Assessing Complex Trauma
This workshop will describe a three session model for the assessment of Complex Trauma (aka Developmental Trauma Disorder). A brief description of what is Complex Trauma and its effects on child development and the importance of parenting will be followed by a presentation of the assessment protocol. This assessment protocol is multi-modal and uses data from records, caregivers, various psychometric instruments. Screening of the various domains of possible impairment is an essential element of this protocol.
This workshop will only be available through Webinar (instructions on how to access the Webinar will be provided upon registration)
Date: June 15th, 2012 10:00am – 11:30am
Workshop Leaders:
Arthur Becker-Weidman, Ph.D., Center for Family Development
Emily Becker-Weidman, PhD, Child Study Center, New York University
To register, please complete the attached registration form and send to Maribel Cruz
(p) 212-660-1318
(f) 212-660-1319
Email: MaribelC@nyfoundling.org
Vincent J. Fontana Center for Child Protection
27 Christopher Street, New York, NY 10014
The New York State
Chapter of American
Professional Society on the Abuse of Children
Presents
The 2011/2012
Child Abuse
Workshop Series
Co-Sponsored by
The New York Foundling
Vincent J. Fontana Center for Child Protection
Villano Conference Center
27 Christopher Street
New York, New York 10014
www.nyfoundling.org/fontana-center
Workshops
1. Preventing Foster Home Disruption: A Programmatic Approach
This workshop is for mental health clinicians, case planners, supervisors and administrators working in the child welfare system. The workshop will identify the risk factors that contribute to foster home disruption and describe clinical and social service interventions designed to
stabilize the foster home and prevent disruption of the foster home.
Date/Time: October 24, 2011 10:00am to 11:30am
Workshop Leader: Mel Schneiderman, Ph.D
Director of Mental Health Services
New York Foundling
Co-founder Vincent J. Fontana Center for Child Protection
2. Forensically Defensible Child Sexual Abuse Evaluations
This workshop, presented by a defense attorney, will focus on issues which arise in the context of child sexual abuse litigation including Parental Alienation “Syndrome,” the suggestibility of children, allegations of child sexual abuse in the context of divorce/custody proceedings, proper forensic interviewing, the professional ethics of mental health professionals maintaining proper records, and other issues.
Date/Time: December 5, 2011 10:00am to 12pm
Workshop Leader: Lawrence Jay Braunstein Esq.
Partner in the Firm of Braunstein & Zuckerman, Esq.
3. Common Myths and Clinical Realities of Child Maltreatment
Child abuse is the physical, sexual, emotional mistreatment or neglect of children. This
workshop will provide a multi-disciplinary forum to explore commonly held beliefs that can
often derail the process of obtaining the best outcomes for a child who has experienced any of these forms of child abuse. Through case-based discussion interspersed with brief didactics we will explore common myths as they relate to each of the forms of child maltreatment while
integrating findings from the literature in the field.
Date/Time: February 3, 2012 10am to 12pm
Workshop Leader: Ingrid Walker-Descartes, MD, MPH, FAAP
Maimonides Infants and Children’s Hospital of Brooklyn Child Abuse Pediatrician
Attending - Pediatric Ambulatory Division
Program Director - Pediatric Residency Training Program
4. Evidence-Based Mental Health Interventions for Child Abuse
This workshop will describe the current state of evidence-based mental health interventions for childhood abuse. Childhood models of PTSD and other sequelae will be described briefly. Em-pirically supported treatment for child sexual abuse, physical abuse and emotional/psychological abuse will be reviewed. Critical issues in treating youth will be described and finally national and state dissemination efforts will be noted, with focus on how New York State can adopt best prac-tices for the treatment of abused children.
Date/Time: April 2, 2012 10am to 11:30am
Workshop Leader: Komal Sharma-Patel, PhD
Assistant Director of Research
PARTNERS Program
St. John’s University
5. Integrating Prevention into Your Practice: American Professional Society on the Abuse of Children Prevention Guidelines
While much of professional practice has the objective of preventing further maltreatment, it is often difficult to understand how to best incorporate prevention activities into our work. This workshop will be hosted by a member of the American Professional Society on the Abuse of Children Board Prevention Task Force who will review current evidence and best practices in the child maltreatment field and discuss guidelines to assist professionals in integrating preven-tion into their work.
Date/Time: May 1, 2012 10am to 11:30am
Workshop Leader: Vincent J. Palusci, MD MS
Professor of Pediatrics at NYU School of Medicine
Child Abuse Pediatrician at the Frances L. Loeb Child
Protection and Developmental Center at Bellevue Hospital
6. Assessing Complex Trauma
This workshop will describe a three session model for the assessment of Complex Trauma (aka Developmental Trauma Disorder). A brief description of what is Complex Trauma and its effects on child development and the importance of parenting will be followed by a presentation of the assessment protocol. This assessment protocol is multi-modal and uses data from records, care-givers, various psychometric instruments. Screening of the various domains of possible impair-ment is an essential element of this protocol.
This workshop will only be available through Webinar
Date and Time to be announced
Workshop Leaders: Arthur Becker-Weidman, Ph.D.
Center for Family Development
Emily Becker-Weidman, PhD
Child Study Center, New York University
The New York State Chapter of
American Professional Society on the
Abuse of Children
The New York State Chapter of the American Professional Society on the Abuse of Children provides an opportunity for professionals in New York State to meet, share ideas and experiences, develop strategies for improving
professional services to clients, influence public policy and educate the public, other professionals, and policy makers about child maltreatment.
The New York Foundling
Vincent J. Fontana Center
for Child Protection
The Fontana Center supports the mission and values of The New York Foundling by serving as the advocacy,
public policy, research, professional and community
education arm of the agency.
The Center’s mission is to eliminate child maltreatment through the identification and promotion of evidence based primary prevention and treatment strategies. To achieve this objective, The Fontana Center engages in
research, professional training, community education and advocacy.
Registration Form
Please, indicate which workshop you would like to register for below.
1._____Preventing Foster Home Disruption: A Programmatic Approach
(October 24, 2011 10:00am to 11:30am)
2. Forensically Defensible Child Sexual Abuse Evaluations
(December 5, 2011 10:00am to 12pm)
3._____Common Myths and Clinical Realities of Child Maltreatment
(February 3, 2012 10am to 12pm)
4._____Evidence-Based Mental Health Interventions for Child Abuse
(April 2, 2012 10am to 11:30am)
5. Integrating Prevention into Your Practice: APSAC Prevention Guidelines (May 1, 2012 10am to 11:30am)
6._____Assessing Complex Trauma: Webinar Only
(Date: TBA)
There is no fee for New York State APSAC members or for NY Foundling staff.
There is a $10.00 fee for all non NYS APSAC members.
Please make check payable to:
Vincent J. Fontana Center for Child Protection
All workshops will be held at the Vincent J. Fontana Center for Child Protection
at 27 Christopher Street in Manhattan.
Subway stops: West 4th (A,C, E, F, B, D, M trains) or Christopher Street (1 train)
Send check and registration form to Maribel Cruz at:
maribelc@nyfoundling.org
Vincent J. Fontana Center for Child Protection
27 Christopher Street, New York, NY 10014
Phone: 212-660-1318
Showing posts with label Trauma. Show all posts
Showing posts with label Trauma. Show all posts
Feb 13, 2012
Feb 10, 2012
Spanking lowers IQ scores
A comprehensive study of the literature in the Canadian Medical Journal finds that spanking children results in poor outcomes: lower IQ scores.
The arguments against spanking and corporal punishment are even stronger when considering its re-traumatizing effects on children who have experienced complex trauma.
The arguments against spanking and corporal punishment are even stronger when considering its re-traumatizing effects on children who have experienced complex trauma.
Feb 5, 2012
Attachment Therapy Companion
The book I wrote with 2 colleagues, Attachment Therapy Companion, will be out in July an is now listed on the Norton website:
http://books.wwnorton.com/books/Attachment-focused-Therapy/
The book is meant to be a statement of best practice in the provision of attachment focused therapy. It described the theory base for this approach, appropriate and evidence-based principles for evaluation and treatment, and ethical principles of practice.
It is a must read for anyone practicing treatment grounded in attachment theory.
http://books.wwnorton.com/books/Attachment-focused-Therapy/
The book is meant to be a statement of best practice in the provision of attachment focused therapy. It described the theory base for this approach, appropriate and evidence-based principles for evaluation and treatment, and ethical principles of practice.
It is a must read for anyone practicing treatment grounded in attachment theory.
Nov 17, 2011
Training in Complex Trauma for Value Behavioral Health Providers
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.
Oct 23, 2011
New Book on the Practice of Attachment-Focused Therapy
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
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
Jul 13, 2011
Exciting new video by ATTACh
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.
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.
May 27, 2011
Reactive Attachment Disorder: For Educators
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
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
Mar 27, 2011
Theory of Mind and Attachment
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
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
Jan 3, 2011
Dec 6, 2010
Effects of Institution care on adoptees
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.
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.
Nov 17, 2010
Childhood trauma memories: New Research
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
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
Nov 10, 2010
Child Abuse & Psychosis: a link?
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
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
Apr 18, 2010
Artyom Savelyev
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.
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.
Feb 17, 2010
Stockholm Syndrome: what it is
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.
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.
Jan 6, 2010
Treatment for PTSD
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
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
Dec 20, 2009
ADHD among Internationally Adopted Children: Empirical Study
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)
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)
Dec 5, 2009
How the brain is affected by relationships
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.
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.
Oct 29, 2009
Nature or Nurture? Which is it? Both!
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
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
Aug 9, 2009
Children with Sexual Behavior Problems
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.
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.
Jul 5, 2009
Orphan: A movie to boycott
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.
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.
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