who would like to know how to work together across disciplines with children and families who have suffered from the effects of Complex Trauma. The conference is directed toward child-centered professionals and community systems that work to help to lessen those effects. This training will provide a perceptual framework to understand what these children and families need as well as readily implementable ideas that can be used at home, school, community, as well as in therapeutic, child welfare, and family court offices.
• Psychologists and Psychiatrists
• Social Workers/Therapists
• Family Therapists
• Play Therapists
• Parents and Caretakers
• Residential Counselors
• Teachers/School Professionals
• Adoption/Post-adoption Caseworkers
• Child Welfare Workers
• Family Court Judges
• Early Childhood Development Specialists
• Teachers/School Professionals
• Adoption/Post-adoption Caseworkers
• Child Welfare Workers
• Family Court Judges
• Early Childhood Development Specialists

Program Schedule
Introduction/Overview of Day-8:30-8:45
Complex Trauma………………..8:45-11:00
1) What is Complex Trauma?
2) 7 Domains of Impairment
3) Effects on Child Development and Behavior
4) DVD: A child’s View
BREAK……………………………..10:30-10:45
Factors affecting placement stability & Breakdown………………………11:00-11:30
Principles of effective interventions-11:30-12:00
LUNCH……………………………..12:00-1:00
Implications for Parents, Teachers, Clinicians, Child Welfare and Family Court …………………..…………………..1:00-5:00
Teachers……………………… ….1:00-2:00
Class and School Practices
Child Welfare and Family Court-2:00-3:00
Placement Policies/Court Issues
Foster Parent Selection & Training
BREAK………………………………..3:00-3:15
Treatment……………………………3:15-4:00
Elements of treatment Parenting
…………….………………………….4:00-5:00
Attachment Facilitating Parenting

FOR FURTHER INFORMATION CONTACT:
Tammy Horan
518-584-9030
conferenceythserv@yahoo.com
DIRECTIONS:
From I-87 take Exit 13N, merge onto US-9
toward Saratoga Springs
4.4m turn left onto Washington St. /NY 29
(Corner with Starbucks)
1.5 m turn left onto Pine Rd
Left into Parking Lot.
50 Pine Rd.
Knights of Columbus Hall

Healing Trauma & Attachment Disorders Workshop

2011-09-08T13:56:00.000-04:00

Justice for Children Conference

2011-09-08T10:56:00.000-04:00

Dr. Becker-Weidman will be presenting a workshop at the Building Justice For Children 2011 Conference to be held in Syracuse NY on October 25-27, 2011. His workshop will be about Assessing Children for Trauma.

For more information, go to

http://www.center4familydevelop.com/workshops.htm

Mental Health issues of Adopted Children

2011-07-27T19:42:00.002-04:00

The National Institutes of Health released a report this week stating “adopted children have higher rates of mental health problems than all other children.”

For those of us in the adoption world, the report — the 15th in a series issued since 1997 by the Federal Interagency Forum on Child and Family Statistics – may state the obvious. But it is also throws a gauntlet at the feet of social service agencies and policy makers.

During the past twenty years, the adoption landscape has been radically transformed. From the secretive adoption of babies born to unwed and predominantly white mothers, the norm today is arranged, open adoption of newborns, children from foster care or children from institutions and orphanages in far flung parts of the world.

Recent statistics help put this shift into perspective. Out of the approximately 135,000 children adopted in the U.S. last year, 11,000 (most between the ages of one and two) were internationally adopted. Here in the U.S. just over 52,000 children were adopted into non-family member homes from foster care.

Adam Pertman, Executive Director of the Evan B. Donaldson Adoption Institute, and author of Adoption Nation (Basic Books, Perseus Book Group, 2000) said in an interview that, “many adopted kids today enter their new families with pre-adoption lives. For them, this means they’ve experienced abuse, neglect, or [if from an inter-country placement] institutionalization.”

Older parents who can’t have their own children are a key factor driving the demand for more international and foster care adoptions. Not only are these new adoptive families not genetically linked, many parents, like myself, don’t even know the genetic history of the children we end up calling our own.

The upside to this expanded adoption domain has been a tremendous surge in diversity. Parents don’t try and adopt children that look like them nor do they demand infants. The linear homogenous family model is out and the crazy quilt is in. The downside, though, is inadequate support to help parents understand the history of their child or to help prepare these families for potential difficulties, both behavioral and cognitive. In their giddy rush to form a family, naïve parents can be blindsided when confronted by the reality of their adopted child’s extreme needs. To help theses parents cope, an industry of medical, cultural and emotional support services have emerged.

Nothing could underscore the point more clearly than the return in April 2010 of adoptee Artyom Savalyev to his native Russia. His single mother, Torry Hansen, allegedly overwhelmed by seven-year old Atryom’s unpredictable and unstable behavior, determined she could no longer parent him. Instead, Hansen sent her son back on a plane to Russia, by himself, with a note pinned inside his jacket. Artyom remains in Russia at an undisclosed location while the case against Hansen languishes in limbo.

Dr. Lisa Albers Prock, a Developmental Behavioral Pediatrician at Children’s Hospital Boston, and a leading advocate of ‘adoption medicine,’ says she tries to prepare parents for what to expect, but it’s hard, she says, for anxious new parents to grasp the complexities of “kids that have been fully programmed and have to be reprogrammed” in a new setting.

The new NIH report highlights some of the realities on the ground. Of the families surveyed, almost 30 percent of adopted children had moderate to severe health problems and foster care children were the most susceptible. In addition to health problems, many of these children also had an assortment of cognitive deficits such as learning disabilities, ADD and ADHD, or behavior and conduct disorders. Exposure to alcohol or drugs during pregnancy is often thought to be the culprit behind these deficits, as is infant trauma, which can have serious and long-lasting implications later in life.

While this data is distressing, Pertman says reports like this are “helpful and a good wake-up call.” To Pertman, these findings demand that policy makers take notice. The once mandatory emphasis on placement should now shift, he says, “to looking at how to help these kids and families succeed.” The NIH findings also coincide with his Institute’s most recent policy and practice report on the need for post-adoption services.

The NIH report demonstrates families feel challenged. But instead of retreating or giving up, these parents are demanding help. Despite the old Beatles refrain, “Love is all you need,” sometimes you also need a safety net.

ATTACh seeks Executive Director

2011-07-22T06:09:00.002-04:00

ATTACh, the Association for Treatment and Training in the Attachment of Children, an international coalition of professionals and families dedicated to helping those with attachment difficulties by sharing our knowledge, talents and resources is seeking a dynamic leader to serve as it's Executive Director. Our vision is to be an international leader in creating public awareness and education regarding attachment and the critical role it plays in human development. We provide an annual conference, educational programs, advocacy, community building, a membership directory, and other benefits to our members and the public. We are seeking an experienced professional to work in a collaborative community environment, building relationships and serving as a leader of a diverse team of professionals and parents. Experience in community organization, fundraising, business development ,budget planning, administration, and personnel management is required. Knowledge of information systems, research and legal issues is highly desirable. Experience in attachment, trauma, or related fields is strongly preferred. This position requires strong analytical, creative thinking and problem-solving abilities. A balance of assertiveness and diplomacy is critical, as well as effective listening skills and excellent verbal and written communications skills. Experience with MS Office (Word, Excel and Access) is essential.

Master's Degree in Human Services, Business, Social Services or related degree is required, with a minimum of five years of progressively responsible combined experience in first line and/or second line management/administration of a non-profit organization.

Geographic location of position within USA is negotiable. Please send cover letter, salary requirements and resume to search committee at email listed above.

Compensation: salary negotiable
Telecommuting is ok.
This is at a non-profit organization.
Principals only. Recruiters, please don't contact this job poster.
Please, no phone calls about this job!
Please do not contact job poster about other services, products or commercial interests.

The email for this is Dynamicleaderforattach@gmail.com.

Dyadic Developmental Psychotherapy: Video on Attachment Focused Therapy

2011-07-14T20:46:00.002-04:00

The Association for the Treatment and Training in the Attachment of Children has a wonderful new video about Attachment Focused Therapy. You can view it here. This video is a must see for parents and professionals. It describes the latest information on evidence-based, effective, and empirically validated treatments for Complex Trauma, Reactive Attachment Disorder, and other disorders of attachment. The speakers and presenters are internationally recognized experts in the evaluation and treatment of these conditions.

See the video here.

Exciting new video by ATTACh

2011-07-13T17:02:00.000-04:00

The Association for the Treatment and Training in the Attachment of Children, had an exciting video about the diagnosis and treatment of attachment disorders. This organization's highly respected and followed publications, such as the Therapeutic Practice Manual and Parent Manual are now enhanced by this video.

The video presents the most up to date material for parents and professionals regarding the diagnosis and treatment of disorders of attachment and has such highly internationally respected professionals on it as Dr. Michael Trout and Dr. Richard Kagan.

Go to the video here.

Dyadic Developmental Psychotherapy Identified as an Effective Treatment by UK Institute

2011-06-09T16:46:00.000-04:00

IN an exciting development, the Institute for Research and Innovation in Social Services, recognizes Dyadic Developmental Psychotherapy as an evidence-based, effective, and empirically validated treatment. The Institute is a large, internationally regarded institute whose function is to promote positive outcomes in the social service field by identifying evidence informed practice and disseminating research, innovations, and improvements in social services policy, practice, and programming.

The Institutes most recent report, "Insights: Attachment-Informed practice with looked after children and young people, had the following key points:

Attachment behaviour ensures the survival of infants and young children by keeping their caregivers close and available to provide protection and comfort. The attachment relationship provides the context for the main developmental tasks of infancy and early childhood, particularly emotional regulation and the development of the capacity to ‘mentalise’.

The characteristics of caregivers affect the organisation and security of children’s attachment relationships with them. Sensitive, responsive parenting and parental ability to reflect on the infant’s own thoughts and feelings are associated with secure attachments in children.

Children who have experienced maltreatment are significantly more likely to develop disorganised
attachments and these can have lifelong physical, emotional and social consequences.

Recent evidence from neuroscience confirms the importance of the early emotional and social experience of
infants for the healthy development of their brains. Maltreatment can disturb the patterns of cortisol
(stress hormone) secretion which can affect immediate and long term mental and physical health.

Looked after children benefit from developing secure attachments with their caregivers and interventions
should support the development of these, whether children remain at home or are cared for outside their family.

Successful placements are more likely when carers are able to respond to children at their emotional age
rather than their chronological one. Interventions with children should aim to address developmental brain
impairment by providing care that can build fundamental brain capacities. For looked after children this will mean less use of verbal techniques and a greater concentration on physical, sensory and emotional ways of working.

Caregivers should be assessed on their capacity to tolerate difficult behaviour and remain sensitive and
responsive to the needs of children.

Support and training should be provided to caregivers on a frequent and regular basis to ensure that they are able to maintain their capacity to be reflective about children rather than reactive to their behaviour.

Attachment-informed practice may require a policy and culture shift to ensure that children’s needs
are appropriately met when they are cared for away from home.

As you can see their key point that carers should respond to children based on their emotional age rather than their chronological age is supported by our study revealing that children with Complex Trauma and disorders of attachment are substantially younger developmentally than their chronological age:
Becker-Weidman, A., (2009) “Effects of Early Maltreatment on Development: A Descriptive study using the Vineland,” Child Welfare, 88 (2)137-161.

The Institue's paper goes on to state it's support for Dyadic Developmental Psychotherapy as an evidence-informed and validated treatment approach:
Dyadic Developmental Psychotherapy is an attachment-focused approach in which a therapist supports the caregiver and child’s relationship and the development of secure attachment by encouraging the reflective function of the caregiver, enabling attunement, regulating emotion and co creating meaning. The therapist
interactions are characterised by PACE (playfulness, acceptance, curiosity and empathy) and similar qualities are supported in the caregiver with the addition of love (PLACE). This approach has been well evaluated with foster carers and adoptive parents and recently elements of this model have been successfully introduced within residential child care (Becker-Weidman and Hughes, 2008).

Becker-Weidman, A., & Hughes, D., (2008) “Dyadic Developmental Psychotherapy: An evidence-based treatment for children with complex trauma and disorders of attachment,” Child & Adolescent Social Work, 13, pp.329-337

Reactive Attachment Disorder: For Educators

2011-05-27T21:33:00.000-04:00

The following is a handout that a colleague produced for Educators. You may find this valuable.

A few references that may also be helpful:

Becker-Weidman, A., 2010, Dyadic Developmental Psychotherapy: Essential Practices & Methods, Lanham, MD: Jason Aronson.
Becker-Weidman, A., & Shell, D., 2010, Attachment Parenting, Lanham, MD: Jason Aronson.
Becker-Weidman, A., & Shell, D., 3rd printing, 2011: Creating Capacity for Attachment.
Becker-Weidman, A., 2006, Principles of Attachment Parenting, DVD, order from Amazon.com

FACT SHEET FOR EDUCATORS
by
Connie Hornyak, LCSW
chlcsw@pacbell.net

Children with disorders of attachment are the victims of abuse, neglect, abandonment, physical illness, multiple placements and/or in-utero drug/alcohol exposure. Their problems are rooted in the first five years of their lives, when trauma occurred. Stable attachments cannot be formed when a child experiences frequent changes in daycare or foster care, or when the child’s social, emotional, physical, and cognitive needs are unmet.

While many children with disorders of attachment have grown up in foster care and/or adoptive homes, these disorders occur in children who are growing up with their biological parents as well. It is estimated that one-third of elementary school children in the United States have some form of an attachment issue, if not the full blown disorder, due to divorce, inappropriate daycare programs, and multiple caregivers. Children who have experienced medical events such as hospitalization, placement in an incubator or a body cast can also develop these disorders.

According to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, published by the American Psychiatric Association, there are two types of Reactive Attachment Disorder. In the Inhibited Type the child persistently fails to initiate and to respond to most social interactions in a developmentally appropriate way. The child shows a pattern of excessively inhibited, hyper vigilant or highly ambivalent responses (for example, frozen watchfulness, resistance to comfort, or mixture of approach and avoidance). In the Disinhibited Type, there is a pattern of diffused attachments. The child exhibits indiscriminate sociability or a lack of selectivity in the choice of attachment figures. For example, the child may be extremely charming and friendly with those who are not trying to be his or her parents, while acting violently toward parents who are attempting to become emotionally close to the child.

What is a Disorder of Attachment?

A person with a disorder of attachment has difficulty forming loving, lasting, intimate relationships. These individuals are unable to be genuinely affectionate with others, have not experienced conscience development, and cannot trust others. Attachment is necessary for the development of an emotionally healthy person who has conscience development, experiences empathy, attains full intellectual potential, thinks logically, copes with stress and frustration, becomes self reliant, develops healthy personal and business relationships, and handles the ups and downs of everyday life. Attachment Disorder is Helen Keller.

Children with disorders of attachment do not respect authority, especially that of their parents. They are sometimes oppositional and defiant in the school setting, although many of these children behave perfectly with those who are not parenting them. It is not uncommon for a child with a disorder of attachment to be a good student as well as the most helpful child in the class. The same child may go home and threaten his mother with a knife, set fires, and/or kill animals. Children with attachment disorder have been so damaged that they cannot trust. Their behavior meets their subconscious need to keep those who love them most at a distance. They are fearful that, if they become emotionally close to their parents, they will somehow be hurt again as they were in the past. These children are terrified of closeness, and will do anything they can to create distance between themselves and their parents. One way this is manifested is in children’s ability to triangulate; that is, to pit one adult against the other. Children with disorders of attachment frequently lie to their teachers, accusing their parents of emotional abuse, physical abuse or neglect, and lie so convincingly that their teachers believe them. Many parents have been erroneously reported for suspected child abuse when school personnel have listened to the child without checking the facts with the parent.

What’s a teacher to do?

• Develop and maintain constant communication with the child’s parents. This will greatly increase the chance of all adults being consistent in the child’s life at home and at school. Be sure to check with parents if you suspect that the child’s story could be untrue. Ask parents to do the same for you. For example, if the child comes home and says that his teacher hit him, yelled at him or otherwise behaved inappropriately, please ask the parents to check out the child’s story with you before acting upon it.
• Children with attachment disorders need a tight, loving, structured environment where the rules never change but the consequences often do.
• These children need a tightly structured environment in order to feel safe. They do not need an overly permissive environment which makes them feel unsafe. Please respect the need of the parents to be the primary attachment figures in this child’s life. While many teachers, especially in younger grades, tend to hug children and openly display affection for them, this type of treatment is inappropriate for a child with a disorder of attachment. If this type of treatment is given in the school setting, the child will simply triangulate, manipulating the teacher into thinking that he or she is an important attachment figure in a child’s life, and using the teacher’s affection to manipulate the parents at home.
• Follow through on any and all consequences. The child’s safety and that of others depends on it.
• Hold the child responsible for his or her actions. Understand that, until the child’s behavior becomes more positive, he or she will have an extremely depressing life. Even though the child has problems and may have a painful past, it is important to hold the child responsible for his or her actions and not excuse those actions because of the child’s previous trauma.
• Remember that these children are superficially charming with strangers and others who are not their parents. These children lack the ability to have true closeness with their parents and other family members.
• Please understand that if this child criticizes his parents and asks to go home with you, this is a means of distancing from closeness with the parents. The child is fearful of closeness with parents because previous parents have left the child or traumatized him/her.
• Children with disorders of attachment need to regress and experience being infants and toddlers, as well as young children, before they can behave in an age-appropriate fashion. Please realize that there are days when the child may need to stay home from school in order to receive therapy, or because the child simply needs to be close to his or her parents. Once attachment issues are resolved, the child will have plenty of energy to make up for lost time at school.

For more information about disorders of attachment, please access the following web sites: www.icfd.net and www.attach.org.

4/26/11

Dyadic Developmental Psychotherapy Training in 2012

2011-04-15T13:49:00.000-04:00

ABOUT THE WORKSHOP
The workshop covers all the "Required Core Training Content" necessary to enter the practicum to become a Certified Dyadic Developmental Psychotherapy therapist. The use of SKYPE, independent study, and consultations will allow remote participants to fulfill the requirements to become Certified Dyadic Developmental Psychotherapy therapists.

The workshop uses a combination of SKYPE sessions, group discussion, independent study, and case presentations. Attachment-focused family therapy workbook, is the course text.

Early deprivation, neglect, abuse, significant early health problems and hospitalizations, repeated moves, or more than one year in an orphanage can create attachment problems that require specialized treatment. Traditional forms of therapy are ineffective with attachment-disordered children. This workshop will provide the therapist and other professionals with an opportunity to learn and practice effective treatment methods for trauma-attachment disordered children.

Participants are encouraged to present videotapes of sessions.

Dyadic Developmental Psychotherapy is an evidence-based, effective, and empirically validated treatment that is grounded in current thinking and research on the etiology and treatment of Complex Trauma or Developmental Trauma Disorder and disorders of attachment. Treatment is primarily experiential and there is an important teaching element as well. Teaching parents about attachment-facilitating parenting methods and the importance of attunement and responsive, sensitive parenting is essential. Direct work with the parents regarding their own family or origin issues is another component of treatment. Finally, intensive emotional work with the child in a manner consistent with sound treatment principles is vital.

The workshop is led by Dr. Arthur Becker-Weidman, who is a certified Dyadic Developmental Psychotherapist, Certified Consultant, and Certified Trainer by the Dyadic Developmental Psychotherapy Institute.

CENTER FOR FAMILY DEVELOPMENT
The Center For Family Development is an internationally recognized treatment and training center specializing in helping adopted and foster families with trauma and attachment disordered children. The Center is a registered agency with the Association for Treatment and Training in the Attachment of Children.

Arthur Becker-Weidman, CSW-R Ph.D. received his doctorate in Human Development from the University of Maryland, Institute for Child Study. He achieved Diplomate status from the American Board of Psychological Specialties in Child Psychology and Forensic Psychology. He is a Vice-President, clinical, with the Association for the Treatment and Training in the Attachment of Children and President of the Dyadic Developmental Psychotherapy Institute. Art is an adjunct Clinical Professor at SUNY at Buffalo. He has published over a dozen scholarly papers and regularly presents at international and national conferences. Art consults with psychologists, social workers, marriage and family therapists and several child treatment agencies, school districts, departments of social services, and governments in the United States, Canada, Finland, Czech Republic, Slovakia, Singapore, & Australia.

EVIDENCE-BASIS FOR TREATMENT
* Becker-Weidman, A., (2006) “Treatment for Children with Trauma-Attachment Disorders: Dyadic Developmental Psychotherapy,” Child and Adolescent Social Work Journal. Vol. 23(2), 147-171.
* Becker-Weidman, A., (2006) “Dyadic Developmental Psychotherapy: A multi-year Follow-up,” in, New Developments In Child Abuse Research, Stanley M. Sturt, Ph.D. (Ed.) Nova Science Publishers, NY, pp. 43 – 61.
* Becker-Weidman, A., (2007). “Treatment For Children with Reactive Attachment Disorder: Dyadic Developmental Psychotherapy,” http://www.center4familydevelop.com/research.pdf
* Becker-Weidman, A., & Hughes, D., (2008) “Dyadic Developmental Psychotherapy: An evidence-based treatment for children with complex trauma and disorders of attachment,” Child & Adolescent Social Work, 13, pp.329-337.
* Craven, P., & Lee, R., (2006) Therapeutic Interventions for Foster Children: A Systematic Research Synthesis, Research on Social Work Practice, 16(3):287-304.

TRAINING OUTLINE
2012
Center For Family Development
5820 Main Street, suite 406
Williamsville, NY 14221

SCHEDULE
A Six-month 56-hour Master Class.
10:00 am– 5:00 pm, 1/20/12, 2/17, 3.16, 4/20, 5/18, 6/21. Dates subject to change based on participant requests, 2012 holidays, and group agreement. Limited to eight.

OUTLINE
* Patterns of attachment
* Engaging and working with parents
* Intersubjectivity & use of self in practice
* Experiential components of training
* Components of Practice
* Phases of Treatment
* Differential use of components of
* Practice in different phases of
treatment
* Treatment with different populations and
circumstances
* Experiential components of training
* Consultation

Dyadic Developmental Psychotherapy is an evidence-based, effective, and empirically validated treatment. Two follow-up studies with control groups found clinically and statistically significant reductions in symptoms of attachment disorder, aggression, anti-social behavior, thought disorders, attention problems, mood, and social relationship dysfunction. Over 80% of the children treated had previously been in treatment on three or more occasions, without any noticeable improvement. Treatment averaged 23 sessions over approximately ten months. (Arthur Becker-Weidman, Ph.D., Child & Adolescent Social Work, vol. 23, pp.137-171, 2006)
SUGGESTED READING
You will find the following list of books helpful. It is strongly recommended that you read the first book before the workshop begins. This will ensure that everyone has a solid foundation of common knowledge.

1. Dyadic Developmental Psychotherapy: Essential Methods & Practices, Arthur Becker-Weidman, Ph.D., Rowman, Lanham, MD, 2010.
2. The Dyadic Developmental Psychotherapy Casebook, Arthur Becker-Weidman, Rowman: Lanham, MD, 2011.
3. Creating Capacity for Attachment, Eds., Arthur Becker-Weidman, Ph.D., Deborah Shell, MA, LCMHC, Wood ‘N’ Barnes, 2005/2008.
4. Attachment Parenting, Ed., Arthur Becker-Weidman & Deborah Shell, Rowman: Lanham, MD, 2010.
5. Attachment-Focused Family Therapy. Daniel Hughes, Norton, 2007.
6. Attachment-Focused Family Therapy Workbook, D. Hughes, Norton: NY, 2011.
7. Handbook of Attachment: Theory, Research, and Clinical Applications. Edited by Jude Cassidy and Phillip Shaver. The Guilford Press, 2008.
8. Building the Bonds of Attachment. 2nd. Ed. Daniel Hughes, Ph.D., 2006
9. Attachment Across the Life Cycle. Edited by Colin Murray Parkes, Joan Stevenson-Hinde, and Peter Marris. Routledge, 1991.
10. A Secure Base. John Bowlby, Basic Books, NY, 1988.
11. John Bowlby & Attachment Theory. Jeremy Holmes, Routledge, NY, 1993.

PURPOSE OF WORKSHOP
This workshop is for therapists who want to learn how to treat trauma-attachment disordered children. Participants will learn effective therapy principals for helping traumatized children. Participants will learn:
1. Initial work to determine parent readiness.
2. The components of Dyadic Developmental Psychotherapy and the phases of treatment.
3. The differential use of components in different phases of treatment.
4. Effective therapeutic techniques to use with traumatized and attachment disordered children and their families.
5. Effective parenting principals.
Participants will have the opportunity to view videotapes of actual therapy sessions with traumatized children that demonstrate therapeutic principals and present their own video tapes or cases.

2011-03-28T19:59:00.002-04:00

Emotional neglect can be defined as 'emotional unresponsiveness, unavailability and neglect characterised by a lack of interaction between parent and child.' It has been linked to children developing more mental-health problems but most research so far has been based on adults' memories of their childhood not how children feel at the time. A team of researchers from the University of Glasgow and the Medical Research Council in Glasgow studied 1,694 children. The children filled out a questionnaire called the Parental Bonding Instrument at 11 to assess their relationship with their parents and then had a computerhttp://www.blogger.com/img/blank.gifised psychiatric interview at 15 to assess any mental-health problems. 3% of the children perceived their parents as almost always emotionally neglectful and controlling and this group had more than twice the risk of developing mental-health problems at 15.

Young, Robert, Lennie, Susan and Minnis, Helen - Children’s perceptions of parental emotional

neglect and control and psychopathology Journal of Child Psychology and Psychiatry
doi:10.1111/j.1469-7610.2011.02390.x

See Center for Family Development for information about Dyadic Developmental Psychotherapy, an evidence-based, effective, and empirically validated treatment. Also see the Center's facebook page.

Theory of Mind and Attachment

2011-03-27T12:08:00.003-04:00

Theory of Mind (ToM) can be defined as the ability to work out what other people are thinking and how this might affect their behavior. In most children ToM shows a significant advance between the ages of three and five. However, the development of ToM is severely delayed in children with autism. In addition, children who have experienced significant trauma and have disorders of attachment also show limited ToM. Several studies have shown that having brothers and sisters can improve children's ToM and researchers from the University of Queensland in Australia studied sixty children with autism to see if this was the case for them too. The researchers measured the children's ToM, executive functioning, verbal mental age and autism symptoms and compared this to the number of siblings the children had and where they fitted into the sequence. The researchers found that the children with older siblings actually had a weaker ToM, perhaps because their older brothers and sisters helped them to interpret other people's actions and stopped them from developing their own skills. Having younger siblings led to a weak improvement in ToM but this was not significant once mental age and autism symptoms were taken into account.

O'Brien, Karen, Slaughter, Virginia and Peterson, Candida C. - Sibling influences on theory of mind

development for children with ASD Journal of Child Psychology and Psychiatry
doi:10.1111/j.1469-7610.2011.02389.x

Caseworker Manual for Adoption Services

2011-03-26T09:46:00.002-04:00

The New York State Office for Families and Children has a good Adoption Services Manual for Caseworkers at
New York State Office for Children

Becoming a Certified DDP therapist

2011-03-20T15:48:00.002-04:00

The workshop covers all the "Required Core Training Content" necessary to enter the practicum to become a Certified Dyadic Developmental Psychotherapy therapist. The use of SKYPE will allow remote participants to fulfill the requirements to become Certified Dyadic Developmental Psychotherapy therapists. Participants may register for the full 56 hours or for Part A or Part B alone.

The workshop uses a combination of SKYPE workshop sessions, group discussion, independent study, and case presentations.
Dyadic Developmental Psychotherapy is an evidence-based, effective, and empirically validated treatment that is grounded in current thinking and research on the etiology and treatment of Complex Trauma or Developmental Trauma Disorder and disorders of attachment. Treatment is primarily experiential and there is an important teaching element as well. Teaching parents about attachment-facilitating parenting methods and the importance of attunement and responsive, sensitive parenting is essential. Direct work with the parents regarding their own family or origin issues is another component of treatment. Finally, intensive emotional work with the child in a manner consistent with sound treatment principles is vital.

The workshop is led by Dr. Arthur Becker-Weidman, who is a certified Dyadic Developmental Psychotherapist, Certified Consultant, and Certified Trainer by the Dyadic Developmental Psychotherapy Institute.

SCHEDULE
Starting dates and SKYPE sessions scheduled based on your availability and convenience. Assignments independent study occur at your pace.

A. 28 hour First half
* Patterns of attachment
* Engaging and working with parents
* Intersubjectivity & use of self in practice
* Experiential components of training
* Components of Practice
* Phases of Treatment
B. 28 hour Second half
* Differential use of components of
* Practice in different phases of
treatment
* Treatment with different populations and
circumstances
* Experiential components of training
* Consultation
Sections A & B cover all the required core training content for training to meet the DDPI requirements to apply for the Practicum to become a certified DDP therapist. Therapists may make application after completing section A.

Dyadic Developmental Psychotherapy is an evidence-based, effective, and empirically validated treatment. Two follow-up studies with control groups found clinically and statistically significant reductions in symptoms of attachment disorder, aggression, anti-social behavior, thought disorders, attention problems, mood, and social relationship dysfunction. Over 80% of the children treated had previously been in treatment on three or more occasions, without any noticeable improvement. Treatment averaged 23 sessions over approximately ten months. (Arthur Becker-Weidman, Ph.D., Child & Adolescent Social Work, vol. 23, pp.137-171, 2006)

SUGGESTED READING
You will find the following list of books helpful. It is strongly recommended that you read the first two books before the workshop begins. This will ensure that everyone has a solid foundation of common knowledge.

1. Dyadic Developmental Psychotherapy: Essential Methods & Practices, Arthur Becker-Weidman, Ph.D., Rowman, Lanham, MD, 2010.
2. The Dyadic Developmental Psychotherapy Casebook, Arthur Becker-Weidman, Rowman: Lanham, MD, 2011.
3. Creating Capacity for Attachment, Eds., Arthur Becker-Weidman, Ph.D., Deborah Shell, MA, LCMHC, Wood ‘N’ Barnes, 2005/2008.
4. Attachment Parenting, Ed., Arthur Becker-Weidman & Deborah Shell, Rowman: Lanham, MD, 2010.
5. Attachment-Focused Family Therapy. Daniel Hughes, Norton, 2007.
6. Attachment-Focused Family Therapy Workbook, Norton: NY, 2011.
7. Handbook of Attachment: Theory, Research, and Clinical Applications. Edited by Jude Cassidy and Phillip Shaver. The Guilford Press, 2008.
8. Building the Bonds of Attachment. 2nd. Ed. Daniel Hughes, Ph.D., 2006
9. Attachment Across the Life Cycle. Edited by Colin Murray Parkes, Joan Stevenson-Hinde, and Peter Marris. Routledge, 1991.
10. A Secure Base. John Bowlby, Basic Books, NY, 1988.
11. John Bowlby & Attachment Theory. Jeremy Holmes, Routledge, NY, 1993.

PURPOSE OF WORKSHOP
This workshop is for therapists who want to learn how to treat trauma-attachment disordered children. Participants will learn effective therapy principals for helping traumatized children. Participants will learn:
1. Initial work to determine parent readiness.
2. The components of Dyadic Developmental Psychotherapy and the phases of treatment.
3. The differential use of components in different phases of treatment.
4. Effective therapeutic techniques to use with traumatized and attachment disordered children and their families.
5. Effective parenting principals.
Participants will have the opportunity to view videotapes of actual therapy sessions with traumatized children that demonstrate therapeutic principals and present their own video tapes or cases.

REGISTRATION
NAME:
ADDRESS:

Degree:
DAY PHONE #: ( )
E-MAIL:
AGENCY NAME (if applicable):

A.: B.: BOTH:______
Fee is $500 (US$) for Sections A or B and $950 for both. A refund, minus a $95 administrative fee, will be given for cancellations. No refunds will be issued beginning course. A $150 deposit is required and full payment is due by the time you being.
$500 or $950 (U.S. $) fee enclosed.
OR
$150 deposit enclosed, balance due before starting.
Purchase Orders: include $25 fee. Payment in full must be received prior to starting training.

Registration fee includes workshop information packet, and Certificate of Attendance for 28 or 56 CEU’s.

To register send application form and check to:
CENTER FOR FAMILY DEVELOPMENT
5820 Main Street, Suite 406
Williamsville, NY, 14221
Website: www.Center4FamilyDevelop.com
E-mail: Aweidman@Concentric.net
Phone: 716-810-0790 Fax: 716-636-6243

Can Empathy be taught?

2011-01-09T14:50:00.002-05:00

Empathy is an essential ingredient for good parenting, good treatment, and good psychotherapy. Empathy allows one to see the world through the eyes of the other, walk in that person's shoes, share emotions, and build common experiences. Intersubjectivity, share emotions, share attention, and complimentary intentions form a core of empathy. It is these shared experiences (when concordant) that can help form the bedrock of stable, secure, safe, and positive relationships.

Many people are aware of "mirror neurons" as a neurological component of empathy. Mirror neurons are activated when one observes another's actions and the same motor neurons in the observers brain are activated as the ones in the "doers" brain that are necessary to carry out the action. Mirror neurons are activated in the emotional centers of the brain when we observe another and share affect.

While all this interesting and informative, it is not prescriptive. The question is, "is there some way to teach or enhance empathy?" Well, it turns out there are a number of ways. One of the easiest, simplest, and best ways is simply to listen and listen carefully. This is one way to get into another's head, so to speak.

Traditional views of the communication process held that speech and listening happened in two different parts of the brain: Broca's area and Wernicke's area. Yet studies show that communication partners unconsciously change their grammar structure, their speaking rate, and even their body postures to that of their partner. One could say that their communication changes show empathy for each other; some call this establishing a common ground. Studies by Dr. Hasson at Princeton University and graduate student Lauren Silbert demonstate this. The study involved having Ms. Silbert talk about emotionally meaningful events, tell stories from her life, while in a functional MRI. Then subjects were put into the f-MRI and listened to the recorded stories.

The most attentive listeners' key brain regions "lit up" in a f-MRI before her words came out. This suggests that the subjects anticipated what Ms. Silbert was going to say; empathy.

So helping parents, professionals, and therapists listen more carefully, more fully, and more deeply will increase their empathic capabilities. Listening is a skill that can be taught, improved on, and mastered.

For more information see:
Center For Family Development

Useful books & DVD's are:

Attachment Parenting

Principles of Attachment Parenting

Creating Capacity for Attachment

Dyadic Developmental Psychotherapy: Essential Practices & Methods

Introduction to Dyadic Developmental Psychotherapy

Facebook page

2011-01-03T10:00:00.001-05:00

The Center for Family Development now has a Facebook page.

Come and see it.

Child Abuse and Alcohol Abuse-a link

2010-12-09T21:31:00.003-05:00

Child abuse is a significant public-health problem with 794,000 confirmed cases in the U.S. in 2007. The Centers For Disease Control's Adverse Childhood Experiences studies have documented this link quite clearly. It is a risk factor for a number of different problems including alcohol abuse, but less is known about this link in boys than in girls.

Researchers from the University of Southern California, Los Angeles studied 3,527 men aged between 17 and 56. Approximately 9% of the participants reported childhood maltreatment - defined as serious neglect or physical or sexual abuse occurring before the age of 15. Those who had been abused were 74% more likely to develop an alcohol problem.

Young-Wolff, K.C. ... [et al] - Accounting for the association between childhood maltreatment and alcohol-use disorders in males: a twin study Psychological Medicine (2011), 41, 59–70

For more information go to The Center For Family Development

Effects of Institution care on adoptees

2010-12-06T19:57:00.003-05:00

What happens when children from severely-deprived institutional backgrounds are adopted into caring families?

Many children adopted internationally have spend months or years in institutional settings. Orphanage care can, at best, be described as neglectful. There is often multiple caregivers and little consistency in care. The opportunity for a caregiver to develop a sensitive, attuned, and responsive relationship with the infant/child is limited or non-existent.

We are finding some answers to these questions bit by bit, as the English and Romanian Adoptees (ERA) Study continues to follow a group of over 300 children adopted from Romanian orphanages in the early 1990s. The ERA researchers are in the process of comparing the Romanian adoptees to non-adopted children as well as to adopted children who never had institutional care. This work is enormously time-consuming and complex, and involves repeated measurements and interviews at different ages, plus delays associated with analyzing, writing, and publishing the results of each phase of the investigation.

A recent presentation of the children’s characteristics up to age fifteen has been published by Michael Rutter and co-authors as "Deprivation-specific psycholcogical patterns: Effects of institutional deprivation" (Monographs of the Society for Research in Child Development, Serial No. 295, Vol.75, No. 1, 2010). The 252 pages of this monograph are absolutely packed with information.

An aspect of the monograph that will be of interest to many is the question raised in the title: whether there are psychological patterns that follow severe social and other deprivation in early life. The ERA investigated a group of characteristics that seemed more likely to occur in post-institutional children than in other adoptees. The following items were included:

1. Quasi-autism: A behavior pattern not identical with autism, but including rocking, self-injurious behavior like hair-pulling, unusual and exaggerated sensory responses, and tantrums in response to changes in routine, as reported in parent interviews (Gindis, B. [2008]. Institutional autism in children adopted internationally: Myth or reality? International Journal of Special Education, 23, 118-123).

2. Disinhibited attachment, as shown in unusual friendliness toward strangers and failure to show strong preferences for familiar people in threatening circumstance. The monograph describes disinhibited attachment as including “inappropriate approach to unfamiliar adults, a failure to check back with a caregiver in unfamiliar settings, and willingness to accompany a stranger and wander away from a familiar caregiver. It is often associated with a lack of appropriate physical boundaries, so that children may interact with strangers intrusively and even seek out physical contact… there is sometimes inappropriate affectionate behavior with strangers and undue physical closeness” ( Monograph, p. 58) .

3. Cognitive impairment, including problems with “mentalization” or the ability to understand what other people might believe or feel about a situation.

4. Inattention and overactivity similar to attention-hyperactivity disorders.

While by no means all children who had come from institutions displayed these problems, even those who had spent more than 6 months in a Romanian orphanage, the ERA group reported that over 90% of those who still showed the behaviors at age 15 had spent more than 6 months in severe deprivation. Those who persisted to age 15 with these problems had often improved (for example, become more likely to be helpful or comforting to others), but odd behaviors still occurred. Some children “annoyed other people but did not know why, and difficulties making or keeping friends were common… In a few cases, … inappropriate remarks included excessively outspoken sexualized use of language” ( Monograph, p. 86). Some children were reported as fascinated with collections, including those of “useless rubbish” like chocolate wrappers.

Child Abuse and Drug Addiction: an important link

2010-11-27T09:01:00.003-05:00

Child abuse is known to be a risk factor for a number of different mental-health problems and antisocial behaviour. For example, the Center's for Disease Control's famous Adverse Childhood Experiences research found a strong link between various adverse experiences in childhood and later physical, social, and mental health problems.

Researchers from the Albert Einstein College of Medicine in New York studied 143 people in an attempt to find out more about the link between child abuse and drug addiction. 48 of them were child molesters, 25 were recovering opiate addicts and the rest formed a healthy control group. The participants were asked whether they had suffered adult sexual advances while they were children or if they had had sexual intercourse with someone at least five years older before they were 13. The participants who were child molesters or recovering opium addicts had lost their virginity at a younger age than the healthy controls. However, while the child molesters were more likely to have been abused themselves the recovering addicts were no more likely to have suffered child abuse than the control group. But, this was a relatively small study and a number of other researchers have found a link between child abuse and drug addiction.

Cohen, Lisa J. ... [et al] - Comparison of Childhood Sexual Histories in Subjects with Pedophilia or Opiate Addiction and Healthy Controls: Is Childhood Sexual Abuse a Risk Factor for Addictions? Journal of Psychiatric Practice 16(6):394-404, November 2010

Center for Family Development

Childhood trauma memories: New Research

2010-11-17T13:52:00.000-05:00

Psychologists have researched how people's memories of a traumatic event can effect how likely they are to develop post-traumatic stress disorder (PTSD) as a result of it. They've found that among adults with PTSD and acute stress disorder (ASD) trauma memories are fragmented and disorganised; are expressed more through the senses than words, and show increased emotional content. However, there has been much less research into how this process works in children. Researchers from the Institute of Psychiatry, King's College London studied 50 children being treated in hospital after an assault or a road-traffic accident. Some of the children developed ASD while others didn't and the children were asked to write the story (or narrative), both of the traumatic event itself and of another event which was unpleasant, but not traumatic. The children with ASD had significantly higher levels of disorganization in their trauma narrative compared to children without ASD and with their own non-trauma narrative. For all the children trauma narratives had significantly higher sensory content and lower positive emotion content than the comparison story. The severity of the children's ASD symptoms was significantly predicted by the level of disorganisation in the trauma narrative and the child's negative appraisals (e.g. 'this event has ruined my life,' 'I'm going mad to feel like this.') of the event.

Salmond, C. H. ... [et al] - The nature of trauma memories in acute stress disorder in children and adolescents Journal of Child Psychology and Psychiatry doi: 10.1111/j.1469-7610.2010.02340.x

Instutional life has negative effects on Executive Function

2010-11-12T09:11:00.003-05:00

Previous research has shown that children who have spent at least some part of their life in an institution tend to have problems with executive functions. Executive functions are higher brain functions such as working memory, the ability to inhibit one's behavior, forward planning, the ability to move from one task to another, impulse control, the ability to start or initiate, and attention. Instruments such a the Behavior Rating Inventory of Executive Function can be used to measure executive functions.

Past research has concentrated on children aged between six and eleven so researchers at the University of Pittsburgh studied 418 children who had been adopted from institutions in Russia where they had been psychologically, but not physically, deprived. 130 of the children were pre-school age while the rest were older. The study found that the older the age the children had been adopted at the worse their executive function was and that those who were adopted after they were 18 months old had worse executive function than those who had been adopted when they were younger. The onset of adolescence was associated with a greater increase in executive function deficits for children adopted after 18 months than for those adopted when they were younger.

Merz, E. C. and McCall, R. B. Parent ratings of executive functioning in children adopted from psychosocially depriving institutions Journal of Child Psychology and Psychiatry doi: 10.1111/j.1469-7610.2010.02335.x

A study using the Vineland Adaptive Behavior Scales found similar delays, lags, and problems among a group of adopted children.
Becker-Weidman, A., (2009) “Effects of Early Maltreatment on Development: A Descriptive study using the Vineland,” Child Welfare, 88 (2)137-161.
Also see The Center For Family Development for very useful information.

Child Abuse & Psychosis: a link?

2010-11-10T09:49:00.002-05:00

There is a growing recognition that having a difficult or traumatic childhood can increase the likelihood of people developing psychosis later in life but it is difficult to untangle what types of trauma or abuse are linked to an increased risk. A team of researchers from the Institute of Psychiatry, King's College London, UK, looked into this in a study of 428 people, 182 of whom had psychosis. The researchers asked people about difficulties and problems in their childhood and found that people with psychosis were three times more likely to report severe physical abuse by their mother before they were 12. There was also some - although not statistically significant - evidence that 'severe maternal antipathy' was linked to an increased risk of psychosis. However, paternal maltreatment and other forms of adversity were not linked to an increased risk of psychosis.

This is another important study the implications of which are that child abuse is a major public health issue with significant implications for later functioning. The Adverse Child Experiences research by the US Centers for Disease Control also point in the same direction. The ACE's studies clearly demonstrate that adverse childhood experiences result in later significant health difficulties, among other problems.

Fisher, H.L. ... [et al] - The varying impact of type, timing and frequency of exposure to childhood adversity on its association with adult psychotic disorder Psychological Medicine (2010), 40, 1967–1978

Cognitive Processing

2010-10-16T08:29:00.004-04:00

Many children with histories of chronic early maltreatment within a care-giving relationship have been prenatally exposed to alcohol and/or drugs. The timing of the exposure and the intensity of prenatal exposure can have differing effects on the developing fetus, psychological functioning, and cognitive functions. These effects can sometimes be very subtle and not noticed or misinterpreted.

For example, some children are described as oppositional and defiant when what we may be observing is a cognitive processing and developmental deficit. As an example of this, the child may be perfectly capable of making a peanut butter and jelly sandwich. However, if you put a jar of peanut butter, a jar of jelly, a plate, knife, and bag of bread on the table and ask the child to tell you how to do this, you may find that the child had great difficulty doing so. This is a not uncommon experience with children prenatally exposed to chemicals. Understanding this cognitive processing deficit can be helpful for teachers and parents and ensure that the child's behavior is not misinterpreted.

Reference:
Becker-Weidman, A., & Shell, D., (Eds), Attachment Parenting, Jason Aronson, Lanham, MD, 2010.

NEW BOOK

2010-09-18T15:31:00.003-04:00

I have written a new book,
Dyadic Developmental Psychotherapy: Essential Practices & Methods
which is due out later this year. It is as close to a treatment manual as one can get with an experimentally based approach for this evidence-based, effective, and empirically validated treatment.

The book describes the theory base of Dyadic Developmental Psychotherapy and the evidence base of the approach. Another chapter describes fourteen components of Dyadic Developmental Psychotherapy. A major chapter in the book describes the phases of treatment:
Developing the Alliance
Maintaining the Alliance
Exploration
Integration
Healing
and the differential uses of the components of Dyadic Developmental Psychotherapy in these phases.
There are chapters about working with care-givers and the importance of caregivers as the key-stone for successful treatment

The book has extensive transcripts and excerpts from actual treatment sessions to illustrate the components and phases and principles being described.

Therapists, parents, psychologists, researchers, professors, social workers, residential treatment staff, and child welfare staff will all find this book a valuable resource.

Dyadic Developmental Psychotherapy WIKI

2010-09-04T06:39:00.004-04:00

There is a new Wiki devoted to Dyadic Developmental Psychotherapy that readers may want to view.
Click on this link to get there.

The url is: http://dyadicdevelopmentalpsychotherapy.wikia.com/wiki/Dyadic_Developmental_Psychotherapy_Wiki

The Wiki has just started, but already has many articles about Dyadic Developmental Psychotherapy and related topics that readers will find quite useful and interesting.

Fathers matter!

2010-08-15T17:22:00.000-04:00

Most psychological research into parenting concentrates on the role of mothers but having a good relationship with one's father can also help people to cope better in later life. Researchers from California State University, Fullerton studied 912 people between the ages of 25 and 74. Over eight days they interviewed the participants about that day's experiences asking them about their mental state and any stressful events. The participants were also asked about the quality of their childhood relationships with their parents. The study found that more people were likely to say their childhood relationship was better with their mother than with their father; a difference that was more pronounced among men. People who had had a good relationship with their mother reported 3% less psychological distress compared to those who reported a poor relationship. Men who had had a good relationship with their father also reported less psychological distress but this effect was not as strong among women.

Researchers spoke to more than 900 men and women aged from 25 to 74 before reaching their conclusion.

Psychology Professor Melanie Mallers, of California State University-Fullerton, who led the research team, said: "Most studies on parenting focus on the relationship with the mother.
"But, as our study shows, fathers do play a unique and important role in the mental health of their children much later in life."

As part of the study, 912 adult men and women completed short daily telephone interviews about that day's experiences over an eight-day period.

The interviews focused on the participants' psychological and emotional distress - such as whether they were depressed, nervous, or sad - and if they had experienced any stressful events that day. These events were described as arguments, disagreements, work-related and family-related tensions and discrimination.

The participants also reported on the quality of their childhood relationships with their mother and father. For example, they answered questions such as: "How would you rate your relationship with your mother during the years when you were growing up?" and "How much time and attention did your mother give you when you needed it?"

The same questions were asked about fathers. The research took into account age, childhood and current family income, neuroticism and whether or not their parents were still alive.

Prof Mallers and her team found participants were more likely to say their childhood relationship with their mother was better than with their father, with more men reporting a better mother-child relationship than women.

People who reported they had a good mother-child relationship reported three per cent less psychological distress compared to those who reported a poor relationship.

Prof Mallers said: "I don't think these results are surprising, given that past research has shown mothers are often the primary care-giver and often the primary source of comfort.

"It got interesting when we examined the participants' relationship with their fathers and their daily emotional reaction to stress."

They also found that men who reported having a good relationship with their father during childhood were more likely to be less emotional when reacting to stressful events in their current daily lives than those who had a poor relationship. This was not found to be as common for the women in the study.

And Prof Mallers said the quality of mother and father relationships was significantly associated with how many stressful events the participants confronted on a daily basis. In other words, if they had a poor childhood relationship with both parents, they reported more stressful incidents over the eight-day study when compared to those who had a good relationship with their parents.

Prof Mallers said: "Perhaps having attentive and caring parents equips children with the experiences and skills necessary to more successfully navigate their relationships with other people throughout childhood and into adulthood."

She said it was difficult to come up with a concrete theory as to why men's relationship with their father had such an influence on their emotional reaction to stress, especially since this study included adults of all ages who were raised during very different eras in the United States.

Prof Mallers added: "The role of fathers has changed dramatically from the time the oldest participants were children.

"We do know that fathers have a unique style of interacting with their children, especially their sons.

"We need more research to help us uncover further influences of both mothers and fathers on the enduring emotional experiences of their children."

Prof Mallers presented the findings at the 118th Annual Convention of the American Psychological Association in San Diego.

Update on Artym

2010-07-05T21:36:00.000-04:00

(July 2) -- Torry-Ann Hansen, the Tennessee nurse who adopted 7-year-old Artyom Savelyev and then returned him because she said he wanted to kill her, apparently never bonded with the Russian boy. But she did give him a new name (Justin), a new language (English) and comfort food (burgers and fries, with ketchup).

For now, Artyom, once again under the care of the Russian state, is not being fed hamburgers, said Pavel Astakhov, the point man on all things Artyom -- though there is talk of ordering out for the boy's second-favorite dish, pizza. The Russians have also junked the American name ("He's Artyom in Russian Federation," one official said), but they're making sure he doesn't lose his English. "It's very important for his future," Astakhov explained.
In an image taken from Rossia 1 television channel, 7-year-old adopted Russian boy Artyom Savelyev gets into a minivan outside a police department office in Moscow, April 8.
Rossia 1 Television Channel / AP
In an image taken from Russian television, 7-year-old Artyom Savelyev gets into a minivan outside a police department in Moscow on April 8. Torry-Ann Hansen, the Tennessee woman who adopted Artyom, created a firestorm when she sent him back to his home country of Russia.

It is not exactly true that Artyom Savelyev has been transformed into the Russian Elian Gonzalez. While many Russians pity Artyom, no one is throwing any parades for him. Still, the analogy is not totally off base.

Less than a year ago, Artyom was living in an orphanage in the town of Partizansk, nine time zones east of Moscow and a few stops from the end of the Trans-Siberian Railway. He had been consigned to a remote corner of a vast country that doesn't think much of orphans -- had he never left the Russian Far East, odds are that Artyom would have faced prison, homelessness, venereal disease and/or premature death. And then, he was magically airlifted to America.

But for Hansen, it turned out that parenting a boy who may have been a victim of fetal alcohol syndrome and definitely had been subjected to violence and hunger was, well, trying. So on April 7, seven months after he arrived in his new hometown of Shelbyville, Tenn., Artyom's new grandmother took him to Dulles International Airport outside Washington. There, Nancy Hansen turned him over to the custody of United Airlines, and he was put on Flight 964 to Moscow's Domodedovo Airport. The flight would be just shy of 10 hours.

Landing in Moscow, he was met by Artur Lukyanov, who had been paid $200 by Nancy Hansen to take him to the Ministry of Education and Science, which has jurisdiction over adoptions. At the ministry, in Moscow's center, Lukyanov gave officials a letter from Torry-Ann Hansen claiming that Artyom had "severe psychopathic issues" and wanted to burn her house down.

Artyom's story soon became a Russian story -- about suffering, fortitude and a child's innocence. Because Artyom was no longer just Artyom but a metaphor for something much bigger, his story had to end triumphantly. America, in the guise of Torry-Ann Hansen, had rejected Russia, and then Russia, in the guise of Artyom, was saved by the Russian state.

And so it was that on April 8, when the twice-abandoned Elian Gonzalez of Siberia -- having zigzagged from post-Soviet backwater to Dixieland nightmare to the loving embrace of the Kremlin -- stepped off an airplane outside Moscow, his journey, Russia's journey, finally began to look up. That was the day everything turned around.

Into the Arms of the State

Artyom's story, naturally, requires an expert storyteller. That Pavel Astakhov has been assigned to that role suggests the Kremlin knows as much.

Astakhov, the 43-year-old, permanently tanned, coiffed and manicured superlawyer whom President Dmitry Medvedev late last year named children's rights commissioner, is the Judge Judy of Russia. Besides running a bustling practice -- according to his website, former clients include Moscow Mayor Yury Luzhkov and accused American spy Edmond Pope -- Astakhov hosts the television program "Chas Suda," or "Hour of the Court."
Russian Presidential Commissioner for Children's Rights, Pavel Astakhov, shows a copy of Artyom Savelyev's US passport to journalists near a children's hospital in Moscow on April 16.
EPA / ZUMA Press
Pavel Astakhov, the Russian presidential commissioner for children's rights, shows a copy of Artyom Savelyev's U.S. passport to journalists near a children's hospital in Moscow on April 16.

The program, which airs daily on state-run Ren TV, amounts to a propaganda organ meant to convince Russians that the Russian Federation is ruled by laws, not men (which is not true). In Judge Astakhov's courtroom, justice is all that counts, not bribes or boyars or even Vladimir Putin. As Astakhov's site notes, "Chas Suda" "creates respect for the law" and "contributes to a positive image of the court in the minds of the people."

Like celebrities everywhere, but especially in Russia, it is important to Astakhov that other people know he is always busy. The first time I called him, on his cell, he didn't answer; nor did he pick up the second, third or fourth time. Eventually, I sent him a text message, and a minute later Astakhov wrote back, saying I should call his assistant. After several scheduled phone interviews that never materialized, I caught the judge in his car going somewhere that, he said, was very important.

On the phone, he was guarded -- not the way lawyers can be guarded, choosing their words carefully to avoid being accused of something they didn't mean; rather, the way celebrities are guarded, shielding from public view the gilded utopia they inhabit.

Artyom, Astakhov said, had been removed to an "undisclosed location" -- an orphanage -- in central Moscow. "It's a special house for orphans," he said. "There are many specialists around him -- pedagogues, psychologists, teachers -- and only five children in this house right now. He is living in one room with a boy of his age." He said Artyom had been put on a special diet for children in his age group (he wouldn't specify what this consisted of) and that doctors had run a battery of tests on him.

Implying not so subtly that Torry-Ann Hansen must be crazy or blind, he added, "He is absolutely normal. I spoke with Artyom many, many times. I saw all the medical exams about his conditions, I mean, mentally and physically, and Artyom is very well."

Lukyanov, the driver, agreed with Astakhov. He said Artyom seemed like a regular little boy when he stepped off the plane. He was wearing a yellow jacket and had a Spider-Man backpack with a Spider-Man doll, a miniature car and pencils inside. But he was confused about where -- and who -- he was. While they were in Lukyanov's Ford heading into Moscow, Artyom began to cry and ask for his "Grandma Nancy." "The boy could not calm down for a few minutes," Lukyanov wrote on his website.

(Lukyanov posted a lengthy dispatch on the site after being accused, in Russia, of abandoning Artyom at the ministry. He insists he stayed with Artyom all day, until he deposited him at Hospital 21, a state children's hospital on the northeastern fringe of the city.)

"When I met him, I didn't know that he is Russian," Lukyanov told me. "After, in the office of the ministry, we recognized that within six months [in the United States] he had forgot his native language ... or pretended that he forgot. At the end of the day, he remembered Russian words and began to understand us better and better."

Astakhov said Artyom was not ready to meet journalists. Nor would he reveal any details about the orphanage where he's staying except to say it has had remarkable success placing orphans with foster and adoptive families. (In the past year, Astakhov said, the orphanage has placed 150 children. He did not say if these children had been placed with foreigners or Russians, who are generally resistant to taking in parentless children.)

That said, photographs of a smiling Artyom at the orphanage have popped up on the website of the state news agency RIA Novosti. In one picture, Artyom, in a short-sleeve, blue-and-white striped shirt, plays with the iconic wooden toy known as a matryoshka doll. Behind the little boy, with his tousled blond hair and toothy grin, is a bright orange stuffed bear and a freshly made twin-sized bed.

"The most traumatic months were in Torry's family, when she pulled his hair and she punished him for everything," Astakhov said. " 'Don't cry, don't yell, don't play, don't go out from this house.' Everything was prohibited for Artyom. I think it's over, and now we are doing all the best for Artyom's future, for Artyom's present."

America and the Scandale d'Artyom

One reason English could be important for Artyom's future is that he may opt to go back to America. That would be easy enough since he is now a dual citizen of Russia and the United States, which granted him citizenship when Hansen adopted him. As one former diplomat put it, "Your mother may give you back, but your motherland never will."

Astakhov said Julie Stufft, a U.S. Embassy official, had visited with Artyom at the orphanage. Stufft referred questions about the boy to embassy spokesman Kevin Kabumoto, who refused to discuss the case, citing the Privacy Act. Tom Armbruster, the U.S. consul general in Vladivostok, cited a May 13 statement issued by the State Department on U.S.-Russian talks on adoption and, presumably, how to make sure that people like Torry-Ann Hansen (or, worse yet, Peggy Sue Hilt, who in 2006 pleaded guilty to killing the Russian girl she'd adopted) don't wind up with future Artyoms.
Artyom Savelyev plays in a children's hospital in Moscow, Russia on April 9.
EPA / ZUMA Press
Artyom Savelyev is all smiles as he plays in a children's hospital in Moscow on April 9.

"Both teams are committed to reach an agreement to increase safeguards for intercountry adoption," Mary Ellen Hickey, head of the U.S. delegation, said in the statement. Furthermore, whatever agreements are hammered out will be "legally binding" and "each country will define its competent bodies responsible for coordinating bilateral cooperation in adoption."

That is exactly what the United States has resisted and Russia has sought for years. What brought an end to the impasse was the scandale d'Artyom. The Americans were embarrassed. The Russians were livid. Finally, the political alignment had shifted, and the Americans -- who have sought to make nice with the Russians ever since Barack Obama reset relations with the Kremlin -- signed off on a slew of new regulations and identity checks.

The final agreement, details of which have yet to be made public, is expected to be signed in a few months. This makes Russia happy (victory over America!) and comes at a low cost to the Obama administration: Many, if not most, of the people who adopt Russian children are churchgoing -- many got the idea to adopt a Russian child while doing missionary work in the former Soviet Union -- and white. (Adoption officials say Russia is a popular destination for adoptive U.S. parents because it has a huge cache of parentless kids with the "correct" skin color, unlike, say, China.) This is a constituency that did not vote for Obama in 2008 and is unlikely to do so in 2012.

Too Many Children, Not Enough Homes

Since the 1991 Soviet collapse, American families have adopted more than 50,000 Russian children. The pace of adoptions held steady in the 1990s but began to drop in 2003. Although no one at the Kremlin ever articulated a change in policy -- the Kremlin rarely, if ever, articulates changes in policy -- that decline parallels a shift in attitudes at the very top toward foreigners and especially Americans.

Now, a mere 1,700 to 1,800 Russian children are adopted by Americans yearly, despite ongoing demand. "It's all about saving the children," said Michelle Helton Jayroe, who traveled in December 2008 from her Alabama home to Samara, about 550 miles southeast of Moscow, with a friend who was adopting a little boy. "She would adopt 25 if her husband would allow. ... She's hoping for two more, at least."

That is likely to get tougher. Russia has permitted foreigners to adopt its children because there are not enough Russians to take them in. That's because most Russians are poor: In 2008, Russia ranked No. 75 in per capita income, with the average Russian grossing the equivalent of $9,660, between No. 74 Mexico and No. 76 Chile, according to a World Bank report this year.

And it's because, since Soviet times, there has been a stigma attached to orphans. "For many years, if a Russian family decided to adopt a child, they would fake a pregnancy," said Ekaterina Bridge, head of the Russian branch of the World Association for Children and Parents, the Renton, Wash., agency that facilitated Artyom's adoption. "They didn't want that someone would later tell their child. They'd prefer not to tell the child that he had been adopted."

Moscow has never been happy about the need for foreigners to pick up the slack. Like capitalism and world peace, the Russian leadership tends to view adoption as an instrument that may or may not serve its interests; the fact that these interests often diverge from those of Russia's roughly 700,000 orphans, most of whom remain in orphanages, is irrelevant.

This is especially troubling to parentless teenagers on the verge of "graduation." Every year about 20,000 kids, having recently turned 17, leave Russian orphanages, according to Anna Sergeeva, director of the New York office of the Russian Children's Welfare Society. "A majority of them fall into a high-risk category (crime, homelessness, prostitution)," she wrote in an e-mail. "Ten percent commit suicide, and only 4 percent are admitted to colleges or universities."

These figures would seem to suggest that Russia should push for more, not fewer, adoptions. Not so: Sergeeva predicted the number of adoptions would drop again this year.

A Country's Outrage -- and Ambivalence

Artyom's story, like that of the Iraq War and the Bush administration's handling of Hurricane Katrina, has provided the Russian state with a prophylactic that safeguards it against external criticism -- We're all rotten, aren't we? But more important, it reaffirms Russia's idea of Russia, that of a battered and impoverished people that fights and perseveres and defies the many forces arrayed against it: fascists, imperialists, CIA agents and, of course, soulless would-be mothers from Tennessee.

Alexandra Ochirova, an adoption specialist who sits on the 126-member Public Chamber, a government panel that is meant to serve as the nation's public conscience, was reflecting on the nature of motherhood. We were at the Winter Garden Cafe, at the National Hotel, across the street from Red Square, and Ochirova was sipping an espresso. She said she was deeply troubled -- pained -- by the case of Artyom Savelyev. "The only motivation to adopt a child is love," Ochirova declared. "This is all that must be there."

(Pavel Astakhov agreed when we spoke. "You really need only love and attention and, of course, patience. For example, Torry Hansen didn't have patience, love or attention.")

What about medical records? I asked Ochirova. Hansen had claimed that orphanage officials in Partizansk withheld information about Artyom that would have alerted her to his behavioral problems. "What information?" Ochirova said. "Was he a terrorist? A killer? Perhaps she was unaware that he didn't enjoy a king's upbringing."

When she was at Moscow State University, Ochirova studied philosophy (Immanuel Kant, Georg Hegel and, of course, Karl Marx) and the greatest of all Russian prophets, Fyodor Dostoevsky. The world would be a better place, she said, if its leaders, beginning with Barack Obama, read more Russian literature and especially more Dostoevsky, whose most famous novel, "The Brothers Karamazov," ends with a little boy's funeral.

She asked if Obama had been following the story of Artyom. I said that I had no idea but that he probably had other things to worry about: the oil spill, the economy, the war in Afghanistan. Ochirova became livid. "What can possibly be more serious than this problem? This is the first problem. What we really need is a new moral order."

No doubt. There's something strange about a country that is teeming with unwanted children and has no one to take them in and can't decide if it should let other people, in other countries, fill that niche. That ambivalence inhibits action, which spawns backlog and, ultimately, a permanent subset of parentless children.

Exhibit A: Artyom Savelyev, Russia's most famous parentless child. Adoption officials, Astakhov said, are reviewing the applications of three families hoping to adopt Artyom. Astakhov stressed that all of the families are Russian, but then he said that that is not important. "A little boy, a little girl, are very flexible. It does not matter to them."

In two to three months, Artyom will be placed in a new home, and then his life will begin. Astakhov wouldn't say much about the candidate families -- for instance, where they were before Torry-Ann Hansen showed up -- except that they live in Moscow and that they are all "promising."

"One of these families," Astakhov said, "is the family of former diplomats who have good experience with adopted children because they raised a boy who was adopted many years before. This family will be the best family for Artyom. Both mother and father speak English very well."

Peter Savodnik is a writer based in New York. His book about Lee Harvey Oswald's time in the Soviet Union, provisionally titled "The Interloper," will be published by Basic Books next year.

Suicide and Child Abuse: a link

2010-07-05T19:06:00.000-04:00

Suicide is one of the leading causes of death worldwide but what causes it is still not well understood. Mental-health problems are an important risk factor but most people with a mental-health problem do not think about killing themselves. There is strong evidence that people's experiences contribute more towards their mental-health problems than their genes and that bad experiences in people's childhood are linked to more thoughts about, or attempts at, killing oneself in later life. However, there has been less research into this than into genetic factors or mental-health problems. A team of researchers led by Ronny Bruffaerts from Gasthuisberg University Hospital in Belgium studied an international sample of 55,299 people asking them about their experiences in childhood and whether they had thought about, or tried to kill themselves. They found that bad experiences in childhood were associated with an increased risk of suicide attempts and thoughts of suicide. Sexual and physical abuse, especially during adolescence, were consistently the strongest risk factors.

Reference:
Bruffaerts, Ronny ... [et al] - Childhood adversities as risk factors for onset and persistence of suicidal behaviour. British Journal of Psychiatry, July 2010, 197(1), 20-27

Seel

Adoption: What disclosures are requuired?

2010-05-02T16:09:00.000-04:00

The lawsuit described in a recent New York Times article by Pam Belluck raised important questions regarding the disclosures that should be made by adoption agencies to their adoptive families.

At the Center for Family Development we frequently find that families have not been fully or adequately informed regarding the mental health, health, and psychological status of the child they are wanting to adopt. In many instances the agency has not informed the family of the potential risks and issues that may be presented. We find that this lack is more common in international adoptions, and particularly in those programs that bring a child to the US for a few weeks for "camp," with a family, and more often with adoptions from Russian and Eastern Europe. We do find that agencies doing domestic adoptions of children in the child welfare system seem to do a more comprehensive job of fully informing parents of actual and potential issues.

By Pam Belluck
New York Times
Apr 28, 2010

Scores of complaints have been made in recent years against adoption agencies by people claiming they were inadequately informed or ill-prepared for problems their children turned out to have.

Many state laws and the Hague Convention now require agencies to disclose “reasonably available” records. But it can be unclear, especially in international cases, how assertive they are expected to be in getting such information.

The case of Chip and Julie Harshaw of Virginia Beach is, in some ways, the reverse of the now-familiar story of a Tennessee mother who put her Russian-born child on a plane home: The Harshaws are committed to raising their Russian son, even though they say they would not have adopted him had they known how severely impaired he was. But when they decided to adopt, the Harshaws told their agency they could care only for a child with minimal health problems and “a good prognosis for normal development,” according to notes in the adoption agency’s paperwork.

They rejected one child because he had abuse-inflicted burns. But when a toddler in a Siberian orphanage appeared to fit their criteria, they brought the boy, Roman, home. ” ‘A beautiful, healthy, on-target, blond-haired boy’ was what they had quoted to us,” Julie Harshaw said.

After the adoption in 2004, Roman began showing “uncontrollable hyperactivity” and aggression, Julie Harshaw said. He has threatened their 5-year-old biological daughter with a steak knife and a two-by-four, and held her underwater in a pool. Their 13-year-old biological son has felt so much stress that he has required therapy.

Therapeutic programs have ejected Roman for kicking, biting, hitting and, most recently, on his 8th birthday, pulling out three of his teeth using a pen cap, fork or spoon.

Doctors finally diagnosed fetal alcohol spectrum disorder, brain damage and neuropsychiatric problems in Roman, whose IQ is 53. He was recently placed in an institution and is not expected to ever live independently, one of his doctors said.

The Harshaws are suing the agency, Bethany Christian Services, seeking compensation for the care Roman will need.

After Roman’s problems were diagnosed, the agency offered to end the adoption, to try placing Roman with another family. The Harshaws refused. “He’s not a dog; you don’t take him to a pound,” Julie Harshaw said.

The family claims that Bethany indicated, inaccurately, that a Russian doctor working for the agency had examined Roman, and that Bethany gave them incomplete medical information when more detailed records were available. (Such records were produced by Bethany more than two years later.)

Bethany, which calls itself “the nation’s largest adoption agency,” disputes most of the claims.

“Bethany is a highly respected adoption agency that provided all the appropriate information for consideration by the Harshaws,” said Mark Zausmer, a lawyer for Bethany, based in Michigan. “Bethany provided this family counseling, extensive documentation, opportunities to consult with physicians, medical records and other materials from which they could fully evaluate how to proceed.”

No organization tracks the number of cases against adoption agencies, and academics and industry officials say many are settled out of court and sealed, so the outcomes are unknown.

But these days, “a far greater percentage of these wrongful adoption suits relate to international adoptions,” said Marianne Blair, a University of Tulsa law professor.

Chuck Johnson, acting chief executive of the National Council for Adoption, an advocacy group, said, “There have been a growing number of families that have sued when they adopted a child from another country.”

Some lawsuits, Johnson said, come from families “expecting you to do the impossible when you did all you could,” but he said there had also been “agencies that have purposely concealed information.”

Issues of disclosure have drawn increasing attention in recent years. Lawsuits erupted in the 1980s over domestic adoptions in which histories of abuse and other problems were kept from adoptive parents.

“The philosophy was the blank slate, that adoption is a new start,” Blair said. Now, she said, experts believe that “disclosure of health information is vital.”

As a result, many states enacted disclosure laws, followed by similar requirements in the Hague Convention, which apply to countries that ratify the treaty, as the United States did in 2008. Russia has signed the agreement but has not yet ratified it.

Those regulations were developing as the Harshaws’ adoption was proceeding, and at most agencies, “the atmosphere was definitely an emphasis in getting what could be obtained and making sure that they disclose that,” said Joan H. Hollinger, a law professor at the University of California, Berkeley, who is serving as an expert witness for the Harshaws. Agencies were also focused on “preparation of adoptive families for what they might encounter,” Hollinger said.

Bethany says it clearly advised the family that children from Russia could have problems, including serious ones, and that records might be inaccurate.

While the Harshaws’ pediatrician raised overall risks after reviewing a video of Roman and a two-page medical summary, observing that some of the notations could indicate learning disabilities, she saw no specific indications of severe problems on the pre-adoption records provided. She noted a lack of detailed, up-to-date information and said she could not see Roman’s face clearly. (Facial characteristics may provide clues to health deficiencies.)

“They were warned about generalities,” said their lawyer, Samuel C. Totaro Jr., but the agency caseworker told them a Russian-trained doctor based in New York had “gone over there and seen him, and you have a healthy, on-target child, and the family took great reassurance from that.”

In a deposition, the caseworker acknowledged she had said that the doctor, Michael Dubrovsky, visited the orphanages to “see the children” and review pictures, videos and medical information. The agency says the Harshaws misinterpreted that to mean Dubrovsky had examined Roman.

In a deposition, Dubrovsky said he had never seen Roman, had not practiced medicine for years and was a facilitator for Bethany, not a medical screener.

The agency also suggests that the fetal alcohol syndrome was unlikely to have been detected before the adoption, noting that the Harshaws did not receive that diagnosis until two years later.

Zausmer said the agency did not conceal information and provided a translated synopsis of the Russian medical records that was standard at the time.

“We don’t believe that there was anything in the Russian records that would have materially affected any adoption decision,” Zausmer said.

But Dr. Ronald S. Federici, a neuropsychologist who diagnosed Roman’s illness, said the full 10-page medical record the agency produced after the adoption, at the parents’ urging, would have shown that “the boy had fetal alcohol syndrome.”

The Harshaws hope the institution can stabilize Roman enough to send him home; either way, he will need extensive lifetime care.

“What we’ve been through and what we’ve lost,” Chip Harshaw said. “Every day is ‘Groundhog Day,’ a repeat of the stress and anger and frustration.”

Bipolar Disorder in Children: Is it being Over-diagnosed?

2010-04-28T14:10:00.000-04:00

Is Bipolar Disorder being over-diagnosed in children?

Many people erroneously argue that it is, so let's take a look at the evidence. First, I am talking about children aged five years into adolescence who actually meet the full DSM-IV criteria for Bipolar Disorder. I am not discussing children who only have irritability or aggression without any other manic criteria.

FACTS:
In 1994/1995 the frequency of the Bipolar Diagnosis was 25 cases per 100,000. In 2002/03 the frequecny increaed over forty-fold to 1003 cases per 100,000. (See: National Trends in the Outpatient Diagnosis and Treatment of Bipolar Disorder in Youth, Carmen Moreno, MD; Gonzalo Laje, MD; Carlos Blanco, MD, PhD; Huiping Jiang, PhD; Andrew B. Schmidt, CSW; Mark Olfson, MD, MPH, Arch Gen Psychiatry. 2007;64(9):1032-1039.)

Put another way, the diagnosis of Bipolar Disorder rose from 0.01% in 1994 to 0.44% in 2002. That is certainly a 40X increase, but is it really over-diagnosis?

The standard method to estimate the actual prevalence of psychiatric conditions is to conduct an epidemiological study, where trained researchers study large representative samples of the general population (not preselected clinical samples) with standardized, validated instruments (like the SCID or MINI or CIDI) to assess and diagnose the general population using DSM-IV criteria (not just irritability or aggression in children as bipolar disorder, for instance). Using those methods in over 5000 persons, the most recent analysis (see: Lifetime Prevalence and Age-of-Onset Distributions of DSM-IV Disorders in the National Comorbidity Survey Replication
Ronald C. Kessler, PhD; Patricia Berglund, MBA; Olga Demler, MA, MS; Robert Jin, MA; Kathleen R. Merikangas, PhD; Ellen E. Walters, MS, Arch Gen Psychiatry. 2005;62:593-602.) reports a one year adult prevalence of bipolar disorder (types I and II) of 3.9%. In an analysis of age of onset in the same citation above, the study found that bipolar disorder began before adulthood in a substantial minority of persons: in 25% of persons, it began by age 17, in 10% it began by age 13.

Let's do the math now and see what results. Excluding the adolescents up to age 17, and using the lower range of the NCS data:
If 10% of bipolar disorder begins by age 13, and 3.9% of the total population is diagnosable with the condition using DSM-IV criteria in a community-based epidemiological study of actual prevalence, then how many children should that clinical study have diagnosed with bipolar disorder? 0.10 multiplied by 0.39 is 0.039, or 0.39%. If we round to 0.4%, then we have the actual prevalence of bipolar disorder in children. The vaunted 40-fold increase from near zero led to the diagnosis being made in 0.4% of children based on percentage of office visits.

0.39% is about the same as 0.44%, so the purported evidence for over-diagnosis seems underwhelming, to say the least.

Notes from ATTACh

2010-04-27T10:05:00.003-04:00

The Association for the Treatment and Training in the Attachment of Children has achieved a number of major accomplishments recently. In addition to preparing and publishing a Therapeutic Parenting Manual, A Clinical Practice Manual, and a wonderful DVD, it wrote an influential letter to the DSM V committee advocating for the inclusion of a diagnosis of Developmental Trauma Disorder. This is exciting work. This international association, with members from across the US, Canada, Europe and Asia is quite influential. Parents and professionals should visit the website of Association for the Treatment and Training in the Attachment of Children.

The organization is now working on a number of projects that will benefit therapists and parents.

Anticonvulsant medications and potential risks

2010-04-23T09:09:00.000-04:00

Certain anticonvulsant drugs could be associated with an increased risk of suicide, attempted suicide or violent death. Anticonvulsants are used to help people with epilepsy but can also be prescribed for bipolar disorder, mania, neuralgia, migraine and neuropathic pain. Researchers from Harvard Medical School analyzed data from 14 states about patients fifteen-years old and over who started taking anticonvulsants between July 2001 and December 2006. They found that the risk of suicidal acts was increased for gabapentin (Neurontin), lamotrigine (Lamictal), oxcarbazapine (Trileptal), tiagabine (Gabitril) and valproate (Depakote).

You can find out more about this research at

http://psychcentral.com/news/2010/04/15/broadly-used-seizure-meds-may-increase-suicide-risk/12858.html

Artyom Savelyev

2010-04-18T14:13:00.000-04:00

In today's New York Times there is an excellent editorial about the story of Artyom Savelyev (Sunday April 18, 2010, pg9) titled "A Safe, Loving Home."

As the editorial states, while we don't know all the facts and details, returning a child is "profoundly wrong." The response of the Russian Foreign Ministry, while understandable, is, in my opinion, also wrong. Since 1991 over 50,000 Russian children have been adopted by US families. Currently there are 250 adoptions nearly completed and 3,500 pending. Children do better in families than in orphanages. That being said, many children who come from orphanages, which are frequently over-crowded and understaffed, have a variety of difficulties that sometimes require very specialized care, such as Alcohol Related Neurological Dysfunction, Sensory-Integration Dysfunction, and various psychological and emotional problems caused by chronic early maltreatment.

The inadequacy of post-placement services for families is a problem that we can fix by requiring agencies to provide those services. The problem of inadequate information from the orphanages, under staffing, and over crowding is something the other government can and must fix.

Artyom Savelyev & Torry Hansen’s Case

2010-04-11T09:25:00.003-04:00

This is a very sad case for the child, first and foremost, for the family, and for the adoption and child welfare systems. It speaks to a gross failure on many levels.

The Case:
A few days ago Artyom's adoptive mother, Torry Hansen, sent Artyom Savelyev back to his native Russia. Seven year old Artyom had been adopted from a Russian orphanage about one year ago, around the age of six. The story has been featured in every major news outlet in the US and is the subject of great attention and outrage in Russia and throughout the world. Russia has suspended the license of WACAP, the adoption agency.

While the facts we do know, sending the child back to Russia on a plane, are unacceptable, a rush to judgment is also not called for. There is too much we don't know. For example:

What was the nature and quality of the homestudy and what were the qualifications of the provider?

What were Ms. Hansen's expectations and motivations regarding adoption.

What was the content and scope of education Ms. Hansen received regarding adopting an older child, and the potential for various psychological, emotional, and behavioral problems?

Who provided post-placement supervision?

What help did Ms. Hansen seek and from whom?

We do know that Ms. Hansen never brought Artyom to a Psychologist or other mental health professional (This from Ms. Hansen's mother as quoted in an Associate Press article, see for example, page A4 of the Buffalo News or similar material in the April 11, 2010 New York Times). "Hansen said her daughter sought advice from psychologists but never had her adoptive son meet with one." What advice was given?

Did the family seek help from the TN child welfare system, if so what was their response, if not, why not?

This case calls for a thorough and detailed gathering of all the relevant facts, followed by a thorough critical review of what happened and why.

ASSESSING CAREGIVER CAPACITY

2010-02-28T14:51:00.002-05:00

Assessing Caregiver Reflective Capacity, Commitment, Insightfulness, and Sensitivity is a new DVD by Arthur Becker-Weidman, Ph.D. . This two DVD set provides a comprehensive approach for the assessment of important caregiver functions.

The first DVD begins with an overview of the factors associated with placement stability. The presentation, which includes lecture, PowerPoint slides and videoclips of actual sessions, goes on to present material about assessing parent state of mind with respect to attachment, insightfulness, and reflective abilities.

The second DVD discusses caregiver sensitivity, how to assess commitment, the Adult Attachment Interview, and related topics.

ISBN: 978-0-9822883-3-7.
The DVD can be ordered directly from The Center For Family Development or at Amazon.com

Temper Dysregulation Disorder & Bipolar Disorder

2010-02-20T18:22:00.000-05:00

TEMPER DYSREGULATION DISORDER AND BIPOLAR DISORDER

The proposed DSM-V will contain a new diagnosis, Temper Dysregulation Disorder (TDD). This new category was created to reflect a syndrome that has been labeled childhood bipolar disorder.
The creation of TDD does not deny the existence of bipolar disorder in childhood. That is, although extremely rare, bipolar disorder can occur in children and adolescents, and it is very similar to adult bipolar. TDD was created to capture a valid syndrome with characteristics and outcomes that are different than those of bipolar disorder. The available scientific data supports the position that the TDD syndrome is not simply the manifestation of bipolar disorder in childhood. This means that thousands of children that have been diagnosed with childhood bipolar disorder may not have bipolar and instead have a completely different syndrome now called Temper Dysregulation Disorder with Dysphoria.
So what is TDD?
Here is the proposed criteria for TDD: (from the DSM-V site see: http://www.dsm5.org/ProposedRevisions/Pages/proposedrevision.aspx?rid=397
A. The disorder is characterized by severe recurrent temper outbursts in response to common stressors.
1. The temper outbursts are manifest verbally and/or behaviorally, such as in the form of verbal rages, or physical aggression towards people or property.
2. The reaction is grossly out of proportion in intensity or duration to the situation or provocation.
3. The responses are inconsistent with developmental level.
B. Frequency: The temper outbursts occur, on average, three or more times per week.
C. Mood between temper outbursts:
1. Nearly every day, the mood between temper outbursts is persistently negative (irritable, angry, and/or sad).
2. The negative mood is observable by others (e.g., parents, teachers, peers).
D. Duration: Criteria A-C have been present for at least 12 months. Throughout that time, the person has never been without the symptoms of Criteria A-C for more than 3 months at a time.
E. The temper outbursts and/or negative mood are present in at least two settings (at home, at school, or with peers) and must be severe in at least in one setting.
F. Chronological age is at least 6 years (or equivalent developmental level).
G. The onset is before age 10 years.
H. In the past year, there has never been a distinct period lasting more than one day during which abnormally elevated or expansive mood was present most of the day for most days, and the abnormally elevated or expansive mood was accompanied by the onset, or worsening, of three of the “B” criteria of mania (i.e., grandiosity or inflated self esteem, decreased need for sleep, pressured speech, flight of ideas, distractibility, increase in goal directed activity, or excessive involvement in activities with a high potential for painful consequences; see pp. XX). Abnormally elevated mood should be differentiated from developmentally appropriate mood elevation, such as occurs in the context of a highly positive event or its anticipation.
I. The behaviors do not occur exclusively during the course of a Psychotic or Mood Disorder (e.g., Major Depressive Disorder, Dysthymic Disorder, Bipolar Disorder) and are not better accounted for by another mental disorder (e.g., Pervasive Developmental Disorder, post-traumatic stress disorder, separation anxiety disorder). (Note: This diagnosis can co-exist with Oppositional Defiant Disorder, ADHD, Conduct Disorder, and Substance Use Disorders.) The symptoms are not due to the direct physiological effects of a drug of abuse, or to a general medical or neurological condition.
The syndrome captured by section A-C (frequent and intense temper outbursts, happening several times per week in the context of negative emotionality) is the core of the symptoms that has been incorrectly interpreted as indicative of childhood bipolar disorder. Section H is very interesting. It states that this diagnosis is not appropriate if the person has experienced classic mania (e.g., bnormally elevated or expansive mood), as in such a case the diagnosis of bipolar is likely more accurate.
So why did the DSM-V decide that this syndrome is not simply bipolar disorder of childhood?
1. Lack of continuity to bipolar.
If TDD is simply the expression of bipolar disorder during childhood, then children diagnosed with this condition would eventually develop symptoms of classic bipolar disorder as they reach adulthood. The data do not support this hypothesis. That is, children who display the TDD syndrome in childhood (and are often incorrectly diagnosed as bipolar) are not more likely to develop classic bipolar disorder later in life as their peers (see Brotman et al., 2006; Leibenluft et al, 2006; Stringaris et al, 2009). Instead, these children are more likely to develop depression, not bipolar!
2. Different Biological Markets.
Youth who are diagnosed with classic bipolar differ significantly from those who have a TDD-like syndrome (see Brotman et al, 2010; Guyer et al, 2007; Rich et al, 2008). If TDD is simply bipolar, then the biomarkers of TDD should be similar to those of bipolar, but this is not the case.
3. Different Demographic Factors.
If TDD is simply bipolar, then the gender distribution of TDD should be similar to that of bipolar. This does not appear to be the case. Specifically, there is no gender differences in the rate of classic bipolar; male and females are equally likely to develop the condition. However, the TDD-like syndrome is disproportionately observed in boys rather than girls.
4. A need for a new category that would impact treatment and research.
In theory, the presence of TDD will educate clinicians, researchers, and the public that this syndrome is not simply a version of bipolar disorder. This would facilitate research on the causes, features, and treatments for this condition. This has major implications for treatment. For example, the standard treatment for bipolar disorder does NOT seem to work in children that have the TDD syndrome (Dickstein et al, 2009). By explicitly stating that TDD is not bipolar, researchers would be less likely to approach the search for treatments from a “bipolar framework”, which would potentially facilitate the discovery of more effective interventions.
I am actually glad about this change as it will have a clear impact on clinical practice and research that will most likely benefit the children affected with this condition.
References:
Brotman MA, Schmajuk M, Rich BA, Dickstein DP, Guyer AE, Costello EJ, Egger HL, Angold A, Pine DS, & Leibenluft E (2006). Prevalence, clinical correlates, and longitudinal course of severe mood dysregulation in children. Biological psychiatry, 60 (9), 991-7 PMID: 17056393
Dickstein DP, Towbin KE, Van Der Veen JW, Rich BA, Brotman MA, Knopf L, Onelio L, Pine DS, Leibenluft E (2009): Randomized double-blind placebo-controlled trial of lithium in youth with severe mood dysregulation. J Child Adolesc Psychopharm 19: 61-73
Guyer AE, McClure EB, Adler AD, Brotman MA, Rich BA, Kimes AS, Pine DS, Ernst M, Leibenluft E (2007): Specificity of face emotion labeling deficits in childhood psychopathology. Journal of Child Psychiatry and Psychology, 48:863-71
Leibenluft E, Charney DS, Towbin KE, Bhangoo RK, Pine DS (2003): Defining clinical phenotypes of juvenile mania. Am J Psychiatry 160: 430-437
Rich BA, Grimley ME, Schmajuk M, Blair KS, Blair RJR, Leibenluft E (2008): Face emotion labeling deficits in children with bipolar disorder and severe mood dysregulation. Development and Psychopathology 20: 529-546
Stringaris A, Cohen P, Pine DS, Leibenluft E (2009): Adult outcomes of adolescent irritabilty: A 20-year community follow-up. Am J Psychiatry 166: 1048-54

Stockholm Syndrome: what it is

2010-02-17T15:08:00.002-05:00

In August 2009, when Jaycee Dugard, a woman kidnapped 18 years ago, was found, the media reported that she displayed symptoms of the psychological disorder known as Stockholm Syndrome, so named after a famous Swedish robbery in which hostages sympathized with their captors. Housed in a shed in her captor’s backyard, Dugard was repeatedly raped since she was eleven years old. But when investigators questioned her, Dugard reported that her captor was a “great person.”

Dugard’s case is only one of the many news stories that have received worldwide media attention. The public is fascinated by victims’ seemingly inexplicable positive responses after having suffered physical, emotional, and sexual abuse.

In her groundbreaking book, Loving to Survive: Sexual Terror, Men’s Violence, and Women’s Lives, Dr. Dee Graham, one of the earliest Stockholm Syndrome researchers, identified four characteristics that typify those suffering from the syndrome:

1. Perceived threat to survival, and belief that the captor is able to carry out the threat at any time.
2. A captor carries out a small act of kindness, and the captive perceives it as redemptive.
3. The captive is isolated for a significant amount of time, such that the victim can only see through the captor’s perspective.
4. Perceived impossibility of escape.

Shirley Julich, a professor at the Auckland University of Technology in New Zealand, focuses her research on child sexual abuse. In 2005, she wrote a comprehensive report analyzing interviews with 21 survivors of childhood sexual abuse. In her attempt to understand her interviewers’ initial reticence to report abuse, she turned to Graham’s research, concluding that Stockholm Syndrome was indeed a major culprit, in effect contradicting an earlier child sexual abuse study conducted by the Otago Women’s Health Survey.

Shirley Julich’s full report is available here.

To read a more in-depth description of Stockholm Syndrome symptoms, read Dr. Joseph Carver’s Mental Health Matters blog post .

To get a brief history of major news stories featuring victims suffering from Stockholm Syndrome, read this recent Time magazine article.

Overview of Proposed DSM-V Changes

2010-02-14T10:24:00.000-05:00

OVERVIEW OF PROPOSED DSM-V CHANGES

There are no proposed changes to the diagnosis of Reactive Attachment Disorder. In addition, the proposals to add Developmental Trauma Disorder of Complex Trauma have been rejected, which is most unfortunate. Many children who have experienced chronic early maltreatment within a caregiving relationship exhibit a range of symptoms across several domains. Without a diagnostic category of Developmental Trauma Disorder that captures the range and depth of dysfunction, we are left giving children a basket of different diagnoses. This can lead to treating a range of symptoms and not the underlying causative factors.

There are substantial changes proposed for the Diagnostic and Statistical Manual of Mental Disorders.
The American Psychiatric Association (APA) has posted the draft of DSM-V on a special Web site, www.dsm5.org, to obtain comments.
A few of the proposed major changes:
• Recategorizing learning disorders, including creation of a single diagnostic category for autism and other socialization disorders, and replacing the controversial term "mental retardation" with "intellectual disability"
• Eliminating "substance abuse" and "substance dependence" as disorders, to be replaced with a single "addiction and related disorders" category
• Creating a "behavioral addictions" category that will include addictions to gambling but not to the Internet or sex
• Offering a new assessment tool for suicide risk
• Including a category of "risk syndromes" for psychosis and cognitive impairment, intended to capture mild versions of these conditions that do not always progress to full-blown psychotic disorders or dementia, but often do
• Adding a new disorder in children, "temper dysregulation with dysphoria," for persistent negative mood with bursts of rage
• Revising criteria for some eating disorders, including creation of a separate "binge eating disorder" distinct from bulimia
• Using "dimensional assessments" to account for severity of symptoms, especially those that appear in multiple diagnostic categories
The draft diagnostic criteria will then undergo two years of field testing. The final DSM-V is scheduled for release in May 2013, a year later than originally planned.
New Categories for Dyslexia, Autism
In the area of neurodevelopmental disorders, DSM-V will put dyslexia and dyscalculia -- reflecting disabilities of reading and mathematics, respectively -- into a new category of learning disabilities.
Autism, Asperger's syndrome, childhood disintegrative disorder, and pervasive developmental disorder not otherwise specified will make up the new "autism and related disorders" category.
The head of the APA's work group on substance-related disorders, Charles O'Brien, MD, PhD, of the University of Pennsylvania, told reporters on a press call that substance dependence and abuse had no basis in the research on addictions.
"We unanimously agreed that . . . there really isn't evidence for an intermediate stage [short of addiction] that is now known as abuse," he said. Instead, there will be substance use disorders for each of the major types of drugs that cause problems, such as alcohol.
He added that the term "dependence" was problematic as a psychiatric diagnosis because some types of physical dependence are "completely normal" for some medications, such as opioid painkillers. The draft, DSM-V will include "discontinuation syndromes" to allow for the proper assessment of symptoms of withdrawal from psychoactive substances, including caffeine.
Dimensional and Risk Assessments
There are two new suicide risk assessment scales planned for DSM-V, one for adolescents and one for adults. The new risk assessment tools focus on risk factors such as impulsive behavior, heavy drinking, and chronic severe pain and illness. In DSM-IV, suicidal ideation is treated as a symptom of major depression and certain other disorders.
Temper Dysregulation Disorder to be used in some cases instead of Bipolar Disorder
There is a proposed new diagnosis. The proposed new childhood disorder, temper dysregulation with dysphoria (TDD). It is reported that about 40% to 60% of the cases seen will be children who are doing things that other people don't want them to do. Many of these are children who are "stubborn and resistant and disobedient and moody, according to David Shaffer, MD, of Columbia University. There is currently a recognized syndrome known as oppositional defiant disorder, but some children also display severe aggression and negative moods that go beyond mere stubbornness.
Such children are often tagged as having juvenile bipolar disorder, but research has shown that the label is often inappropriate, since they usually do not qualify for a bipolar disorder diagnosis when they reach adulthood, although they remain dysfunctional. More often, these children are diagnosed as depressed when they become adults, according to Dr. Shaffer. He said the addition of TDD would better describe the severity and frequency of irritable behavior while also recognizing the mood disorder that goes with it.
Dimensional Assessment
Another innovation in DSM-V will be the extensive use of so-called dimensional assessments. Whereas DSM-IV relied heavily on present-absent symptom checklists, the new edition will include severity scales for symptoms, such as anxiety or insomnia, that may appear to larger or smaller degrees in many different mental illnesses.
Gender Identity Disorder Stays
A closely watched issue in the DSM-V revision has been whether to change or do away with gender identity disorder, now listed in DSM-IV. In the draft, APA leaders are proposing to rename the condition "gender incongruence" for adults and children.
People who consider themselves "transgendered" have long criticized DSM-IV and previous editions for labeling them with a mental disease when their problems, they believe, are purely somatic -- that is, they have the wrong genitalia and hormonal balance.
At the APA's annual meeting last May, members of the transgender community made a case for dropping gender identity disorder from DSM-V, but keeping some kind of "gender variance" diagnosis as a medical condition. Such an approach would eliminate the stigma of a psychiatric diagnosis while leaving a pathway for third-party payment for gender transition treatments, they said.
APA officials said the organization planned more discussions with members of the transgender community.
Kupfer, the DSM-V task force chairman, stressed that further changes in many diagnostic categories are likely following the comment period and field trials.
Final revisions will be submitted in 2012 for approval by the APA's two governing bodies, the Assembly and the board of trustees.

How does Attachment Develop?

2010-02-03T10:22:00.001-05:00

The attachment system evolved over time to ensure the survival of the infant. The attachment system is a biologically based system found in nearly all mammals. The attachment system operates in a manner similar to your home heating and cooling system. If the temperature is just right, nothing happens. Only when the temperature goes outside of preset bounds does your heating and cooling system turn on. The same type “homeostatic” process is at the core of the attachment system.
In its most simple form, the attachment system is a proximity seeking system. When the child feels some threat, the child gravitates toward the preferred caregiver, who is most likely to care for and protect the child. This is how the attachment system evolved as a means of ensuring the survival of the vulnerable infant and child. The attachment system and the exploration system operate like a see-saw. If one is activated, the other is deactivated. When the child feels safe and secure, the exploration system is active. When threatened, fearful, anxious, the attachment system is active.
Attachment behavior, which is proximity seeking behavior, is exhibited throughout the life cycle. The toddler, when threatened, will go to the parent, maybe grab the parent’s leg, hide behind the parent, or in some other way make contact with the parent. Once the child feels safe, the child will then go about exploring the environment (playing). An example of attachment behavior in a young adult can be seen in the actions of a young student away at college on 9/ll 2001. On that day the student called home several times during the day to give her parents “news updates” about the unfolding events. Her first call was to, “turn on the TV Dad, a plane just hit the world trade center.” Her second call was, “Mom, did you see, a second plane hit….” And so it went throughout that awful day. Something terrible was happening that was a threat to the girl, and so she felt the need to make contact with her primary attachment figures. For a young adult, the telephone worked fine; while for a toddler, physical contract may be necessary.
So, then, how does this system develop? Remember Erik Erikson’s stages of development? The first stage, Trust vs. Mistrust? During this stage the foundation of attachment and patterns of attachment emerge. Infants cannot easily regulate themselves and they need a caregiver to regulate them. The normally sensitive parent responds to the child’s cries, figures out what is wrong, and then responds to meet the need. When this happens is a fairly regular and consistent manner the child learns, experientially, several important things. The child learns that the world is largely a benign place. The child learns that discomfort will be remedied before it gets too bad; this forms the basis for impulse control. The child learns that its needs will be met in a timely manner. The infant learns that caregivers are largely reliable, good, and helpful. And the child learns that the child is valued, valuable, loved, and loveable.
During the toddler years, which are about shame, the child is ambulatory, exploring the world, and “getting into trouble,” largely because the child does not recognize dangers. As a result, the caring parent is saying “NO!” a lot; to protect the child. When the parent sets this sort of limit, the child experiences shame. The child may cry, hide, cover the child’s face, or in some other manner evidence shame. Shame is about who you are and when we feel shame, we hide. The normally sensitive parent responds by comforting the child while setting the limit. “It’s ok, sweetie, I don’t want you to grab that cup because it is very hot and you could hurt yourself.” The child looks at the parent, experiences that the parent is not angry at the child, and then the parent repairs the relationship and reconnects with the child. When this happens repeatedly, the child moves from shame to guilt. The child learns, experientially, that while the child is loved and loveable, it is what the child does, not the child, that is upsetting the parent. Guilt is about what you do; shame is about who you are. When you feel shame you hide; when you feel guilt you want to confess and fix it.

Finding homes for Children in Foster Care

2010-02-01T11:26:00.002-05:00

A recent article in the NY Times describes the efforts of one man to track down the relatives of children in foster care and to help children move into permanent adoptive homes. His work is quite inspiring. Mr. Lopez, a former police detective, now does gumshoe work for what he calls a more fulfilling cause: tracking down long-lost relatives of teenagers languishing in foster care, in desperate need of family ties and in danger of becoming rootless adults.

"Finding an adoptive parent for older children with years in foster care is known in child welfare circles as the toughest challenge. Typically, their biological parents abused or neglected them and had parental rights terminated. Relatives may not know where the children are, or even that they exist. And the supply of saints in the general public, willing to adopt teenagers shaken by years of trauma and loss, is limited."

This is an inspiring article.

The article can be found at:
http://www.nytimes.com/2010/01/31/us/31adopt.html?pagewanted=1&em

href="http://www.nytimes.com/2010/01/31/us/31adopt.html?pagewanted=1&em">

New book for parents

2010-01-29T09:04:00.000-05:00

Attachment Parenting, a new book edited by Arthur Becker-Weidman, Ph.D., & Deborah Shell, will be out in May of this year. Many of the chapters are written by myself and Deb. In addition, there are a number of chapters by various experts in the fields of Theraplay, Sensory-Integration, and Neuropsychology. The book is for parents and professionals and provides a home-based approach for parents to use to help children with complex trauma and disorders of attachment. The book is grounded in Dyadic Developmental Psychotherapy, which is an evidence-based, effective, and empirically validated treatment.

Treatment for PTSD

2010-01-06T12:22:00.002-05:00

Post Traumatic Stress Disorder (PTSD) is quite different from Complex Trauma. PTSD is a clinical diagnosis usually applied when an person has experienced a life-threatening event and develops certain symptoms. Complex Trauma refers to the pervasive effects of chronic early maltreatment within a care-giving relationship. Complex Trauma usually results in more impairments that does PTSD.

Dyadic Developmental Psychotherapy is an evidence-based, effective, and empirically validated treatment for Complex Trauma.

Post-traumatic stress disorder (PTSD) is characterized by symptoms such as repeated, intrusive upsetting memories of the trauma; avoidance of similar situations and things which might remind one of them; a feeling of detachment from others; hypervigilance, and overarousal. It is associated with problems at work and at home and it is estimated that between 1% and 14% of people might suffer from it over the course of their lifetime. A team of researchers from New York reviewed 57 studies into treatments for PTSD and acute stress disorder which can often lead to it. They found that there was the strongest evidence for trauma-focused cognitive-behavioural therapy (CBT) and eye-movement desensitization and reprocessing (EMDR). There was some evidence that stress innoculation training, hypnotherapy, interpersonal psychotherapy and psychodynamic psychotherapy were effective for PTSD and that trauma-focused CBT was effective for acute stress disorder. The study also found evidence that trauma-focused CBT was effective for assault- and road-traffic-accident-related PTSD.

Ponniah, Kathryn and Hollon, Steven D. - Empirically supported psychological treatments for adult acute stress disorder and posttraumatic stress disorder: a review Depression and Anxiety December 2009, 26(12), 1086-1109

ADHD among Internationally Adopted Children: Empirical Study

2009-12-20T09:21:00.002-05:00

There is a very interesting and informative study in the most recent issue of the European Child & Adolescent Psychiatry titled, ADHD in international adoptees: a national cohort study The abstract is summarized below:

Several investigators have reported an increased frequency of attention/hyperactivity symptoms in internationally adopted children. In this national cohort study, the authors aimed to determine the prevalence of ADHD medication in international adoptees in Sweden, in comparison to the general population. A further purpose was to study gender, age at adoption and region of origin as predictors of ADHD medication in international adoptees. The study population consisted of all Swedish residents born in 1985–2000 with Swedish-born parents, divided into 16,134 adoptees, and a comparison population of 1,326,090. ADHD medications were identified in the Swedish Prescribed Drug Register during 2006. Logistic regression was used to calculate the "odds ratios".

The rates of ADHD medication were higher in international adoptees than in the comparison population for both boys (5.3 vs. 1.5% for 10–15-year olds) and girls (2.1 vs. 0.3% for 10–15-year olds). International adoptees from all regions of birth more often consumed ADHD medication compared with the majority population, but the age and sex adjusted odds ratios were particularly high for adoptees from Eastern Europe, Middle East/Africa and Latin America. Adjusting for maternal education and single parenthood increased the odds ratios even further. The risk also increased with higher age at adoption. Adoptees from Eastern Europe have a very high risk for ADHD medication. A structured identification and support programme should be tailored for this group. Adoptees from other regions have a more moderately increased risk, which should be communicated to adoptive parents and to professionals who care for adoptees in their clinical practice.

Of course it is still unclear whether the children actually had ADHD since attention difficulties and related "ADHD" symptoms can also be caused by sensory-integration dysfunction, trauma symptoms, Complex Trauma, attachment difficulties and disorders, and Bipolar disorder. The fact that the children from Eastern Europe had the highest rate of use of ADHD medication does suggest some environmental rather than a genetic cause for the attention problems; suggesting that the cause may lie with the effects of chronic early maltreatment on development (Complex Trauma)

How the brain is affected by relationships

2009-12-05T09:09:00.001-05:00

In the “Clinician’s Digest” section of the November/December 2009 issue of Psychotherapy Networker http://psychcentral.com/psychotherapy/, Garry Cooper discusses a study led by psychiatrist Jakob Koch of Christian-Albrechts University in Kiel, Germany suggesting that “effective psychotherapy with depressed clients is associated with changes at the brain’s cellular level,” increasing the production of a key brain protein that assists in creating neural pathways. In this study they used Interpersonal Psychotherapy (IPT) which looks through the lens of both cognitive and interpersonal issues. It would be interesting to know how other theoretical orientations would fare.

There is a lot known about the power of oxytocin (the hormone of love) to bond people together but oxytocin can also be an ally to encourage therapeutic change. According to Linda Graham, MFT and trainer on the integration of relational psychology, mindfulness and neuroscience, it is “the neurochemical basis of the sense of safety and trust that allows clients to become open to therapeutic change.” It was a class I recently took with Linda, “The Neuroscience of Attachment,” that left me feeling so inspired about the implications of this in my practice. As a therapist, it’s nice to have something solid and research-based to hang my hat on.

Daniel Siegel, MD, one of the pioneers in this field has been saying for years that there is potential for the growth of new brain cells via relationships. I remember seeing him speak at a conference about five years ago but got derailed somehow and didn’t follow up on any further research on the matter. I’m glad to have made my way back to these concepts so I can further learn how to provide the most fertile soil possible for therapeutic change within the four walls of my own psychotherapy office.

The power of the “relationship” is not to be underestimated. Important relationships can do monumental damage – or they can facilitate profound healing. Many psychotherapists have known that the therapeutic relationship is one that can provide a “safe container” for emotional and psychological healing. Many of us believe that by providing a stable, nurturing model of something “different,” there is the potential for a corrective experience that the client can integrate into his life.

Now we know there is the potential for changes within the brain as well — which is only more encouragement for the lasting, deep shifts that we hope for our clients — and they hope for themselves. Perhaps the commonly held belief that “people can’t change” will finally, truly be a thing of the past.

Trauma's effects

2009-11-29T19:55:00.000-05:00

Having a stressful childhood may slash decades off a person’s life, researchers from the Centers for Disease Control and Prevention (CDC) report.

Among people who reported experiencing at least six of eight different bad childhood experiences-from frequent verbal abuse to living with a mentally ill person-average age at death was about 61, compared to 79 for people who didn’t have any of these experiences as children, the researchers found.

Dr. David W. Brown and Dr. Robert Anda of the CDC and colleagues from the CDC and Kaiser Permanente have been following 17,337 men and women who visited the health plan between 1995 and 1997 to investigate the relationship between bad childhood experiences and health.

So far, Anda noted in an interview, they have shown links between childhood stressors and heart disease, lung disease, liver disease and other conditions. “The strength of it really surprised me, how powerfully it’s related to health,” the researcher said.

In the current analysis, the researchers reviewed death records through 2006 to investigate whether these experiences might also relate to mortality. During that time, 1,539 study participants died.

Each person was asked whether they had any of eight different categories of such experiences, including verbal abuse, physical abuse, sexual abuse with physical contact, having a battered mother, having a substance-abusing person in the household, having a mentally ill person in the household, having a household member who was incarcerated, or having one’s parents separate or divorce.

Sixty-nine percent of the study participants who were younger than 65 reported at least one of the adverse childhood experiences, while 53 percent of people 65 and older did.

Those who reporting experiencing six or more were 1.5 times more likely to die during follow-up than those who reported none, the researchers found. They were 1.7 times as likely to die at age 75 or younger, and nearly 2.4 times as likely to die at or before age 65.

There are a number of ways that a traumatic childhood could contribute to ill health, Anda noted. For example, childhood stress affects brain development, so individuals who’ve experienced it may be more likely to suffer from depression and anxiety, and more prone to deal with stress in unhealthy ways, for example by drinking alcohol or smoking cigarettes.

Just a third of the people in the study were completely free of any sort of childhood trauma, Anda added, making it clear that these sorts of harmful experiences are widespread.

“If we want to address a lot of major public health issues we’ve got to address the kind of stressors children have in our society as a way of primary prevention,” he said.

SOURCE: American Journal of Preventive Medicine, November 2009.

Having a stressful childhood can significantly reduce people’s life expectancy. Researchers from the U.S. Centers for Disease Control and the Kaiser Permanente Organisation studied 17,337 men and women to investigate the links between bad childhood experiences and health. The researchers defined eight different adverse childhood experiences: verbal abuse, physical abuse, sexual abuse with physical contact, having a battered mother, having a substance-abusing person in the household, having a mentally ill person in the household, having a household member who was incarcerated, or having one’s parents separate or divorce. 69% of the study participants under the age of 65 reported at least one of these experiences while 53% of those over 65 did. Those people who reported six or more adverse experiences were 1.7 times more likely to die at 75 or younger and 2.4 times more likely to die at 65 or younger. The authors of the study thought that having a troubled childhood makes people more likely to develop anxiety and depression which they cope with by using tobacco and alcohol.

More on Nature and Nurture and Violence

2009-11-27T11:02:00.000-05:00

In intriguing research conducted at the University of California and other locations, it appears that psychopathic killers often have lower intelligence, which can be the result of brain damage; often from severe chronic maltreatment as a child. Three factors appear to be present among violent offenders:
1. Several "violence" genes.
2. Damage to certain areas of the brain
3. Exposure to extreme trauma and poor parental bonding in childhood.

Among genetic markers related to aggression and mood is MAOA. The high risk variant of this gene gets inherited more by males than females. MAOA regulates serotonin, which affects mood (which is why medications like Prozac affect mood. These medications are called SSRIs: Selective Serotonin Reuptake Inhibitors. They function to keep more serotonin in the synapses between brain cells.). In the womb the high-risk version of MAOA can lead to a buildup of serotonin in the brain making the brain less sensitive to the normally calming effects of serotonin. Other research indicates that people who inherit the high-risk gene and who are raised in abusive homes may be more prone to violent behavior.

In another study pbulished in Comprehensive Psychiatry early in 2009, it was found that boys who inherit a mutated variant of MAOA are more likely to be in a gang than those without the mutation and are more likely than those without the mutation to be the most violent gang members.

Nature or Nurture? Which is it? Both!

2009-10-29T15:23:00.000-04:00

Most scientists now accept that the nature/nurture debate is not a case of either/or but of genes and environment working together in a complex pattern to influence people's mental health. Researchers from the University of Iowa looked into one example of this examining how genes and attachment work together to influence how good young children are at self-control. They studied 89 children testing them to see whether they had a variation in a gene called 5-HTTLPR, measuring the quality of their relationship with their mothers at 15 months and how good they were at self-control at 25,38 and 52 months. They found that among children who carried a certain variant of the gene insecure attachment to their mothers at 15 months led to poorer ability to control their emotions later. However, those children who had secure attachment to their mothers at 15 months did not have problems with self-control later even if they carried the variation in the 5-HTTLPR gene.

Kochanska, Grazyna, Philibert, Robert A. and Barry, Robin A. - Interplay of genes and early mother-child relationship in the development of self-regulation from toddler to preschool age The Journal of Child Psychology and Psychiatry November 2009, 50(11), 1331-1338

Child Sexual Abuse causes later problems

2009-10-28T08:18:00.001-04:00

An investigation published in the current issue of Psychotherapy and Psychosomatics explores the link between child sexual abuse and inability to express emotions in adulthood.

Alexithymia, a clinical condition typified by a reported inability to identify or describe one’s emotions, is associated with various forms of psychopathology, including depression. Highly alexithymic (HA) outpatients are more likely to be female, less likely to have children and are characterized by more somatic-affective symptoms of depression and interpersonal aloofness.

The Authors of this investigation extended these findings by examining personality traits and childhood sexual abuse history. Participants were 94 depressed patients [57.45% with recurrent major depressive disorder (MDD), 37.23% with single-episode MDD, 5.32% with depressive disorder not otherwise specified] 50 years of age and older recruited from psychiatric treatment facilities in Upstate New York. Individuals completed the Structured Clinical Interview for DSM-IV Axis I disorders. Alexithymia was assessed with the 20-item self-report Toronto Alexithymia Scale. Its 3 subscales measure difficulty identifying feelings and distinguishing them from bodily sensations (DIF), difficulty describing and communicating feelings (DDF) and externally oriented thinking (EOT), the latter being a tendency to focus on concrete details of external events rather than on aspects of inner experience. Depressive symptom severity was assessed with the Beck Depression Inventory-II (BDI-II). Five personality domains, i.e. neuroticism, extraversion, openness to experience, agreeableness and conscientiousness, were assessed with the NEO Personality Inventory. History of childhood sexual abuse was assessed using the Childhood Sexual Abuse subscale of the Childhood Trauma Questionnaire. A latent class cluster analysis (M-Plus 4.20) was performed on the DIF, DDF and EOT subscales. All 3 indicators favored a 3-cluster solution. This solution identified 3 groups, i.e. low alexithymia (LA; n = 11, 63.64% women), moderate alexithymia (MA; n = 40, 60% women) and HA (n = 43, 60.47% women). The distribution of mood diagnoses, single-episode MDD, recurrent MDD and depressive disorder not otherwise specified was not significantly different among the 3 alexithymic clusters (p> 0.05). The Authors conducted 10 separate multivariate generalized logit regressions; odds ratios were calculated for LA versus HA and MA versus HA class membership. Putative predictors were total BDI-II and the 3 subscales, childhood sexual abuse and the 5 personality domains. Covariates were age, gender and education. The 3 BDI-II subscales as well as the total score significantly distinguished LA and MA from HA. Lower levels of depressive symptoms significantly decreased the odds of HA membership. Odds ratios ranged between 0.32 and 0.94 (p< 0.05).

Childhood sexual abuse distinguished MA from HA; lower levels of childhood sexual abuse decreased the odds of HA membership (p< 0.05). Neuroticism, openness and conscientiousness also distinguished the 3 groups. Low neuroticism decreased the odds of HA membership, with odds ratios ranging between 0.95 and 0.97 (p< 0.01). Low openness and conscientiousness increased the odds of HA membership, with odds ratios ranging between 1.02 and 1.07 (p<0.05).

The HA group in this study was characterized by higher neuroticism and lower openness to experience and conscientiousness, a profile that reflects a distressed personality type, which has been related to poorer health outcomes and general functioning and more psychological distress. A similar personality profile was observed for the MA group, with the notable exception being their above-average levels of agreeableness and openness to experience. Interestingly, the HA group was characterized by more childhood sexual abuse compared to the MA patients. These findings add to the mounting evidence for a relationship between childhood sexual abuse and alexithymia; individuals with a history of childhood sexual abuse may have a reduced capacity to experience emotion in relation to their trauma, and this phenomenon may generalize to experiencing all emotions. Childhood sexual abuse has been found to interfere with the development of emotion regulation and to be related to attachment disturbance. The combination of childhood sexual abuse and alexithymia must be considered in the design and implementation of treatment studies, as these patients are more resistant to treatment (the attachment disturbance makes it more difficult for these clients to engage in a therapeutic relationship) and have slower recovery rates and poorer outcomes. Identifying a patient as alexithymic may suggest a history of early traumatic events which increases the likelihood and severity of depression. Treatment should be tailored to address the depressive symptoms along with the affective experience (identification, differentiation, labelling and management of feelings).
Source:Psychotherapy and Psychosomatics: Topciu, R.A. ; Zhao, X.; Tang, W; Heisel, M.J.; Talbot, N.L.; Duberstein, P.R. Childhood Sexual Abuse and Personality Differentiating High and Low Alexithymia in a Depressed Population. Psychother Psychosom 2009;78:385-387

Effects of Trauma (PTSD) on the Brain

2009-10-23T12:31:00.001-04:00

Brain scans of people with post-traumatic stress disorder (PTSD) have shown abnormalities in parts of the brain called the anterior cingulate cortex, the amygdala and the hippocampus but it is not known whether these abnormalities have developed because of the PTSD or if they reflect an inherited risk factor for the condition. A team of researchers from Massachusetts and New Hampshire investigated this issue in a study of 66 people. All the participants in the study were identical twins and they were divided into two groups. One group was made up of pairs of twins where one twin had fought in a war and developed PTSD and the other twin had not fought. The other group was made up of one twin who had fought but not developed PTSD and their twins who had not fought. Those veterans who had developed PTSD and their non-combatant twins both showed more activity in their dorsal anterior cingulate cortex and their midcingulate cortex than the group of twins who had not developed PTSD after combat and their twins. The more active the brain regions were in the twins not exposed to combat whose siblings had developed PTSD the worse their siblings' PTSD symptoms were. The study shows that enhanced activity in this part of the brain is a risk factor for PTSD, not a consequence of it.

These findings clearly have implications for people who have experienced Complex Trauma and disorders of attachment.

Shin, Lisa M. ... [et al] - Resting metabolic activity in the cingulate cortex and vulnerability to posttraumatic stress disorder Archives of General Psychiatry October 2009, 66(10), 1099-1107

Against Coercion

2009-10-18T15:07:00.001-04:00

Against Coercion
Arthur Becker-Weidman, Ph.D.
Director,
Center For Family Development

The APSAC Report on Attachment Therapy offers ATTACh and all in the field an opportunity to state unequivocally and clearly our opposition to coercive methods in treatment. Another set of excellent standards are the recommendations of the American Academy of Child and Adolescent Psychiatry, “Practice Parameter for the Assessment and Treatment of Children and Adolescents with Reactive Attachment Disorder of Infancy and Early Childhood.”

I think that all clinicians in the field should be very clear and specific about what methods they use and what methods they do not use or condone. At The Center For Family Development we have an informed consent document that clearly spells out our practice and methods and that clearly spells out our opposition to coercion in therapy and parenting. In addition we have statements on our website clearly stating our acceptance of and adherence to the recommendations of the APSAC report and the Academy’s report in addition to our adherence to the Association for the Treatment and Training in the Attachment of Children's White Paper on Coercion and ATTACh's new Professional Practice Manual.. The central component in our treatment and in what we teach parents, is attunement; the ability to develop and maintain an emotionally positive, sensitive, engaged, and responsive relationship. It is based on Attachment Theory and what occurs in the normal parent-child relationship during development. I find nothing in Attachment Theory that would support or condone the use of coercion or intrusive methods in child rearing or treatment. In fact, I defy anyone to find me anything to the contrary in the writings of John Bowlby, Micheal Rutter, Mary Ainsworth et. al., Mary Main, Erik Hesse, Jude Cassidy, Philip Shaver, Thomas O’Conner, Howard Steele, Charles Zeanah, Daniel Siegel, or any of the other well known names in the fields of attachment theory and research, developmental psychology, or infant mental health. It is my opinion and recommendation that all practitioners of attachment-based treatment state their acceptance of and adherence to the APSAC and Academy recommendations.

Coercion has usually been defined in terms of the therapist’s or parent’s behaviors. This is not a useful approach because it ignores intention, effect, and process. Coercion is the result of interplay among the actor’s behavior and intentions; the recipient’s perceptions and experience; power differentials in the relationship; and the nature and quality of the relationship between the persons involved. For this reason, a better approach may be to focus on the effects of the behavior on the recipient.

Within this context, coercion can be described as behavior that continues to increase the dysregulation of the other. Dysregulation is never a goal in treatment; indeed, it may well undermine progress. Increasing the distress of another without their consent and without actively working to reduce dysregulation when encountered is coercive. Helping the client to explore a trauma for sake of integration is the goal. Some degree of dysregulation may occur along with the processing, but dysregulation is never sought. Any dysregulation occurring needs to be immediately and sensitively addressed to help the child move toward greater regulation. If the goal of therapy is to actively assist the child to move toward greater degrees of regulation, while preventing or limiting experiences of further dysregulation, then there would be no place for the repetitive kicking/screaming and other abusive “techniques” that have caused controversary.

There are three types of coercion:
1. Behavior that continues to increase the dysregulation of the other.
2. Behavior that unintentionally causes dysregulation without then following with efforts to assist the child in re-attaining regulation.
3. Behavior that is likely to cause distress (addressing trauma, shame, or other intense affects/conflicts/losses, etc.) without incorporating interventions that will assist the child in remaining regulated and managing the distress. These interventions include: empathy/comfort from therapist and/or attachment figure, slow pace, frequent breaks, allowing child to stop the exploration, providing information, encouraging child to participate in the control of the process, teaching self-regulation skills.

Distress may be defined as perceived discomfort. Dysregulation is an overwhelming of the client’s ability to function, resulting in dissociation or other extreme defensive manifestations. When the client responds with discomfort and distress, the therapist uses empathy and emotional support to help co-regulate the client’s affect so that it does not move into dysregulation. While experiencing discomfort and distress, the client maintains the ability to be regulated in affect, cognition, and behavior. However, when a client shows terror, rage, or dissociative features, the client requires our help to become regulated. So, for example, in a therapeutic situation a client may willingly discuss an event that is upsetting and increases the client’s discomfort and distress. However, if the client then indicates a desire to stop, yet the therapist or parent ignores this signal, so that the client is forced to continue, this is coercive. It is also coercive to maintain or increase a client’s dysregulated state until the client is exhausted or has a “break through.” In addition, if a client becomes dysregulated and the therapist or parent does not act to decrease the client’s dysregulation that is coercive. Increasing a client’s dysregulation is never acceptable. Whenever a client exhibits such dysregulation, the therapist must act to decrease dysregulation and act to restore the client to a more regulated emotional state.

A therapist or parent may say or do something that unintentionally dysregulates the child, perhaps by not anticipating the power of a conditioned emotional response or missing the child’s cues. What is imperative is that the therapist or parent immediately engages in behaviors or uses words to decrease the child’s dysregulation. In summary, any actions or words that shame, provoke, or sustain interactions that increase a child or other’s dysregulation are coercive and clearly counter-therapeutic.

Another aspect of coercion is using force to require compliance with physically painful commands, such as forced jumping jacks, “power” sitting, prolonged and forced kicking until the child “decides” to answer a question or comply. The key issue in these instances is the use of power and coercion to force compliance for the sake of compliance with a command, which has no basis in safety. Remember, it is about connections not compliance.

ATTACh believes that all attachment-based therapy should be based on sound theory and principle, and that therapists should practice within their competence and training, and with appropriate supervision/consultation.

To review ATTACh's White Paper, Parent Manual, and Professional Practice Manual, go to

Adverse Childhood Experiences

2009-10-14T21:19:00.000-04:00

Having a stressful childhood may slash decades off a person's life, researchers from the Centers for Disease Control and Prevention (CDC) report.

Among people who reported experiencing at least six of eight different bad childhood experiences-from frequent verbal abuse to living with a mentally ill person-average age at death was about 61, compared to 79 for people who didn't have any of these experiences as children, the researchers found.

Dr. David W. Brown and Dr. Robert Anda of the CDC and colleagues from the CDC and Kaiser Permanente have been following 17,337 men and women who visited the health plan between 1995 and 1997 to investigate the relationship between bad childhood experiences and health.

So far, Anda noted in an interview, they have shown links between childhood stressors and heart disease, lung disease, liver disease and other conditions. "The strength of it really surprised me, how powerfully it's related to health," the researcher said.

In the current analysis, the researchers reviewed death records through 2006 to investigate whether these experiences might also relate to mortality. During that time, 1,539 study participants died.

Each person was asked whether they had any of eight different categories of such experiences, including verbal abuse, physical abuse, sexual abuse with physical contact, having a battered mother, having a substance-abusing person in the household, having a mentally ill person in the household, having a household member who was incarcerated, or having one's parents separate or divorce.

Sixty-nine percent of the study participants who were younger than 65 reported at least one of the adverse childhood experiences, while 53 percent of people 65 and older did.

Those who reporting experiencing six or more were 1.5 times more likely to die during follow-up than those who reported none, the researchers found. They were 1.7 times as likely to die at age 75 or younger, and nearly 2.4 times as likely to die at or before age 65.

There are a number of ways that a traumatic childhood could contribute to ill health, Anda noted. For example, childhood stress affects brain development, so individuals who've experienced it may be more likely to suffer from depression and anxiety, and more prone to deal with stress in unhealthy ways, for example by drinking alcohol or smoking cigarettes.

Just a third of the people in the study were completely free of any sort of childhood trauma, Anda added, making it clear that these sorts of harmful experiences are widespread.

"If we want to address a lot of major public health issues we've got to address the kind of stressors children have in our society as a way of primary prevention," he said.

SOURCE: American Journal of Preventive Medicine, November 2009.

Having a stressful childhood can significantly reduce people's life expectancy. Researchers from the U.S. Centers for Disease Control and the Kaiser Permanente Organisation studied 17,337 men and women to investigate the links between bad childhood experiences and health. The researchers defined eight different adverse childhood experiences: verbal abuse, physical abuse, sexual abuse with physical contact, having a battered mother, having a substance-abusing person in the household, having a mentally ill person in the household, having a household member who was incarcerated, or having one's parents separate or divorce. 69% of the study participants under the age of 65 reported at least one of these experiences while 53% of those over 65 did. Those people who reported six or more adverse experiences were 1.7 times more likely to die at 75 or younger and 2.4 times more likely to die at 65 or younger. The authors of the study thought that having a troubled childhood makes people more likely to develop anxiety and depression which they cope with by using tobacco and alcohol.

Teen maturity

2009-10-09T12:42:00.001-04:00

Teenagers are as logical as adults but lack their social and emotional maturity. This might not be a surprise to too many parents but it comes as the result of a study of 935 10-30 year-olds by researchers at Temple University in Philadelphia. Participants in the study were tested on their psychosocial maturity, including tests of impulse control, sensation seeking, resistance to peer influence, future orientation (jam today vs jam tomorrow) and risk perception. They were also tested on their cognitive abilities such as logical thinking. There were no differences in psychosocial maturity throughout the 10-17 year-old age group but there were differences between those who were 16-17 and those 22 and over, and between those who were 18-21 and those above 26. People's cognitive capacities got better from 11-16 but their was no improvement thereafter.

You can find out more about this research at

http://www.sciencedaily.com/releases/2009/10/091007153745.htm

Research Cited

2009-10-06T11:06:00.003-04:00

My article detailing the developmental lags of children with complex trauma and disorders of attachment was picked up and described on the Evan B. Donaldson Adoption Institute's Research Summary page.

It is a good summary of the article.

ATTACh Conference in TX

2009-10-01T11:27:00.002-04:00

I just came back from the Association for the Treatment and Training in the Attachment of Children's annual conference, this year in San Antonio Texas. It was a wonderful conference for professionals, parents, and researchers. I had the pleasure of hearing Dr. Bruce Perry, a key note speaker, talk about the effects of trauma in childhood on later development. The mediating factor is the effects of trauma on brain development and brain function. This leads to an approach or sequencing of treatment that takes into account which systems of the brain are impaired. This was a very useful talk.

I strongly recommend that people consider the conference next year, in California. More information can be found at www.attach.org

Book Review

2009-09-20T13:13:00.000-04:00

ENHANCING EARLY ATTACHMENTS:
THEORY, RESEARCH, INTERVENTION, AND POLICY
EDITED BY LISA BERLIN, YAIR ZIV, LISA AMAYA-JACKSON, MARK T. GREENBERG
NY: GUILFORD PRESS, 2005

BY ARTHUR BECKER-WEIDMAN, PH.D.

This is a pretty decent text on the subject. There are a couple of chapters that I found most useful. The Chapter by Frank Putnam, “The Developmental Neurobiology of Disrupted Attachment: Lessons from Animal Models and Child Abuse Research,” is a good summary of current research on the linkages between abuse, brain development, and later behavior. Dr. Putnam does a very good job of explaining some quite complex issues here. He states, “In aggregate, research…conclusively demonstrates that early adverse experiences can have lifelong effects on subsequent responses to stressors. Maternal stress is clearly communicated to the infant and can be as detrimental as direct stress.” (p. 93). The next chapter by Alica Liberman and Lisa Amaya-Jackson, “Reciprocal Influences of Attachment and Trauma: Using a Dual Lens in Assessment and Treatment of Infants, Toddlers, and Preschoolers,” is also an excellent chapter. As you know, the field is increasingly moving toward an integration of trauma research and practice and disorders of attachment theory and research. This chapter is a very nice integration of those two domains. The inclusion of a very detailed case study makes this chapter quite useful.

The last sections of the book describe program and policies. In the chapter by Marinus H. van Ijzendoorn, Marian J. Bakermans-Kraneburg, and Femmie Juffer, “Why Less is More,” they describe the current state of affairs with regard to program research. They find that interventions that focus only on sensitive maternal behavior are most effective in changing insensitive parenting and infant attachment security. They found that sensitivity-focused interventions are more effective than interventions with a broader focus. As might be expected, interventions with involved families and at-risk infants were more effective than interventions with at-risk parents. The book also addresses the ongoing concerns with intrusive methods such as holding therapies, rebirthing, and rebirthing. The chapter by Thomas O’Connor and Wendy Nilson, “Models versus Metaphors in Translating Attachment Theory to the Clinic and Community,” discusses this issue and encouragingly states, “This is changing. For example, a recent issue of Attachment and Human Development…was dedicated to this problem, and several clinicians working with children with attachment disorder have begun to develop alternative intervention models that do not rely on holding (e.g. Hughes, 2003).”

Like too many books in the field, this one focuses primarily on theory, research, and treatment programs for infants and toddlers. It takes some adapting to see how this material can be useful in work with latency and teen age children. None the less, the material is helpful and useful for practitioners.

John Rosemond got it wrong

2009-09-16T08:43:00.000-04:00

In a Baltimore Sun article, Sept 2nd 09, John Rosemond, wrote an article that is inaccurate regarding the factors sometimes associated with adoption. He claims that "Attachment Disorder lacks scientific proof," and goes on to state, "The facts: A consistent body of hard, objectively gathered scientific evidence to the effect that adopted children are more prone to psychological problems than children who live with one or two biological parents is lacking." The article goes on to criticize "adoption specialists," and describes the "case" of a three-year old to bolster his point. I find that the article is simplistic and distorted.

Mr. Rosemond has little or no training on the subject about which he is writing here. Mr. Rosemont is a "Psychological Associate," holding a MS. His background does not qualify him to offer expert advice on this particular topic.

Mr. Rosemond's statement is just wrong. Many children adopted through the child welfare system and internationally have suffered years of maltreatment (abuse and/or neglect). As you know, in the US and most countries, it is very difficult to remove a child from the parents and even more difficult to terminate parental rights. Things have to be pretty gruesome to have a parent's rights terminated and the child placed for adoption. So, the facts are: There is a consistent body of hard, objectively gathered scientific evidence to the effect that adopted children are more prone to psychological problems than children raised from birth. For example, Approximately 2% of the population is adopted, and between 50% and 80% of such children have attachment disorder symptoms (Carlson, Cicchetti, Barnett, & Braunwald, 1995; Cicchetti, Cummings, Greenberg, & Marvin, 1990).Children who have experienced chronic maltreatment and resulting complex trauma are at significant risk for a variety of other behavioural, neuropsychological, cognitive, emotional, interpersonal and psychobiological disorders (Cook et al. 2005; van der Kolk 2005). Many children with histories of maltreatment are violent (Robins 1978) and aggressive (Prino & Peyrot 1994) and as adults are at risk of developing
a variety of psychological problems (Schreiber & Lyddon 1998) and personality disorders, including antisocial personality disorder (Finzi et al. 2000), narcissistic personality disorder, borderline personality disorder and psychopathic personality disorder (Dozier et al. 1999). Neglected children are at risk of social withdrawal, social rejection and pervasive feelings
of incompetence (Finzi et al. 2000). Children who have histories of abuse and neglect are at significant risk of developing PostTraumatic Stress Disorder as adults (Andrews et al. 2000; Allan 2001). Children who have been sexually abused are at significant risk of developing anxiety disorders (2.0 times the average), major depressive disorders (3.4 times average), alcohol abuse (2.5 times average), drug abuse (3.8 times average) and antisocial behaviour (4.3 times average) (MacMillian 2001). The effective treatment of such children is a public health concern (Walker et al. 1992).

Mr. Rosemont goes on to state, " On the other hand, there is significant evidence to the effect that even orphaned children exposed during their early, supposedly "formative" years to severe conditions of emotional deprivation and material neglect recover quite nicely when adopted by loving parents." This statement does have an element of truth to it. One element of helping children who have experienced chronic early maltreatment within a caregiving relationship is loving parents. But there are other elements necessary to address and resolve the underlying traumas that may be continuing to distort the child's relationships and psychological functioning.

New Book

2009-08-23T20:06:00.002-04:00

The book I co-edited with a colleague, Attachment Parenting: Developing Connections
and Healing Children, will be published in early 2010. The book has a number of chapters on topics such as sensory-integration, activities for parents, theory, use of media and other subjects that parents and therapists will find useful.

The pervasive effects of maltreatment on child development can be repaired when parents use effective, empirically validated, and evidence-based methods. This book describes a comprehensive approach to parenting that discusses a variety of issues including attachment, trauma, neuro-psychological impairments, sensory-integration, and treatment approaches as well as the use of media, play, and narratives to create connections. Professors teaching family-therapy, child-welfare, and child-treatment courses will find the book a good adjunct text.

People who live or work with children who have histories of maltreatment or institutional care, complex trauma, or disorders of attachment. Parents, psychologists, social workers, mental health professionals, child welfare staff, residential treatment program staff, and educators will find this book of value. In addition, those who teach classes in child welfare, family therapy, and the treatment of children will find the book to be a useful adjunctive text.

This book describes a comprehensive approach to parenting children. Grounded in attachment theory, this book will give parents, therapists, educators, and child welfare and residential treatment professionals the tools and skills necessary to help children who have a history of neglect, abuse, orphanage care, or other experiences that may interfere with the normal development of attachment between parent and child. The approach is rooted in Dyadic Developmental Psychotherapy, which is an evidence-based, effective, and empirically validated treatment for complex trauma and disorders of attachment.

The book provides practical and immediately usable approaches and methods to help children develop a healthier and more secure attachment. The book covers a wide range of topics. The first few chapters will appeal to professionals who work with parents. These chapters describe the basic principles of this approach. The book then moves on to discuss how to select a therapist and who to expect from a comprehensive evaluation. The chapter on logistics will be particularly valuable for parents and residential treatment staff. This chapter provides detailed suggestions for everything from how to organize the child's room, schools concerns, and problem solving. The chapters on sensory-integration, art therapy for parents, narratives, and Theraplay give parents specific therapeutic activities that can be done at home to improve the quality of the child's attachment with the parent. Other chapters on neuropsychological issues, mindfulness, and parent's use of self will help parents directly. The two chapters by parents on their story and what worked for them provide inspiration to parents and demonstrate that there is hope. Finally, the book ends with a comprehensive chapter on resources for parents and a summary of various professional standards regarding attachment, treatment, and parenting.

Overall, this comprehensive book covers a broad range of topics that are of concern to parents who raise and others who work with children with difficult histories, trauma, and disorders of attachment.

Training Psycholgists from other counties: What I've learned

2009-08-19T12:35:00.000-04:00

Recently a psychologist from the Czech Republic completed a month-long training program at The Center for Family Development. I’ve been reflecting on how training professionals from other countries here at the Center, and my travels training others overseas has affected my work I’ve trained professionals from any countries: Canada, Singapore, Australia, Bermuda, Finland, and the Czech Republic. Those of you who teach may have an experience similar to mine; that teaching keeps my thinking fresh, current, and in an ongoing process of development. Having to explain and demonstrate treatment principles causes me to think about my work and the work of others in a fresh and deep way. It also prods me to read and research. Training professionals from other nations who have a different culture, history, and language has enriched my work in a number of ways. It causes me to think about the differences in:
Child Welfare policies
Child Welfare practices
Effects of different experiences on child development
Universals
The meaning of symptoms
The meaning of words

Some examples of the differences I’ve noticed in child welfare policy and practice include the following. In the US many domestically adopted children receive a subsidy from the state. This is to encourage families to adopt since adoption is preferable to “permanent” foster care. Many other nations do not provide adoption subsidies and we find that their placement rates are much lower than in the US and the length of time children spend in care is much longer. The Czech Republic uses primarily institutional care for children and not foster care. In some countries the government places children only within their community (ethnic and religious).

My travels and training at the Center have led me to think much more precisely about language. For example, some concepts and words in our language are very difficult to translate into the other language, For example, the concept “Dyadic” in Dyadic Developmental Psychotherapy cannot be translated into Finnish. I think much more precisely about language in my practice and I listen carefully to words and the many meanings of similar words. Words define and give meaning to experiences and define one’s reality. Different words lead to different meanings and different realities, even though the objective experiences may be the same in treatment now I focus a lot on the words families and children us and how that affects relationships for good and bad. For example, how often have you heard a child say, “I was bad,” instead of “I did something bad/wrong.” What a difference that represents. Or, “When I think about John and my kids,” versus “When I think about John and my other sons.” My work overseas as made me more open to ambiguity in language and to then explore that ambiguity (“What do you mean by xxxx,” or “Does that mean xxxx?”). I find that clarifying those ambiguities is helpful for development and healing. Discussing the meaning of events, experiences, and words with families and helping them discuss that among themselves seems to help increase their reflective function, empathy, and insightfulness.

Ten Take-Away Ponts

2009-08-12T16:55:00.000-04:00

People often ask me what are the main points to "take away" from my Master Class or other multi-day training programs I provide. The trainings are about Dyadic Developmental Psychotherapy, an evidence-based, effective, and empirically validated treatment and associated parenting approaches. I've come up with what I call the Ten Take-Away Points that I'd like parents and professionals to come away understanding after training:

1. Kind attributions
2. All behavior is adaptive.
a. Mental health is flexibility. Many children’s “problems” can be seen as caused by rigidity and not feeling safe.
b. Much of the child’s behavior can be explained by their being “relationship phobic.”
3. Strange or odd behavior represents our lack of empathy.
a. Is this a child who like to argue or a child who is fearful of being hurt, scared, hurt, and lacking trust?
4. It’s about connections not compliance
5. Mistakes are not a problem, lack of repair is.
6. Who owns the button?
7. Alliance is the key. Alliance is necessary to create a secure base, which is necessary to for exploration, integration, and healing.
8. Parents are the keystone.
9. How to stop a behavior? Treat the cause not the symptom. Address the underlying driver.
10. Shame, fear, anxiety underlie much.

Children with Sexual Behavior Problems

2009-08-09T18:09:00.002-04:00

Children with Sexual Behavior Problems

Arthur Becker-Weidman, Ph.D.

Children with sexual behavior problems, a broad category including such diverse behaviors as public masturbation, touching others, and aggressive behaviors, are challenging for the adults in their lives. The most recent issue of Child Maltreatment, Vol. 13, #2, May 2008 is devoted to this topic. The issue describes important material regarding assessment, treatment, policy and stereotypes.

I found the material that countered “common knowledge,” most interesting. Do children who have been sexually abused develop sexual behavior problems? Yes, they do have increased rates of sexual behavior problems (SBP), as do other children with other types of trauma. In fact exposure to violence has a much stronger association with SPB’s than does prior sexual abuse. The material makes clear that SBP’s are complex behaviors with multidimensional elements.

The issue is encouraging and supportive of our work. Several articles make the point that including the family in treatment is an important element of efficacious treatment.

The article by Mark Chaffin on policy is very interesting. The perception that youthful sex-offenders are high risk, unique and require special treatment, are homogeneous, and impossible or very difficult to treat turns out to be false. Research shows that children with SBP’s pose a low long-term risk for future child sexual abuse perpetration and sex crimes. For example, for teenage sex offenders the long-term future sex offense rates are between 5% (for those who received treatment) 15% (for those without treatment). For pre-teen children the range is 2% to 10% at ten year follow-up. At ten year follow-up the rate of sex abuse perpetration among those with SBP’s who received treatment was no different than for those children with ADHD. This and other material supports the argument that the policy issue of putting such children on public lists is simply bad policy. Other material shows that children with SBP’s do not require specialized treatment and that generally effective treatment approaches are effective for these children.

There are several other excellent articles in this issue. One describes the impact of various maltreatment experiences on sexualized behaviors. Another describes predictors of SPB’s among children with complex histories of maltreatment. There are two outcome studies and a very well written meta-analysis of treatment for children with SBP’s. Finally, the issue ends with the Report of the ATSA Task Force on Children with Sexual Behavior Problems which describes best practices for the evaluation and treatment of children with SBP’s and various policy recommendations.

In summary, this is an outstanding journal issue and it should be in every clinician’s library.

Effects of early maltreatment on development

2009-08-07T17:30:00.000-04:00

An empirical study completed by me at the Center for Family Development has just been published in Child Welfare, which is the Journal for the Child Welfare League of America. The article is

Becker-Weidman, A., (2009). Effects of Early Maltreatment on Development: A Descriptive Study Using the Vineland Adaptive Behavior Scales-II, 88(2) pp.137-161.

Children with histories of chronic early maltreatment within a care giving relationship may develop complex trauma or developmental trauma disorder and experience a variety of deficits in several domains. This study explored the effects of complex trauma on the development of 57 children, as measured by the Vineland Adaptive Behavior Scales-II. This is the first descriptive study to report on the significant discrepancies between chronological and developmental ages in adopted and foster children. This study found that adopted and foster children with a psychiatric diagnosis of reactive attachment disorder show developmental delays i the domains of communication, daily living skills, and socialization. The average adaptive behavior composite score for the children in this study yielded a developmental age (age equivalency) of 4.4 years, while the average chronological age was 9.9 years. The study describes the various delays in each domain and then discusses the implications for treatment and parenting, schools, child welfare policy, programs, and practices, and for further research.

Therapeutic Parent Manual

2009-07-28T16:02:00.000-04:00

The new Parent Manual, put out by the Association for the Treatment and Training in the Attachment of Children, is a wonderful resource for parents. It has a wealth of information and practical suggestions.

It covers many issues that children with Complex Trauma and disorders of attachment face.

copies can be ordered on Amazon.com or at www.attach.org

Complex Trauma

2009-07-24T21:33:00.000-04:00

Complex Post Traumatic Stress Disorder: Definition, Assessment, Treatment.
Arthur Becker-Weidman, Ph.D.,

Complex Post Traumatic Stress Disorder (CPTSD) is a clinical formulation (which may be included in the proposed DSM-V expected out in 2011) that refers to the results or outcomes of four simultaneous factors:
1. Chronic
2. Early
3. Maltreatment
4. Within a care-giving relationship
Maltreatment refers to abuse or neglect. Early, meaning occurring in early childhood; within the first several years of life. Chronic meaning a pervasive pattern, no a single or discrete event. Very important is that all the above occurs within a care-giving relationship. It is this last factor that makes the chronic early maltreatment so insidious and that leads to such pervasive negatives effects on later development and impairment in so many domains of functioning.
The domains of impairment include the following:
1. Attachment
2. Biology
3. Emotional regulation
4. Dissociation
5. Behavioral control
6. Cognition
7. Self-concept
As a result of pervasive impairment, assessment must be multi-modal and comprehensive in nature. This is important since “symptoms,” can have many causes and it is the cause that is the primary focus of treatment not the surface symptom. For example, anxiety can be caused by an anxiety disorder, brain trauma, PTSD, or various medical conditions. A comprehensive assessment of a child who has CPTSD must include, at a minimum, a review of all previous records, clinical sessions with the parents and with the child, and the use of various psychometric instruments to screen for a variety of issues. The areas that a through assessment must cover include: mental health differential diagnosis, sensory-integration screening, a screening for neuro-psychological issues, screening for executive function problems, attachment, developmental screening, consideration of Alcohol Related Neurological Dysfunction (ARND), and consideration of the nature and quality of the family’s interpersonal, emotional, and psychological constellation.
Children and adolescents with complex trauma require a multimodal approach (Cook, et. al., 2005), (Cook, Blaustein, Spinazzola, van der Kolk, 2003, Cook, Spinazzola, Ford, Lanktree, et. al., 2005). These authors identify six core components of complex trauma interventions, which are the following: “safety, self-regulation, self-reflective information processing, traumatic experience integration, relational engagement, and positive affect enhancement” (Cook, Spinazzola, Ford, Lanktree, et. al, 2005 p. 395).
Safety, actual safety and the client’s perception of safety, is vital for the creation of a secure base and a healthy attachment. At a minimum this must include the absence of physical danger, emotional and psychological maltreatment, and other threats to the physical, emotional, psychological, and interpersonal integrity of the child. One aspect of this includes creating an environment in therapy and at home in which coercive and shaming interactions are reduced and eliminated (Becker-Weidman, 2005).
Self-regulation is achieved in treatment by focusing on helping develop and enhance the capacity to modulate arousal in a variety of domains such as emotional, behavioral, physiological, and interpersonally. Children who have experienced chronic maltreatment and complex trauma have difficulty with self-regulation, especially with affect regulation. They can become dysregulated quite easily. The co-regulation of affective states through experiences of parent-infant attunement necessarily precedes the ability to self-regulate such states (Schore, 2001). Such attunement experiences were very infrequent for most of these children. In one relevant approach, Dyadic Developmental Psychotherapy, the practitioner expends a considerable amount of attention and energy to dyadically regulating the child’s level of arousal much like the responsive and attuned parent does (Hughes, 2007). The therapist functions to maintain a “therapeutic window” (Briere & Scott, 2006). The therapist actively works to avoid either inadequate or overwhelming activation of affect during treatment. If dysregulation occurs, the therapist acts swiftly to re-regulate the child, repair the relationship, and achieve emotional safety and balance.
Self-reflective information processing is achieved in treatment by developing and maintaining the shared affect, attention, and intentions that characterize intersubjectivity (Hughes, 2007). Through these intersubjective experiences the therapist and caregiver assist the child in exploring past events again so that the experience of them can be reorganized. With these additional perspectives of the event, the child is much more able to reflect on it with new meaning and less terror and shame.
Traumatic experience integration can be achieved in treatment by using such techniques as the judicious use of psychodramatic re-enactments, role-playing, and the reading of relevant historical documents such as police reports (Becker-Weidman, 2006). Again, these interventions are only employed within the intersubjective context, with the need for psychological safety remaining primary.
Relational engagement is achieved in treatment by its emphasis on acceptance and by developing and maintaining a therapeutic alliance with all family members. The child’s frequent avoidant or controlling behavioral patterns are likely to decrease when these are also met with acceptance. These defensive patterns are understood as viable coping strategies when the child has not been able to turn to attachment figures for safety. Engaging the child in a reparative relationship therapeutically and at home is an important dimension of complex trauma treatment.
Positive affect enhancement is achieved in treatment by the playful attitude of the therapist. In addition, the therapist’s acceptance of the caregiver’s and child’s feelings and motives and the development of a deep level of empathy enhances self-worth. The positive regard with which the practitioner of Dyadic Developmental Psychotherapy holds the family underscores their intrinsic worth as valued and valuable, as loved and loveable individuals (Becker-Weidman & Shell, 2005), (Hughes, 2007).

REFERENCES
Becker-Weidman, A. (2005). Dyadic Developmental Psychotherapy: the theory. In A. Becker-Weidman & D. Shell (Eds.), Creating capacity for attachment (pp. 7-43). Oklahoma City, OK: Wood ‘N’ Barnes.
Becker-Weidman, A. & Shell, D. (Eds.) (2005). Creating capacity for attachment (pp. 7-43). Oklahoma City, OK: Wood ‘N’ Barnes.
Becker-Weidman, A., (2006 c). Treatment for children with Reactive Attachment Disorder: Dyadic Developmental Psychotherapy. Child and Adolescent Mental Health, Online electronic version, 11/21/2006, doi: 10.1111/j.1475-3588.2006.00428.x
Briere, J., & Scott, C. (2006) Principles of trauma therapy. NY: Sage.
Cook, A., Blaustein, M., Spinazolla, J., van der Kolk, B. (2003) Complex trauma in children and adolescents. White paper from the national child traumatic stress network complex trauma task force. Los Angeles, CA: National Center for Child Traumatic Stress.
Cook, A., Spinazzola, J., Ford, J., Lanktree, C., et. al. (2005) Complex trauma in children and adolescents. Psychiatric Annals, 35:5, 390-398.
Hughes, D., (2007), Attachment-Focused Family Therapy. NY: Norton.
Schore, A.N. (2001). The effects of early relational trauma on right brain development, affect regulation, and infant mental health. Infant Mental Health Journal, 22, 201-269.

Master Class in Dyadic Developmental Psychotherapy

2009-07-18T07:44:00.002-04:00

A new Master Class for Therapists is planned for 2010.
This class is designed to teach therapists how to provide Dyadic Developmental Psychotherapy, which is an evidence-based, effective, and empirically validated treatment.

MASTER CLASS

Dyadic Developmental Therapy
(An attachment-based therapy)

Training for Therapists in the Treatment of Children with Trauma-Attachment Problems

2010

This workshop is for professionals who have a working knowledge of attachment, how it develops, how attachment disorders develop, and a general knowledge of treatment principals and attachment theory.

Early deprivation, neglect, abuse, significant early health problems and hospitalizations, repeated moves, or more than one year in an orphanage can create attachment problems that require specialized treatment. Traditional forms of therapy are ineffective with attachment-disordered children. This workshop will provide the therapist and other professionals with an opportunity to learn and practice effective treatment methods for trauma-attachment disordered children.

Participants are encouraged to bring in videotapes of sessions or to make arrangements to have a family attend a session for a consultation with the therapist and Dr. Becker-Weidman. .

Dyadic Developmental Psychotherapy is an evidence-based treatment, effective, and empirically validated treatment that is grounded in current thinking and research on the etiology and treatment of Complex Trauma or Developmental Trauma Disorder. Treatment had an educational dimension, designed to help parents understand their child’s attachment disorder: how the child feels and thinks, and the child’s internal psychological dynamics. Second, teaching parents about attachment-facilitating parenting methods and the importance of attunement and responsive, sensitive parenting is essential. Direct work with the parents regarding their own family or origin issues is another componen5t of treatment. Finally, intensive emotional work with the child in a manner consistent with sound treatment principles is vital.

The workshop is led by Dr. Arthur Becker-Weidman, who is certified by the Dyadic Developmental Psychotherapy Institute as a certified Dyadic Developmental Psychotherapist, Certified Consultant, and Certified Trainer. This workshop provides training hours that may be used by the participant to meet the required training hours necessary to become a Certified Dyadic Developmental Psychotherapist.

Purpose of Workshop

This workshop is for therapists who want to learn how to treat trauma-attachment disordered children. Participants will learn effective therapy principals for helping traumatized children. Participants will learn:

Initial assessment and treatment planning.

Beginning, middle, and ending phase interventions.

Developing attunement and maintaining attunement.

Practical implications of the relationship between neurobiology and attachment.

Effective therapeutic techniques to use with traumatized and attachment disordered children.

Effective parenting principals.

Participants will have the opportunity to view videotapes of actual therapy sessions with traumatized children that demonstrate therapeutic principals, present their own video tapes or bring in a client for a consultation, and view live therapy sessions.

SCHEDULE

A Six-month 42-hour Master Class.
10:00 am – 5:00 pm, March 27 – August 28, 2010 (3/27, 4/24, 5/22, 6/26, 7/24, 8/28). The schedule may be adjusted if all the participants agree, so contact the office for the most current schedule. Limited to 7 professionals.

OUTLINE

Evaluation & parenting preparation.
First session, beginnings, attunement, and managing resistance.
Neurobiology of interpersonal experience
Middle phase issues & psychodrama
Facilitating parent-child attachment
Complex Post Traumatic Stress Disorder.
Ending phase issues.

The treatment presented has demonstrated effectiveness. A follow-up study (see our website) clinically and statistically significant reductions in symptoms of attachment disorder, aggression, anti-social behavior, thought disorders, attention problems, mood, and social relationship dysfunction. Over 80% of the children treated had previously been in treatment on three or more occasions, without any noticeable improvement. Dyadic Developmental Psychotherapy produced measurable and stable improvements. Treatment averaged 23 sessions over approximately ten months. (Arthur Becker-Weidman, Ph.D., Child & Adolescent Social Work, vol. 23, pp.137-171, 2006)

Click here for the brochure. http://www.center4familydevelop.com/2010MasterClass.pdf

Orphan: boycott

2009-07-06T18:09:00.001-04:00

The bad press this movie is getting is heating up as more and more adoption groups and outraged parents voice their objections to this movie.

I encourage people to contact Warner Brothers. More to the point, I encourage you to contact your local theater and request that they do not screen the movie. Getting many people to contact the theater and to state that you will not attend that theater as long as that movie is showing may get them to not screen the film.

Editorials in the local paper would also help.

Orphan: A movie to boycott

2009-07-05T17:40:00.000-04:00

Warner Brothers is releasing a movie that is already evoking serious concern among adoption groups, mental health professionals, and others in the child welfare system. "Orphan" presents the story of an adopted child who is "damaged goods" and is violent and aggressive toward her adoptive family while appearing sweet and innocent to others. She is presented as a calculating, cunning child whose intention is to hurt her new family.

Children with complex trauma or disorders of attachment may be aggressive, violent, and difficult to live with. However their behavior is usually grounded in fear. Their early experiences may have "taught" them that relationships and intimacy are to be feared and avoided because these are inconsistent, painful, and not helpful.

This movie is a grounded in the myth that adopted children are emotionally disturbed because of "bad genes," and so there is not hope. Nothing could be further from the truth. See: "Brown University Child and Adolescent Behavior Letter" (Demick, K.( 2007) "Challenging the common myths about adoption". Vol. 23 (4), p. 8).

Complex trauma often results in impairment in several domains and must be treated with effective, evidence-based, and empirically validated treatments, such a Dyadic Developmental Psychotherapy. How long the child has experienced maltreatment is a major factor in outcome. In addition, the adoptive parent's understanding of the early trauma and how that effects later behavior is also key to a good outcome. For older children "usual" or "automatic" parenting is usually not good enough and some form of therapeutic parenting is necessary (see Creating Capacity for Attachment edited by Arthur Becker-Weidman & Deborah Shell). The research is clear that the factors associated with "placement stability," include the caregiver's commitment, sensitivity, insightfulness, and state of mind with respect to attachment.

This film sends the wrong message. It is also based on incorrect data and information regarding the effects of early trauma on child development and what parents can do.

Boycott this film.

The Boy Who Was Raised as a Dog

2009-07-04T09:21:00.001-04:00

BOOK REVIEW
The Boy Who was Raised as a Dog by Bruce Perry & Maia Szalavitz, Basic Books, NY, 2006.

This terrifically engaging and readable book can be thought of as the case-book companion to Dr. Daniel Siegel’s The Developing Mind. Dr. Perry and Ms. Szalavitz, an award winning writer, present eleven stories, hence the subtitle: “And other stories from a Child Psychiatrist’s Notebook. What traumatized children can teach us about loss, love, and healing.” In this book each story describes a child’s trauma, how this affected the child, and what could be done about that. Much of what Dr. Perry presents may not be new, but the manner in which his insights are woven into these stories is wonderful. A major theme is how early maltreatment dysregulates the stress-response system and how this state eventually becomes a trait. He peppers the book with some very interesting tidbits…such as that many children who have experienced chronic early trauma have elevated resting heart rates. This is one of those things that, after reading, I said, Oh, I think I new that, but never really thought about it. (BTW, this helps explain why and how the blood pressure medication, Clonadine can sometimes be helpful for children who experience Complex Post Traumatic Stress Disorder.) When I began asking the families I see to take the pulse of their children while the child was asleep, a large percentage (over half!) reported resting pulse rates of over 110 bpm.

The book emphasizes and underscores the power of relationships to wound and heal. “To calm a frightened child, you must first calm yourself.” This simple and profound statement is echoed throughout the book and can be considered one of the cornerstones of good parenting and treatment. In another section of the book, “The Coldest Heart,” he describes how many traumatized children have a large split between verbal and performance scores and how this reflects imbalances in the brain’s capacity to modulate affect. Although this, and other insights, may seem esoteric, it is the way these insights are woven into very touching stories that make the material memorable and usable.

Each story is both delightful and horrifying to read. Dr. Perry’s compassion and insights are models of how a therapist should act. The stories include the Branch Davidian children and some other famous cases. This is a must read book that should be in every clinician’s bookcase. I have also begun recommending it to parents, who are finding the insights presented very helpful in understanding their child and developing better ways of managing their own feelings.

Children with Sexual Behavior Problems

2009-06-24T08:47:00.001-04:00

Children with sexual behavior problems, a broad category including such diverse behaviors as public masturbation, touching others, and aggressive behaviors, are challenging for the adults in their lives. The most recent issue of Child Maltreatment, Vol. 13, #2, May 2008 is devoted to this topic. The issue describes important material regarding assessment, treatment, policy and stereotypes.

I found the material that countered “common knowledge,” most interesting. Do children who have been sexually abused develop sexual behavior problems? Yes, they do have increased rates of sexual behavior problems (SBP), as do other children with other types of trauma. In fact exposure to violence has a much stronger association with SPB’s than does prior sexual abuse. The material makes clear that SBP’s are complex behaviors with multidimensional elements.

The issue is encouraging and supportive of our work. Several articles make the point that including the family in treatment is an important element of efficacious treatment.

The article by Mark Chaffin on policy is very interesting. The perception that youthful sex-offenders are high risk, unique and require special treatment, are homogeneous, and impossible or very difficult to treat turns out to be false. Research shows that children with SBP’s pose a low long-term risk for future child sexual abuse perpetration and sex crimes. For example, for teenage sex offenders the long-term future sex offense rates are between 5% (for those who received treatment) 15% (for those without treatment). For pre-teen children the range is 2% to 10% at ten year follow-up. At ten year follow-up the rate of sex abuse perpetration among those with SBP’s who received treatment was no different than for those children with ADHD. This and other material supports the argument that the policy issue of putting such children on public lists is simply bad policy. Other material shows that children with SBP’s do not require specialized treatment and that generally effective treatment approaches are effective for these children.

There are several other excellent articles in this issue. One describes the impact of various maltreatment experiences on sexualized behaviors. Another describes predictors of SPB’s among children with complex histories of maltreatment. There are two outcome studies and a very well written meta-analysis of treatment for children with SBP’s. Finally, the issue ends with the Report of the ATSA Task Force on Children with Sexual Behavior Problems which describes best practices for the evaluation and treatment of children with SBP’s and various policy recommendations.

In summary, this is an outstanding journal issue and it should be in every clinician’s library.

Bringing Your Child Home from the Orphanage: ideas

2009-06-20T16:06:00.000-04:00

Generally, infants adopted before the age of six months fare no differently than infants raised from birth. However, after six months, the effects of institutional care begin to emerge. It is important to realize that even the best orphanages are not good places to raise a child. In NY state the infant-care giver ratio required by regulation for infant day care is no more than two infants per care provider...so 5:1 is better than 10:1, but still it won't help the child develop a normal, healthy, and secure attachment to a specific figure, which is what the attachment system is supposed to do. Several visits during a year won't make much of any difference on your child's development or on this most important process.

That being said, it is also important to remember that children are rather "plastic" and that attachment develops during the first two to three years of life. So, you will need to do some work when you bring your child home to make up for the early deprivations that your child has experienced.
1. It is best to make the room as similar to the orphanage as possible to make for an easier transition.
2. Serve the same foods at first.
3. Keep ALL others at a distance for the first several weeks to months so your child develops a specific and unique bond with you.
4. It would be best for you to spend the first two to three months at home constantly with the child; carrying the child and physically being present to meet the child's needs and to develop a affectively attuned relationship that will allow you to anticipate your child's needs and meet those, as well.

1) YOU, AND ONLY YOU, WEAR YOUR BABY!! Carry them with you wherever you go, and whatever you do. (Unless dangerous) Attach them to your bodies. A great baby carrier is one that the baby can have skin to skin contact with you – Baby Trekker (1-800-665-3957) is a good one. Carry the baby on your hip; tie to your body under a sweatshirt, front carrier, or in your arms. The more contact the better. These babies were not held enough. Hold Them!!!! A LOT!!! ALL THE TIME!!!! For the rare times the baby is not in your arms, have them in the same room as you are in.

2) YOU ARE THE ONLY CAREGIVER!! You always bottle, feed, bath, dress, change and most of the play. If friends and family want to help let them walk the dog or clean your house, wash bottles or do laundry, bring food or make you tea. No baby-sitters and no sending the baby away for respite. Until your baby is firmly emotionally attached to you, NO ONE the baby doesn't see daily should hold or even touch him or her, and even those that the baby sees daily should hold him or her at a very minimum.

3) KEEP THE BOTTLE AS LONG AS POSSIBLE –EVEN LONGER! You, not the baby, hold the bottle. You can hold the bottle with your chin so you have two hands to snuggle your baby close to you. One handed it also fine. Hold the child the way a nursing mother does – chest to chest, close to you with as much skin-to-skin contact as possible. Look your baby in the eyes and when they do, instantly put the bottle in their mouth and tell them good job!! Keep looking at their eyes so when they are ready for eye contact, you don't miss it. Note: some babies with sensory-integration difficulties may find eye contact too stimulating and it may actually be disruptive to the child.

4) BATHE WITH YOUR BABY; this encourages skin-to-skin contact in a nice relaxing warm fun way.

5) A LOT OF FACE-TO-FACE baby games and funny faces and TONS of smiles and kisses!! Paint bright circles around your eyes. Close one eye, then the other, rapidly blink, and then change speeds, all the time with funny noises. Cover both eyes then one, and so on. Have the baby sit on your lap, and if this is too hard for them at first, lay them on a bed to do it. Then slowly trick them into letting you touch and hold them!! Keep it fun for them.

6) WHEN THERE IS A GREAT DEAL OF ANGER OR AVOIDANCE, the baby NEEDS you to hold them, even if they don't WANT to be held. They feel so far away from you, and have to be brought closer to heal. Cradle the baby in your arms. Have their arm closest to you held close. Talk soothingly to them, and tell them to look in mommy's eyes. They most likely won't at first, and will become very angry, (actually they were already very angry, the anger is just allowed to come out in a safe loved way) other times in their life they were not able to get their needs met; anger and avoidance came out of that. They were often ignored, hit, or yelled at. That is why it is SO IMPORTANT this ALL be done in an extremely loving way. Never squeeze the baby too close, speak harshly, lose your cool or forget why you are doing this. If you get to feel their anger, immediately put them down and call support. You have to remain supportive, yet expect their best. They may try to hit you, scratch, bite, scream and get to you any way they can. Their intense rage is there. Yes, even little babies. Eye contact, feeling safe, and being accepted no matter what in a loving way is the goal here. For whatever reason, they have shut off people. Now they need YOU to heal. Rub them, soothe them in singing, and soft speech, rock them and tell them you love them. Keep it up until they will calm down and look in your eyes and FEEL connected to you. At times they will fall asleep screaming. If so, and if possible, continue to hold them until they wake up, and then continue above. If you need to lay them down, have a monitor on so you can pick them up as soon as they wake up. For the very avoidant baby one unsolicited eye contact a week could be considered good! Keep it up; you have several good eye contacts a minute to look forward to! Remember, you did not create this anger in your baby.

7) NOW IS THE BEST AND EASIEST TIME TO WORK WITH YOUR BABY.

8) DO A LOT OF BABY MASSAGES. For the real avoidant baby, a half-hour. Each day you delay, the harder it is for them and you. Attachment issues do NOT just go away on their own. They only get worse. Twice a day would be minimum. All the time talk, sing and let that baby know how special they are!! Most of the babies seem to really enjoy this, and my daughter would even get out the lotion as soon as she could reach for it!!

9) ROCK THAT BABY!! They often can't stand you sitting in a rocking chair, but can often tolerate and enjoy you walking and dancing with them in your arms. (Remember face-to-face contact during this) Gentle motion, bouncing and rocking are a must!!

10) SLEEP WITH THE BABY. If you can, the best is to have the baby in your bed close to you. Second choice is to have the baby in their crib right next to your side of the bed with the side rail down. Have the crib touching snug to your bed, so if they climb out, they climb safely onto you!! They need t hear your breathing and know you are close. Yet for someone over one, you get special permission (in writing) to have him or her sleep in your room for mental health reasons. Should not be a big problem. Have the baby always fall asleep in your arms. Nap or night. They need to get used to feeling loved!!

11) SING, SING, SING!!! It lightens the load, and helps the baby feel the happy friendliness they missed out on. Joyful voices are so important!

12) ENCOURAGE EYE CONTACT WHEN FEEDING, BOTTLING, TALKING, CHANGING, AND ALL THE TIME!!

13) EXPECT A DIRTY HOUSE, soup out of the can and sandwiches for supper and piles of laundry. Know that you are not super mom, and that baby can't wait until all is in order to get on with their lives. Here is where all those well-meaning friends that want to hold that precious baby come in!! Let them work!!!

14) EXPECT TO BE CRITICIZED AND ACCUSED as over possessive, spoiling the baby, and making more than you should out of the baby's problems. You will be told all babies do that. This is by well meaning friends, neighbors, relatives, doctors, and social workers. Stick to what YOU KNOW the baby needs, and fight to get that for them. Remember YOU know that baby more than anyone else.

15) HAVE A GREAT SUPPORT SYSTEM. Have a trusted friend (hopefully someone who has had experience in attachment disorder) that you can call without being told you are making too much of it. Read books on attachment disorder. Know what dangers await that baby if they are not helped. Working with an infant or toddler has such a HUGE chance for success!! Not one act of kindness is wasted.

16) GET AN OFFICIAL EVALUATION BY AN ATTACHMENT EXPERT.
That way in court and with workers you do have leg to stand on in getting these babies what they need!!! It is a lot easier when you have a well-respected expert stick up for you.

17) KNOW YOU NEITHER CREATED YOUR BABY'S PROBLEMS, NOR CAN YOU CURE THEM. Your job is to give the baby the tools they need. The rest is up to them.

18) FOR THE BABY THAT HAS NOT YET ENTERED YOUR HOME – when you get that baby, get a piece of clothing or blanket unwashed and used recently by the primary caregiver. The smell will help the move. And don't you wash it!! Keep it close to the baby to help the baby adjust. No matter the baby's age or living conditions, the move to you is not easy. Never push this object, but make it available.

19) HELP YOUR BABY WITH A TRANSITIONAL OBJECT. This is a blanket or soft toy they can sleep with, use it in the car seat, and for the RARE time you cannot be with them. Helps in security.

21) IF YOU DO ALL OF THESE WITH LOVE AND KINDNESS AND THINGS GET WORSE OR REMAIN THE SAME, GET HELP.

What I've learned by working overseas

2009-06-16T11:32:00.000-04:00

When your infant doesn't make eye contact

2009-06-14T09:47:00.000-04:00

“Have that baby that won't look at your face, even if standing on your head? Will look at your mouth or nose, yet not your eyes, especially when you are holding them? That baby that won't snuggle deep in your arm? That baby that you just don't FEEL cares if you are around or not, or seems to care until you pick them up? Doesn't cry or coo? Frets and whines a lot? Very withdrawn or passive? Has poor muscle tone? Slow to creep, crawl or sit up? Is called a "too good baby?”” While some may state that if your infant shows these behaviors that your infant has, “signs of attachment disorder, this may or may not be true. The prescription to hold such a child even if the child does not want to be held may actually be damaging to your infant. Such advice falls into the all too common error of making a “diagnosis” based on only on behaviors.

Why might a child have difficulty making eye contact, be irritable when snuggled, fret, have poor muscle tone, be slow to creep, crawl, or sit up? Certainly chronic maltreatment, such as neglect, abuse, or institutional care may be one cause. Such care may create attachment difficulties. However, such care may also cause sensory-integration difficulties. Furthermore, the behaviors mentioned may also be caused by prenatal exposure to alcohol or other chemicals, neurological disorders, or other causes. In each instance, the appropriate and effective intervention is different. Forcing a child to look at you or forcing physical contact when a child has a sensory disorder may actually make things worse. With a sensory-defensive child you would want to begin gently encouraging and facilitating a variety of sensory experiences. In addition, you would probably be implementing a number of sensory exercises under the direction of an Occupational Therapist who is SIPT (Sensory Integration Praxis Test) certified. If your child’s difficulties were caused by prenatal exposure to alcohol or other chemicals, then you would want to begin an early intervention program. The important point I’d like to make is that before your assume that your child has an attachment disorder and then treat that disorder, that you get a thorough assessment. This way you can be sure that you are treating the actual cause of the behaviors and not merely the symptoms, which as I described, can stem from many different causes and which require different interventions.

Where to start? Well, one place is to discuss the problem with your pediatrician. You may then want to consult with a developmental pediatrician or a pediatric neurologist. A good place to start is with your regional Children’s Hospital or University Hospital Pediatric Department. For sensory-integration concerns you will want to consult with an Occupational Therapist who is SIPT certified. Be sure that the professional you consult with has significant experience and training evaluating infants such as yours (from an overseas orphanage, chronically abused or neglected, prenatally exposed to alcohol, etc.).

RESOURCES:
1. The Out of Sync Child by Carol Stock Kranowitz, 1998.
2. The Out of Sync Child Has Fun by Carol Stock Kranowitz, 2003.
3. Understanding Your Child’s Temperament. William Carey, 1997.
4. Becoming a Family. Lark Eshleman, Ph.D., 2003.

Brain Research on Wisdom: Implications for Attachment

2009-06-12T09:28:00.000-04:00

Thomas Meks and Dilip Jeste, two neuroscientists at the University of CA at San Diego have completed a detailed "meta-analysis" of several decades worth of research and have found that many of the characteristics that we associate with wisdom (social decision making, control of emotions, balancing competing values and objectives, etc) may be accounted for by the activity of just a few brain regions. They term this the "wisdom network."

The anterior cigulate cortex is one part of this network. It detects conflicts and makes decisions. Recently psychologists at Stanford U found that activity in this region predicts how we balance short term and long term rewards. Wisdom involves both logical calculations and the influence of emotions, feelings, and instincts. For this we turn to the ventromedial prefrontal cortex, among other regions of the brain. A recent study from the U of Iowa and Caltech found that damage to the ventromedial prefrontal cortex made people less susceptible to guild and led to poor social decision making.

What does this mean for attachment, trauma, and treatment? Well, we know that these, and other important areas of the brain are heavily influenced by early childhood experiences and that chronic early maltreatment within a caregiving relationship (Complex Trauma) result is poorer functioning and integration of these and other significant areas of the brain (See Daniel Siegel's and A. Shore's seminal works on the influence of attachment and brain development and functioning for more details). In other words, early experiences affect the development of patterns of attachment and affect brain development. The integration of various systems of the brain involved in assessing and managing relationships, emotions, and other "executive functions," is directly affected by early parent-child relationships. The implications of this for assessment, treatment, child welfare policies and practices is obvious. Early relationships have a long-term and significant impact on latter development and functioning because of the effects of these experiences on brain development and integration.

Brain Research on Wisdom: Implications for Attachment

2009-06-12T09:06:00.004-04:00

Attachment and Autism

2009-06-03T06:18:00.000-04:00

let me answer your last question first. "Attachment Disorder" is a loosely defined term with wide variation in meaning. The five categories of patterns of attachment used in the research with adults (Secure, Avoidant, Preoccupied, Disorganized, and Cannot Classify) are research categories not clinical diagnoses. Same for the corresponding patterns defined by the Strange Situation Procedure (Mary Ainsworth).

Autism and Reactive Attachment Disorder a distinct disorders with distinct diagnostic criteria (DSM IV) and that require different treatments and approaches. One is caused by chronic early maltreatment within a caregiving relationship; the other is more of a neuological disorder).

The books you've mentioned I'm not familiar with. If you do want a good orientation to Attachment Theory and Attachment Research, let me suggest any of the following book:

1. Becker-Weidman, A., & Shell, D., (Eds.) (2005), Creating Capacity for Attachment, Wood ‘N’ Barnes, Oklahoma City, OK.
2. Handbook of Attachment: Theory, Research, and Clinical Applications 2nd Edition. Edited by Jude Cassidy and Phillip Shaver. The Guilford Press, 2008.
3. A Secure Base. John Bowlby, Basic Books, NY, 1988.
4. John Bowlby & Attachment Theory. Jeremy Holmes, Routledge, NY, 1993.
5. Parkes, C.M., Stevenson-Hinde, J., & Marris, P., (Eds.), (1991). Attachment Across the Life Cycle, Routledge, NY.

If you are interested in evidence-based, effective, and empirically validated treatments for Reactive Attachment Disorder and Complex Trauma, you could look at:

1. Becker-Weidman, A., & Shell, D., (Eds.) (2005, second printing 2008) Creating Capacity for Attachment.
2. Becker-Weidman, A., (2007) “Treatment For Children with Reactive Attachment Disorder: Dyadic Developmental Psychotherapy,” http://www.center4familydevelop.com/research.pdf
3. Becker-Weidman, A., (2008) "Treatment for Children with Reactive Attachment Disorder: Dyadic Developmental Psychotherapy" Child and Adolescent Mental Health Volume 13, No. 1, 2008, pp. 52-60.
4. Becker-Weidman, A., (2009) “Effects of Early Maltreatment on Development: A Descriptive study using the Vineland,” manuscript submitted for publication.
5. Becker-Weidman, A., & Hughes, D., (2008) “Dyadic Developmental Psychotherapy: An evidence-based treatment for children with complex trauma and disorders of attachment,” Child & Adolescent Social Work, 13, pp.329-337.
6. Hughes, D., (2008). Attachment Focused Family Therapy.

Also the folloiwng links may help:

http://psychology.wikia.com/wiki/Main_Page

You can then look at articles about Attachment theory, Reactive Attachment Disorder, Dyadic Developmental Psychotherapy, Attachment disorder, etc.

I hope this helps.

regards. I look forward to hearing back from you.

Temperament

2009-05-31T09:55:00.001-04:00

Temperament is a largely genetically determined set of characteristics that remain unchanged from birth throughout life. Beginning as early as four months of age, a child’s temperament can be determined. These temperamental traits are largely unchanged throughout life. Understanding temperament is important since these personality traits do not change. A parent needs to understand these dimensions so that the parent can adapt to the child.

Temperament refers to enduring traits of a person’s approach to the world. These dimensions are found in all children across cultures. A child’s temperament is a core element of the child’s personality. Since it is unchangeable, understanding temperament is essential to knowing how to approach your child. What may appear to be a problem may actually be a mismatch between your temperament and that of your child.

1. ACTIVITY LEVEL: Physical motion during sleep, play, work, eating, and other daily activities.
(High or Low; Active or Inactive).

2. REGULARITY: The predicable recurrence of a child’s response to daily events. The rhythm of their body functions such as sleeping, eating, elimination. In school age children, regularity is observed as consistency, organization, or predictability. Is the child orderly with toys and possessions? Is the child’s after-school routine the same each day?
(Predictable or Unpredictable).

3. INITIAL REACTION: The child’s reaction to new people, places, things, foods, and routines. For example, tries new foods, refuses, or looks it over, pokes it, and then tries a bite.
(Bold or Inhibited; Approaching or Cautious).

4. ADAPTABILITY: Like initial reaction, but refers to the child’s long-term adjustment after the initial response. The ease or difficulty with which the child’s first reaction can be changed. How quickly does the child make transitions or adapt to changes in routine? How quickly can the child make a choice? How does the child react to last minute changes?
(Flexible or Rigid; Quick or Gradual).

5. INTENSITY: How much energy the child puts into a response. Is the child loud? How does the child respond to disappointments, praise, failure, surprise, or frustration?
(Intense or mild).

6. MOOD: What is the child’s dominant mood or overall pattern? Is the child generally positive, negative, or in between?
(Positive or Negative).

7. DISTRACTIBILITY: Is the child able to tune out surrounding sights, sounds, or people and continue without interruption or is the child distracted by outside stimuli? This is not the same as persistence. A child can be easily distracted yet return immediately to the task at hand and stick with it until it is completed. How quickly can a baby be soothed?
(Rarely or Often)

8. PERSISTENCY AND ATTENTION SPAN: Persistency is the child’s tendency to stick with an activity despite interruptions or outside distractions. Attention span is demonstrated by how long a child sticks with an activity when there are no interruptions.
(Often or Rarely; Persistent or not; Short or long).

9. SENSITIVITY: Sensory threshold or the amount of stimulation required to get a response. Watch all five senses (sight, hearing, touch, smell, taste).
(Nonreactive or Sensitive).

TEMPERAMENT CHECKLIST

Temperament is composed of nine dimensions. Temperament is easily determined at birth and does not change; it appears to be genetically determined. Temperament can be thought of as one of the basic elements of personality that is not changeable. It is not right or wrong, it just is; although temperaments different than one’s own can seem to be “wrong,” they are not. At the Center we use the Cary Temperament Scales to measure a child’s temperament and provide parents with a report detailing their child’s temperament and the potential strengths and pitfalls that the parent and child may experience. The traits on each continuum are neither good nor bad. However, mismatches between a parent’s and child’s temperament can create discord and problems. The following check list is not meant to replace a professional assessment or to substitute for a reliable and valid test such as the Cary. However, this check list can help you identify areas of match and mismatch between your temperament and that of your child.

The fact that you have temperament traits on the other side of a scale item form your child, or spouse for that matter, does not mean that a problem exists. It merely means that you and your child have different temperaments on that dimension. It does mean that as a parent you do need to be particularly sensitive to that dimension since your proclivities and those of your child are different. However, as a parent it is your responsibility to adapt to these differences and accommodate your child. Knowing that you and your child differ on a dimension of temperament, which is not a changeable dimension of personality, allows the parent to know that he or she must adapt to the child. This also can help a parent realize that when a child is “pushing” your buttons, that it is your issue and not something that your child should be expected to change. When there are significant differences in parent-child temperament, the parent will need to take extra steps to be sure that he or she adapts to the child.

Therapeuctic Crisis Intervention

2009-05-20T16:07:00.002-04:00

I found this article quite interesting and valuable:

Josh Lechter, assistant director of child care for the Community-Based Acute Treatment program at Walker, has written a paper featured in the most recent issue of Refocus, the Residential Child Care Project newsletter published by Cornell University.tci

His paper, Using TCI’s Family Care Provider Training To Break Down Language Barriers Between Residential Treatment and Life at Home, discusses the success of a new initiative at Walker to share therapeutic crisis intervention training and techniques with the families of Walker students.

Therapeutic Crisis Intervention For Family Care Providers (TCIF) is a curriculum-based class adapted from the same crisis prevention and behavior management skills taught to The Walker School staff. Developed by the The Family Life Development Center at Cornell University, the 5-day course involves modeling and role playing to familiarize family members with strategies and techniques for deescalating problems and emotionally volatile situations with their children at home. According to the developers at Cornell, Walker is the first organization to offer TCIF training to the families of children with serious emotional and behavior issues.

Judging from the enthusiastic response of participating families, the availability of this specialized training for parents and caregivers will help to improve the likelihood of a child’s successful transition from residential treatment to home and community. In the paper, Lechter recounts the comments of several grateful parents, including one who said, “the course was a blessing. I now do not feel alone in helping my children with their mental health needs.”
See this article for more details

http://www.walkerschool.org/upload/REFOCUS_VOL_14.pdf

Learning Disabilities Explained

2009-05-20T08:39:00.002-04:00

Noah felt like he was always hitting the books. While his friends were meeting for pickup soccer games after school, he was back home in his room reading and rereading the same material. But no matter how hard Noah studied, he had difficulty remembering things and his grades stayed average. Meanwhile, his friend Sean, who never seemed to study, always aced tests. It didn't seem fair.

Because Noah was so frustrated, his dad and teachers made an appointment with the school psychologist. She diagnosed Noah with a learning disability. Although Noah felt relieved to know what was going on, he was also worried. He didn't like the "disability" label. And he was concerned about what it might mean for his future. Would he be able to go to college and study engineering as he'd hoped?

What Are Learning Disabilities?

For someone diagnosed with a learning disability, it can seem scary at first. But a learning disability doesn't have anything to do with a person's intelligence - after all, such successful people as Walt Disney, Alexander Graham Bell, and Winston Churchill all had learning disabilities.

Learning disabilities are problems that affect the brain's ability to receive, process, analyze, or store information. These problems can make it difficult for a student to learn as quickly as someone who isn't affected by learning disabilities. There are many kinds of learning disabilities. Most students affected by learning disabilities have more than one kind. Certain kinds of learning disabilities can interfere with a person's ability to concentrate or focus and can cause someone's mind to wander too much. Other learning disabilities can make it difficult for a student to read, write, spell, or solve math problems.

The way our brains process information is extremely complex - it's no wonder things can get messed up sometimes. Take the simple act of looking at a picture, for example: Our brains not only have to form the lines into an image, they also have to recognize what the image stands for, relate that image to other facts stored in our memories, and then store this new information. It's the same thing with speech - we have to recognize the words, interpret the meaning, and figure out the significance of the statement to us. Many of these activities take place in separate parts of the brain, and it's up to our minds to link them all together.

If, like Noah, you've been diagnosed with a learning disability, you're not alone. Nearly four million school-age children and teens have learning disabilities, and at least 20% of them have a type of disorder that makes it difficult to focus.

What Are the Signs of Learning Disabilities?

You can't tell by looking that a person has a learning disability, which can make learning disabilities hard to diagnose. Learning disabilities typically first show up when a person has difficulty speaking, reading, writing, figuring out a math problem, communicating with a parent, or paying attention in class. Some kids' learning disabilities are diagnosed in grade school when a parent or a teacher notices a kid can't follow directions for a game or is struggling to do work he or she should be able to do easily. But other kids develop sophisticated ways of covering up their learning issues, so learning disabilities don't show up until the teen years when schoolwork - and life - gets more complicated.

Most learning disabilities fall into one of two categories: verbal and nonverbal.

People with verbal learning disabilities have difficulty with words, both spoken and written. The most common and best-known verbal learning disability is dyslexia, which causes people to have trouble recognizing or processing letters and the sounds associated with them. For this reason, people with dyslexia have trouble with reading and writing tasks or assignments.

Some people with verbal learning disabilities may be able to read or write just fine but they have trouble with other aspects of language. For example, they may be able to sound out a sentence or paragraph perfectly, making them good readers, but they can't relate to the words in ways that will allow them to make sense of what they're reading (such as forming a picture of a thing or situation). And some people have trouble with the act of writing as their brains struggle to control the many things that go into it - from moving their hand to form letter shapes to remembering the correct grammar rules involved in writing down a sentence.

People with nonverbal learning disabilities may have difficulty processing what they see. They may have trouble making sense of visual details like numbers on a blackboard. Someone with a nonverbal learning disability may confuse the plus sign with the sign for division, for example. Some abstract concepts like fractions may be difficult to master for people with nonverbal learning disabilities.

A behavioral condition called attention deficit hyperactivity disorder (ADHD) is often associated with learning disabilities because people with ADHD may also have a hard time focusing enough to learn and study. Students with ADHD are often easily distracted and have trouble concentrating. They may also be excessively active or have trouble controlling their impulses.

What Causes Them?

No one's exactly sure what causes learning disabilities. But researchers do have some theories as to why they develop. They include:

Genetic influences. Experts have noticed that learning disabilities tend to run in families and they think that heredity may play a role. However, researchers are still debating whether learning disabilities are, in fact, genetic, or if they show up in families because kids learn and model what their parents do.
Brain development. Some experts think that learning disabilities can be traced to brain development, both before and after birth. For this reason, problems such as low birth weight, lack of oxygen, or premature birth may have something to do with learning disabilities. Young children who receive head injuries may also be at risk of developing learning disabilities.
Environmental impacts. Infants and young children are susceptible to environmental toxins (poisons). For example, you may have heard how lead (which may be found in some old homes in the form of lead paint or lead water pipes) is sometimes thought to contribute to learning disabilities. Poor nutrition early in life may also lead to learning disabilities later in life.

How Do You Know If You Have a Learning Disability?

Just because you have trouble studying for a test doesn't mean you have a learning disability. There are as many learning styles as there are individuals. For example, some people learn by doing and practicing, others learn by listening (such as in class), and others prefer to read material. Some people are just naturally slower readers or learners than others, but they still perform well for their age and abilities. Sometimes, what seems to be a learning disability is simply a delay in development; the person will eventually catch up with - and perhaps even surpass - his or her peers.

But many people with learning disabilities struggle for a long time before someone realizes that there's a reason they're having so much trouble learning. For most people in their teen years, the first telltale sign of most learning disabilities occurs when they notice that there's a disconnect between how much they studied for a test and how well they performed. Or it may just be a feeling a person has that something isn't right. If you're worried, don't hesitate to share your thoughts with a parent or a teacher.

The first step in diagnosing a learning disability is ruling out vision or hearing problems. A person may then work with a psychologist or learning specialist who will use specific tests to help diagnose the disability. Often, these can help pinpoint that person's learning strengths and weaknesses in addition to revealing a particular learning disability.

Coping With a Learning Disability

Although a diagnosis of a learning disability can feel upsetting, it's actually the first step in resolving the condition. Once an expert has pinpointed a person's particular problem, he or she can then follow strategies or take medicines to help cope with the disability. And taking steps to manage the disability can often help restore a student's self-esteem and confidence.

Some students who have been diagnosed with a learning disability work with a special teacher or tutor for a few hours a week to learn special study skills, note-taking strategies, or organizational techniques that can help them compensate for their learning disability. If you've been diagnosed with a learning disability, you may need support just for the subjects that give you the most trouble. Your school may have a special classroom with a teacher who is trained to help students overcome learning problems.

Some schools develop what is called an Individualized Education Program (or IEP), which helps define a person's learning strengths and weaknesses and make a plan for the learning activities that will help the student do his or her best in school. A student's IEP might include some regular time with a tutor or in a specialized classroom for a certain subject, or the use of some special equipment to help with learning, such as books on tape or laptop computers for students who have dyslexia.

Medication is often prescribed to help students with ADHD. There are several medicines on the market today to help improve a student's attention span and ability to focus and to help control impulses and other hyperactive behavior.

There's no cure for a learning disability. And you don't outgrow it. But it's never too late to get help. Most people with learning disabilities learn to adapt to their learning differences, and they learn strategies that help them accomplish their goals and dreams.

Reviewed by: D'Arcy Lyness, PhD

http://kidshealth.org/teen/diseases_conditions/learning/learning_disabilities.html?tracking=T_RelatedArticle

2009-05-16T22:21:00.000-04:00

Department of Public Instruction

Another very informative site for more information regarding instruction in the classroom is the Wisconsin Department of Public Instruction. Found in the link below or click on the graphic above.

http://dpi.wi.gov/

Link for Information on Education Law

2009-05-14T14:56:00.002-04:00

IDEA 2004 Statute and Regulations

There is a lot of legal information on the Wrightslaw home page regarding everying from IEPs and Regulations regarding Special Education. Click on the link below or the graphic above to check it out.

http://www.wrightslaw.com/idea/law.htm

Schools

2009-05-09T09:45:00.000-04:00

This is a review of two excellent books for educators, parents, social workers, psychologists, and therapists.

The first book, Attachment in the Classroom by Heather Geddes, (2006), London: Worth Publishing, is a superior resource and should be on your book shelf. The subtitle says it all, “The links between children’s early experience, emotional well-being and performance in schools.” In this book, Dr. Geddes uses the research categories of patterns of attachment (secure, avoidant, ambivalent, and disorganized) to describe how each pattern affects a child’s ability to function in the classroom, use the teacher, and approach the task at hand. She offers extensive examples from the classroom and provides specific suggestions for educators to use for each pattern of attachment. The book should be of general utility to many teachers, not just special education teachers or those who work with children with Reactive Attachment Disorder. This is the real beauty of the book: its general utility as an approach to pedagogy.

Dr. Geddes begins by describing “The Learning Triangle,” which is the relationships among teacher, pupil, and task. Her chapter, “Behavior has meaning,” is a wonderful description of how and why it is vital to focus on the cause, motivation, or driver of behavior and not merely the surface behavior. Dr. Geddes chapter, “Outline of Attachment Theory,” is a good refresher for those who know Attachment Theory and an excellent introduction for those new to it. Her next several chapters on avoidant attachment, ambivalent attachment, and disorganized attachment in the classroom are wonder. Her use of examples, explanations of behavior, and then the provision of specific suggestions and recommendations for teachers will be very helpful for parents, educators, and those who work with educators. She presents clear recommendations that are soundly connected to each attachment style’s pattern of relating. I have been able to use this material in my work with schools with great success. Dr. Geddes as an educator herself provides enormous credibility for this work with school personnel.

I found this book to be very readable and wonderfully informative. I can, without reservation, recommend it to parents, therapists, and educators.

The second book want to recommend to you is, “Learn the Child,” by Kate Cairns and Chris Stanway, (2007), London: British Association for Adoption and Fostering. This book will be of interest primarily to educators and those who train educators. The book begins with an overview of the issues presented by “looked after children,” (British for children in care) and is primarily about UK laws and their evolution and impact on education. However, there are several very detailed case-studies of children in care and how they functioned in educational settings. These case examples will be familiar with anyone who works in our field and highlight the impact on educational processes of chronic early maltreatment. The bulk of the book is a set of forty-eight PowerPoint slides with detailed explanations of each slide. This is the part of the book I found most useful. While the material may be familiar to many of us, it is presented in a format that is easy to understand and that will be very helpful for educators and educational administrators and policy makers. I can envision using this material in presentations to school personal, special education staff, the education staff at residential treatment centers, and policy makers and administrators. The book comes with the PowerPoint slides on a CD for easy of use. Also included in the CD are the case examples, handouts, and other useful material.

While the book is narrow in focus, it should be on the book shelf of anyone who regularly provides training for educators, administrators, and policy makers. The book is expensive, 33.75 pounds, including shipping, but I think it is worth it.

Bringing Your Child Home from the Orphanage: ideas

2009-05-05T14:17:00.001-04:00

A FEW TIPS ON BRINGING YOUR BABY HOME FROM AN ORPHANAGE

Generally, infants adopted before the age of six months fare no differently than infants raised from birth. However, after six months, the effects of institutional care begin to emerge. It is important to realize that even the best orphanages are not good places to raise a child. In NY state the infant-care giver ratio required by regulation for infant day care is no more than two infants per care provider...so 5:1 is better than 10:1, but still it won't help the child develop a normal, healthy, and secure attachment to a specific figure, which is what the attachment system is supposed to do. Several visits during a year won't make much of any difference on your child's development or on this most important process.

That being said, it is also important to remember that children are rather "plastic" and that attachment develops during the first two to three years of life. So, you will need to do some work when you bring your child home to make up for the early deprivations that your child has experienced.
1. It is best to make the room as similar to the orphanage as possible to make for an easier transition.
2. Serve the same foods at first.
3. Keep ALL others at a distance for the first several weeks to months so your child develops a specific and unique bond with you.
4. It would be best for you to spend the first two to three months at home constantly with the child; carrying the child and physically being present to meet the child's needs and to develop a affectively attuned relationship that will allow you to anticipate your child's needs and meet those, as well.

1) YOU, AND ONLY YOU, WEAR YOUR BABY!! Carry them with you wherever you go, and whatever you do. (Unless dangerous) Attach them to your bodies. A great baby carrier is one that the baby can have skin to skin contact with you – Baby Trekker (1-800-665-3957) is a good one. Carry the baby on your hip; tie to your body under a sweatshirt, front carrier, or in your arms. The more contact the better. These babies were not held enough. Hold Them!!!! A LOT!!! ALL THE TIME!!!! For the rare times the baby is not in your arms, have them in the same room as you are in.

2) YOU ARE THE ONLY CAREGIVER!! You always bottle, feed, bath, dress, change and most of the play. If friends and family want to help let them walk the dog or clean your house, wash bottles or do laundry, bring food or make you tea. No baby-sitters and no sending the baby away for respite. Until your baby is firmly emotionally attached to you, NO ONE the baby doesn't see daily should hold or even touch him or her, and even those that the baby sees daily should hold him or her at a very minimum.

3) KEEP THE BOTTLE AS LONG AS POSSIBLE –EVEN LONGER! You, not the baby, hold the bottle. You can hold the bottle with your chin so you have two hands to snuggle your baby close to you. One handed it also fine. Hold the child the way a nursing mother does – chest to chest, close to you with as much skin-to-skin contact as possible. Look your baby in the eyes and when they do, instantly put the bottle in their mouth and tell them good job!! Keep looking at their eyes so when they are ready for eye contact, you don't miss it. Note: some babies with sensory-integration difficulties may find eye contact too stimulating and it may actually be disruptive to the child.

4) BATHE WITH YOUR BABY; this encourages skin-to-skin contact in a nice relaxing warm fun way.

5) A LOT OF FACE-TO-FACE baby games and funny faces and TONS of smiles and kisses!! Paint bright circles around your eyes. Close one eye, then the other, rapidly blink, and then change speeds, all the time with funny noises. Cover both eyes then one, and so on. Have the baby sit on your lap, and if this is too hard for them at first, lay them on a bed to do it. Then slowly trick them into letting you touch and hold them!! Keep it fun for them.

6) WHEN THERE IS A GREAT DEAL OF ANGER OR AVOIDANCE, the baby NEEDS to experience comfort, safety, and security. They feel so far away from you, and have to be brought closer to heal. Cradle the baby in your arms. Have their arm closest to you held close. Talk soothingly to them, and tell them to look in mommy's eyes. They have been ignored, hit, or yelled at in the orphanage. That is why it is SO IMPORTANT this ALL be done in an extremely loving way. Never squeeze the baby too close, speak harshly, lose your cool or forget why you are doing this. If you get to feel their anger, immediately put them down and call support. You have to remain supportive, yet expect their best. They may try to hit you, scratch, bite, scream and get to you any way they can. Their intense rage is there. Yes, even little babies. Eye contact, feeling safe, and being accepted no matter what in a loving way is the goal here. For whatever reason, they have shut off people. Now they need YOU to heal. Rub them, soothe them in singing, and soft speech, rock them and tell them you love them. Keep it up until they will calm down and look in your eyes and FEEL connected to you. At times they will fall asleep screaming. If so, and if possible, continue to hold them until they wake up, and then continue above. If you need to lay them down, have a monitor on so you can pick them up as soon as they wake up. For the very avoidant baby one unsolicited eye contact a week could be considered good! Keep it up; you have several good eye contacts a minute to look forward to! Remember, you did not create this anger in your baby.

7) NOW IS THE BEST AND EASIEST TIME TO WORK WITH YOUR BABY.

8) DO A LOT OF BABY MASSAGES. For the real avoidant baby, a half-hour. Each day you delay, the harder it is for them and you. Attachment issues do NOT just go away on their own. They only get worse. Twice a day would be minimum. All the time talk, sing and let that baby know how special they are!! Most of the babies seem to really enjoy this, and my daughter would even get out the lotion as soon as she could reach for it!!

9) ROCK THAT BABY!! They often can't stand you sitting in a rocking chair, but can often tolerate and enjoy you walking and dancing with them in your arms. (Remember face-to-face contact during this) Gentle motion, bouncing and rocking are a must!!

10) SLEEP WITH THE BABY. If you can, the best is to have the baby in your bed close to you. Second choice is to have the baby in their crib right next to your side of the bed with the side rail down. Have the crib touching snug to your bed, so if they climb out, they climb safely onto you!! They need t hear your breathing and know you are close. Yet for someone over one, you get special permission (in writing) to have him or her sleep in your room for mental health reasons. Should not be a big problem. Have the baby always fall asleep in your arms. Nap or night. They need to get used to feeling loved!!

11) SING, SING, SING!!! It lightens the load, and helps the baby feel the happy friendliness they missed out on. Joyful voices are so important!

12) ENCOURAGE EYE CONTACT WHEN FEEDING, BOTTLING, TALKING, CHANGING, AND ALL THE TIME!! Not coerced or forced, but loving eyes.

13) EXPECT A DIRTY HOUSE, soup out of the can and sandwiches for supper and piles of laundry. Know that you are not super mom, and that baby can't wait until all is in order to get on with their lives. Here is where all those well-meaning friends that want to hold that precious baby come in!! Let them work!!!

14) EXPECT TO BE CRITICIZED AND ACCUSED as over possessive, spoiling the baby, and making more than you should out of the baby's problems. You will be told all babies do that. This is by well meaning friends, neighbors, relatives, doctors, and social workers. Stick to what YOU KNOW the baby needs, and fight to get that for them. Remember YOU know that baby more than anyone else.

15) HAVE A GREAT SUPPORT SYSTEM. Have a trusted friend (hopefully someone who has had experience in attachment disorder) that you can call without being told you are making too much of it. Read books on attachment disorder. Know what dangers await that baby if they are not helped. Working with an infant or toddler has such a HUGE chance for success!! Not one act of kindness is wasted.

16) GET AN OFFICIAL EVALUATION BY AN ATTACHMENT EXPERT.
That way in court and with workers you do have leg to stand on in getting these babies what they need!!! It is a lot easier when you have a well-respected expert stick up for you.

17) KNOW YOU NEITHER CREATED YOUR BABY'S PROBLEMS, NOR CAN YOU CURE THEM. Your job is to give the baby the tools they need. The rest is up to them.

18) FOR THE BABY THAT HAS NOT YET ENTERED YOUR HOME – when you get that baby, get a piece of clothing or blanket unwashed and used recently by the primary caregiver. The smell will help the move. And don't you wash it!! Keep it close to the baby to help the baby adjust. No matter the baby's age or living conditions, the move to you is not easy. Never push this object, but make it available.

19) HELP YOUR BABY WITH A TRANSITIONAL OBJECT. This is a blanket or soft toy they can sleep with, use it in the car seat, and for the RARE time you cannot be with them. Helps in security.

21) IF YOU DO ALL OF THESE WITH LOVE AND KINDNESS AND THINGS GET WORSE OR REMAIN THE SAME, GET HELP.

Resources:

Creating Capacity for Attachment, edited by Arthur Becker-Weidman & Deborah Shell

Nurturing Attachments by Kim Golding.

Child Maltreatment: Effects on Brain Development and Behavior

2009-04-23T15:42:00.001-04:00

Effects on child development, brain development, psychopathology, and interpersonal relationships

Neglect, physical abuse, and sexual abuse (broadly termed, child maltreatment) have profound and long-term effects on a child's development. The long-term effects of chronic early maltreatment within a care-giving relationship (also called Complex Post Traumatic Stress Disorder) of a child can be seen in higher rates of psychiatric disorders, increased rates of substance abuse, and a variety of severe relationship difficulties. Child maltreatment is an inter-generational problem. Most frequently the perpetrators of abuse and neglect are profoundly damaged people who have been abused and neglected themselves.

There are clear links between neglect and abuse and later psychological, emotional, behavioral, and interpersonal disorders. The basis for this linkage is the impact that abuse and neglect have on brain development. Daniel Siegel, medical director of the Infant and Preschool Service at the University of California, L.A., has found important links between interpersonal experiences and neurobiological development.

We know that a child uses the parent's state of mind to regulate the child's own mental processes. It is through a sensitive, responsive, and caring relationship with a primary care-giver that a child develops self-regulation abilities, emotional control, behavioral regulation, and such cognitive abilities as cause-effect thinking, among others. The child's developing capacity to regulate emotions and develop a coherent sense of self requires sensitive and responsive parenting. The National Adoption Center found that 52% of adoptable children have attachment disorder symptoms. In another study, by Cicchetti, & Barnett , 80% of abused or maltreated infants exhibited attachment disorder symptoms. The best predictor of a child's attachment classification is the state of mind with respect to attachment of the birth mother. A birth mother's attachment classification before the birth of her child can predict with 80% accuracy her child's attachment classification at six years of age. That is a remarkable finding. Finally, recent research by Mary Dozier, Ph.D. found that the attachment classification of a foster mother has a profound effect on the attachment classification of the child. She found that the child's attachment classification becomes similar to that of the foster mother after three months in placement. These findings strongly argue for a non-genetic mechanism for the transmission of attachment patterns across generations.

Children who have been sexually abused are at significant risk of developing anxiety disorders (2.0 times the average), major depressive disorders (3.4 times average), alcohol abuse (2.5 times average), drug abuse (3.8 times average), and antisocial behavior (4.3 times average) .

Generally the left hemisphere of the brain is the site of language, motor activity on the right side of the body, and logical thought based on language. The right hemisphere of the brain is responsible for motor activity on the left side of the body, context perceptions, face recognition, interpersonal and emotional processing, and holistic perception. The orbito-frontal cortex (the part of the brain directly behind the eyes) is responsible for integrating emotional responses generated in the limbic system with higher cognitive functions, such as planning and language, in the cerebral cortex's prefrontal lobes. The left orbito-frontal cortex is responsible for memory creation while the right orbito-frontal cortex is responsible for memory retrieval. Healthy functioning requires an integrated right and left hemisphere. A substantial number of synaptic connections among brain cells develop during the first year of life into the middle of the second year of life. An integrated brain requires connections between the hemispheres by the corpus callosum. Abused and neglected children have smaller corpus callosum than non-abused children. Abused and neglected children have poorly integrated cerebral hemispheres. This poor integration of hemispheres and underdevelopment of the orbitofrontal cortex is the basis for such symptoms as difficulty regulating emotion, lack of cause-effect thinking, inability to accurately recognize emotions in others, inability of the child to articulate the child's own emotions, an incoherent sense of self and autobiographical history, and a lack of conscience.

The brains of maltreated children are not as well integrated as the brains of non-abused children. This helps explain why maltreated children have significant difficulties with emotional regulation, integrated functioning, and social development. Conscience development and the capacity for empathy are largely functions of the orbito-frontal cortex. When development in this area of the brain is hindered, there are important social and emotional difficulties. It is very interesting that the orbito-frontal cortex is sensitive to face recognition and eye contact. Maltreated children frequently have disorders of attachment because of their birth-parents lack of sensitive responsive interactions with the child.

Early interpersonal experiences have a profound impact on the brain because the brain circuits responsible for social perception are the same as those that integrate such functions as the creation of meaning, the regulation of body states, the regulation of emotion, the organization of memory, and the capacity for interpersonal communication and empathy. Stressful experiences that are overtly traumatizing or chronic cause chronic elevated levels of neuroendocrine hormones. High levels of these hormones can cause permanent damage to the hippocampus, which is critical for memory. Based on this we can assume that psychological trauma can impair a person's ability to create and retain memory and impede trauma resolution.

Abused and neglected children exhibit a variety of behaviors that can lead to any number of diagnoses. However, the effect of early abuse and neglect on the child can be seen in several critical areas of development. These areas include emotional regulation, behavioral regulation, attachment, biology, response flexibility, a coherent integrated sense of self across time, the ability to engage in affect attunement with significant others (empathy and emotional connectedness), self-concept, cognitive abilities and learning, and conscience development.

The effects of early maltreatment on a child's development are profound and long lasting. It is the impact of maltreatment on a child's developing brain that causes effects seen in a wide variety of domains including social, psychological, and cognitive development. The ability to regulate emotions and become emotionally attuned with another depends on early experiences and the development of specific regions of the brain. Early maltreatment causes deficits in the development of these brain regions, primarily the orbito-frontal cortex and corpus callosum, because of the toxic effects of stress hormones on the developing brain.

These findings strongly suggest that effective treatment requires a sensitive affectively attuned relationship. Siegel stated, "As parents reflect with their securely attached children on the mental states that create their shared subjective experience, they are joining with them in an important co-constructive process of understanding how the mind functions. The inherent feature of secure attachment - contingent, collaborative communication - is also a fundamental component in how interpersonal relationships facilitate internal integration in a child." This has implications for the effective treatment of maltreated children. For example, when in a therapeutic relationship the client is able to reflect upon aspects of traumatic memories and experience the affect associated with those memories without becoming dysregulated, the client develops an expanded capacity to tolerate increasing amounts of affect. The client learns to self-regulate. The attuned resonant relationship between client and therapist enables the client to make sense (a left-hemisphere function) out of memories, autobiographical representations, and affect (right hemisphere functions).

Arthur Becker-Weidman, Ph.D.
Center For Family Development
5820 Main Street, suite 406
Williamsville, NY 14221
716...

Becker-Weidman, A., (2006) "Treatment for Children with Trauma-Attachment Disorders: Dyadic Developmental Psychotherapy," Child and Adolescent Social Work Journal. Vol. 23 #2, April 2006, 147-171.
Becker-Weidman, A., (2006). "Dyadic Developmental Psychotherapy: A multi-year Follow-up," in, New Developments In Child Abuse Research, Stanley M. Sturt, Ph.D. (Ed.) Nova Science Publishers, NY, pp. 43 -- 61.
Becker-Weidman, A., (2007) "Treatment For Children with Reactive Attachment Disorder: Dyadic Developmental Psychotherapy," at: "center4familydevelop.com/research.pdf"
Becker-Weidman, A., & Hughes, D., (2008) "Dyadic Developmental Psychotherapy: An evidence-based treatment for children with complex trauma and disorders of attachment," Child & Adolescent Social Work, 13, pp.329-337.
Craven, P. & Lee, R. (2006) Therapeutic interventions for foster children: a systematic research synthesis. Research on Social Work Practice, 16, 287-304.

Article Source: http://EzineArticles.com/?expert=Arthur_Becker-Weidman,_Ph.D.

Continued Schooling for Violent Students is Required

2009-04-19T09:39:00.001-04:00

I read this and think it is an important article

IDEA DISCIPLINE RULES ENSURE CONTINUED SCHOOLING FOR VIOLENT STUDENTS
Sunday, April 19, 2009

WASHINGTON -- Schools can no longer drop educational services for special education students while they are suspended from school for violent incidents, under new regulations approved this spring for the 1997 Individuals with Disabilities Education Act. This may become a difficult issue for schools that do not have the resources to continue educating a student in an "alternative setting," as prescribed by the law, American Institutes of Research Senior Research Scientist Mary Magee Quinn says.

Outlining the new rules during the American Federation of Teachers' QuEST '99 Conference, Quinn noted the rules require a school district to continue educating a suspended student in an alternative setting if the suspension lasts longer than 10 days. The students must get all services required for them to continue progressing under their individualized education plans, and any therapies prescribed in the IEP must also be provided as scheduled, the rules state.

The continuation of services rule, as well as several other complexities in the new regulations, helped draw dozens of teachers and other faculty members to hear Quinn speak at the four-day teachers' conference. As deputy director of the Center for Effective Collaboration and Practice, Quinn and her staff have studied the new regulations and consulted with government officials and attorneys to clarify the new rules and help school districts implement the changes. The center also offers extensive information about IDEA '97 and other special education issues on its Internet site: www.air-dc.org/cecp/.

Defining the Problem

Among other confusing issues: determining whether the student's conduct is a manifestation of his or her disability and whether the conduct is part of a larger pattern. For the purposes of determining how a school district can discipline special ed. students who exhibit violent behavior, those questions can determine whether the student is treated like a mainstream student or one who is not accountable for his or her actions. For example, if the student's action is deemed not a manifestation of his or her disability, the student can be suspended for as long as school policy says a general ed. student would be suspended. The difference, however, is the special ed. student must receive educational services after the first 10 days of the suspension.

If the student frequently or repeatedly breaks rules, even if they seem like different rules and separate incidents, the student may be exhibiting a pattern of behavior that calls for a change in his or her IEP, Quinn noted. One red flag that could indicate such a pattern is the repeated suspension of the student. While special ed. students may be repeatedly suspended for up to 10 days at a time for various rule violations, they must be reevaluated if those suspensions constitute a pattern of behavior.

Getting to the Root of the Problem

If a special ed. student is removed for more than 10 cumulative days from school, a functional behavioral assessment must be conducted, according to the law. However, IDEA does not specify what the assessment should be, Quinn said. CECP offers what it calls "best practices" or guidelines to reevaluating students. Quinn also argued IEP teams should take the assessments seriously rather than consider it another mandatory set of forms to fill out to keep a child in school. "If you have to do a functional assessment, you might as well do it to the point where you are actually going to get information you can use from it," she told the teachers. "It's a long process, but it does yield very good information that will make your lives as teachers infinitely easier."
In addition to continuing services for suspended special ed. students and reassessing whether their IEPs are appropriate and effective, Quinn said the law requires IEP teams to add a behavioral intervention plan to students' IEPs if they do not already have them. Before IDEA '97, only 8 percent of students with behavioral problems had such intervention plans in place, she said. The intervention plan should be based on conclusions the IEP team draws from the functional behavioral assessment, Quinn said, and should incorporate other people and settings in the child's life besides school. For example, she said, families, peer support programs, speech and language therapists and community agencies, such as religious or community programs, can all reinforce the positive behaviors the IEP team is trying to teach a child.8