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.

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
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.

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.

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.