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)
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.
Nov 29, 2009
Trauma's effects
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.
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.
Nov 27, 2009
More on Nature and Nurture and Violence
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.
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.
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
Oct 28, 2009
Child Sexual Abuse causes later problems
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
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
Oct 23, 2009
Effects of Trauma (PTSD) on the Brain
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
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
Oct 18, 2009
Against Coercion
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
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
Oct 14, 2009
Adverse Childhood Experiences
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.
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.
Oct 9, 2009
Teen maturity
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
You can find out more about this research at
http://www.sciencedaily.com/releases/2009/10/091007153745.htm
Oct 6, 2009
Research Cited
Oct 1, 2009
ATTACh Conference in TX
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
I strongly recommend that people consider the conference next year, in California. More information can be found at www.attach.org
Sep 20, 2009
Book Review
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.
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.
Sep 16, 2009
John Rosemond got it wrong
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.
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.
Aug 23, 2009
New Book
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.
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.
Aug 19, 2009
Training Psycholgists from other counties: What I've learned
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.
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.
Aug 12, 2009
Ten Take-Away Ponts
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.
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.
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.
Aug 7, 2009
Effects of early maltreatment on development
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.
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.
Jul 28, 2009
Therapeutic Parent Manual
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
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
Jul 24, 2009
Complex Trauma
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.
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.
Jul 18, 2009
Master Class in Dyadic Developmental Psychotherapy
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
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
Jul 6, 2009
Orphan: boycott
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.
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.
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.
Jul 4, 2009
The Boy Who Was Raised as a Dog
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.
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.
Jun 24, 2009
Children with Sexual Behavior Problems
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.
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.
Jun 20, 2009
Bringing Your Child Home from the Orphanage: ideas
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.
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.
Jun 16, 2009
What I've learned by working overseas
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.
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.
Jun 14, 2009
When your infant doesn't make eye contact
“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.
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.
Jun 12, 2009
Brain Research on Wisdom: Implications for Attachment
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.
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
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.
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.
Jun 3, 2009
Attachment and Autism
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.
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.
May 31, 2009
Temperament
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.
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.
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