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.
Jun 24, 2009
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.
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