Treating attachment/trauma - MO-CASE

Treating attachment/trauma - MO-CASE

Understanding and addressing trauma challenges in child Jane Gavril, MS, Childrens Services Manager Crider Health Center, Compass Health This information comes from: Complex/ Developmental Trauma White Papers from Bessel van der Kolk and Bruce Perry Books from Dan Hughes (Building the Bonds of Attachment), Heather Forbes (Beyond Consequences, Logic and Control), Dan Siegel

(Mindsight, The Developing Mind, Healing Trauma) Studies (and a conference) on attachment and trauma from Dan Siegel, Mary Main (who studied with Mary Ainsworth who studied with John Bowlby) Shirley Crenshaw trainings Stress, trauma and attachment basics Basic perspectives and foundation Trauma Trauma can come in many forms: A one-time event that appeared to the child to threaten his own life and/or the life of someone close (experiencing, witnessing, or hearing about) Exposure to perceived threat or actual serious injury or sexual violence to self or someone

close Repeated exposure to vivid aspects of traumatic events Ongoing threatening events TRAUMA Abuse of child, domestic violence of parent Resilience

Resilience is a capacity to bounce back, return to or maintain wellbeing in the face of distressing situations Some core physiological/ genetic factors can predispose a person to have greater/ lesser resilience Personality factors, like hardiness, grit and sense of humor, can contribute towards enhancing resilience Resilience can be developed A healthy, secure attachment serves as a key buffer to manage stress, enhancing resilience The stress-trauma spectrum Stress is an emotional and physiological response to the perception that the demands of a situation overwhelm the persons

resources to maintain safety, personal integrity, and wellbeing. Individuals have differing levels of resilience based upon genetic/ physiological predispositions as well as experiences in life up to that point. Stressful situations destabilize a person. The stress-trauma spectrum Soothing and time to return to calm is important after a stressor/ traumatic event. People need time/ skill/ nurturing environment to restabilize.

If too many stressful/ traumatic events occur without enough resilience/ time/ healing/ nurturing to restabilize, this begins to deplete the persons resilience and capacity to manage stress. Life becomes overwhelming. Trauma is an extreme form of stress, yet intense and ongoing/ frequent stressful situations can cause a person to develop pervasive patterns of stress responses similar to trauma responses. Bonding strains as trauma

Children learn to self-soothe by being othersoothed. Its the natural instinct for a child to turn to caregiver or adult when in distress. Sometimes, that person is not able to calm the distress (anxiety, her own trauma, on drugs, distracted, depressed) Sometimes, that person is actually causing harm In cases of abuse, or when the caregiver has extreme negative reactions to reasonable needs/ bids for attention/ guidance/ help

Bonding strains as trauma Inconsistent early caregiving creates an insecure/ worried sense of how things work in the world. The child cant effectively predict the world around him, does not gain confidence about how to get needs met or to feel safe/good. And small amounts of time feel like a very long time to a young person. Lack of consistent and nurturing parent figure Parent has addiction or mental illness or chaotic life (e.g. domestic violence, works excessive hours to barely make

ends meet) Changes in caregivers such as with adoption, foster care often coupled with one of the other issues listed before Lack of basic needs being consistently met Can be traumatic to not have a place to live, not know when the next food will come, not know when the discomfort from the dirty diaper will ever go away Attachment theory Need for a secure base to be free to explore

and playfully learn about the world Secure attachment relies upon effective integrative communication between child and caregiver The more the child can rely upon the caregiver to meet needs and aid in resolving distress, the more the child develops a sense of secure base. This secure base must be physically present at the earliest of stages, becomes internalized over time Having a sense of caregiver(s) as secure base is paramount to allowing a child to relax enough to fully explore and navigate

lifes situations Types of Attachment Secure Comes Attachment from receptive, sensitive caregiving. Child feels supported when needs are met. Child relaxes and trusts, self soothes easily. Bonding cycle The child begins to feel secure to rely upon the idea that key caregiver(s) will meet needs and

maintain safety/ wellbeing Bonding disruptions The child does not develop sense that key caregiver(s) can be relied upon to meet needs and maintain safety/ wellbeing With insecure attachments: Types of Attachment Ambivalent Attachment

Develops typically when parents are invalidating at times, but validating others, and the pattern is predictable. Child learns to watch for cues and responds with detachment or possibly exaggerated emotion responses. Develops clingy, dependent, insecure connections. Types of Attachment Avoidant Attachment Develops typically when parents reject, ignore or dismiss the child (seem unresponsive to child). Feels rejected/ dismissed and sees self as unworthy. Avoids connection.

Types of Attachment Disorganized Develops in response to unpredictable patterns of responsiveness to childs needs. Child cant predict what to expect. Child mixes responses of being clingy, to being rigid, to being dismissive, to being aggressive. Types of Attachment https://www.youtube.com/watch?v=iGDqJ YEi_Ks Disorganized Types of Attachmen

t Table credit: Svanberg, P. O. G. (1998). Attachment, resilience and prevention. Journal of Mental Health, 7(6), 543-578. Retrieved from http://search.proquest. com/docview/2152832 09? Trauma and the brain The brains of children whove experienced trauma actually function differently Trauma and the brain

Neural connections - Neurons that fire together wire together Trauma produces fewer connections, and many of those connections are have negative quality (fear, anxiety, anger, sadness) r, et al, 2014 /www.drugabuse.gov/news-events/nida-notes/2015/11/childhood-maltreatment-c But the child was too young to remember It can seem as though events which occurred during pregnancy or in the first couple years of life shouldnt effect the childs feelings or

behaviors now, because they dont even remember. (We hear this a lot) But the child was too young to remember This can be explained by understanding the memory system Implicit memory stores/ recalls sensations, emotions, drives Implicit memory comes online early even in pregnancy Explicit memory stores/ recalls information in more

of an organized, narrative form. Explicit memory comes online more along the time when language emerges, and develops more refined as language becomes more refined Explicit Memory Factual / semantic memory (facts and meaning) Autobiographical memory

This emerges as collections of episodic memory become linked (ones sense of self across time) Both involve conscious awareness and focused attention during encoding of the energy and information Language development and basic mental models lay a foundation for

explicit memory to come online Usually not until 18-24 months. Its rare to have anyone with explicit/ episodic memory before this time gel, D. J. (2012). The developing mind: how relationships and the brain interact to shape who we are. 2 nd ed, New York: The Guilford Press. Implicit Memory Involves parts of brain that do not require conscious processing when memory is being stored or when it is being retrieved

Involve raw behaviors, emotions, bodily sensations and images which are a foundation for the subjective sense of self This becomes an underlying sense which helps to filter current experiences in each moment Siegel, D. J. (2012). The developing mind: how relationships and the brain interact to shape who we are. 2 nd ed, New York: The Guilford Press. Implicit Memory Early attachment relationships are encoded implicitly and become generalized A parent who has been the source of confusion, fright, unpredictability, or pain causes infant to generalize a

confused, distant or terrifying view of that relationship (and self/life). The mind grows relationally. This implicit mental model shapes the childs sense of self and serves as a foundation for the automatic reactions he will have to future experiences (at home, school, community) Siegel, D. J. (2012). The developing mind: how relationships and the brain interact to shape who we are. 2 nd ed, New York: The Guilford Press. Traumas pervasive impact So early experiences of harm, pain, neglect can be traumatic for a child

The younger the child is, the more helpless and vulnerable the child is as they cannot resolve the situation. An implicit sense of the world as unsafe, the child as unlovable, other people as not helpful/trustworthy, can emerge Then traumatic events which occur at any point in a persons life also resonate with that implicit sense of the world not being safe and ACES Adverse Childhood Experiences http://www.cdc.gov/violenceprevention/acestudy/

http://vetoviolence.cdc.gov/apps/phl/resource_center_infographic.html ACES Adverse Childhood Experiences http://www.cdc.gov/violenceprevention/acestudy/ http://vetoviolence.cdc.gov/apps/phl/resource_center_infographic.html ACES Adverse Childhood Experiences http://www.cdc.gov/violenceprevention/acestudy/ace_graphics.html Traumas effects on mind, body, behavior, and relationships

Symptoms and signs Trauma & attachment strains can produce many challenging behaviors: Under acting/under performing Shutting down, withdrawing Excessive anxiety about small things Poor self esteem Lack of effort Memory, verbal, focus, and learning difficulties Sleep challenges Lots of somatic complaints (seems to feel sick a lot)

Wets bed longer (longer to potty train) May have accidents at school or on bus ride Difficulty transitioning between school years Seems to be obsessed with food (especially Trauma & attachment strains can produce many challenging behaviors: Acting out Verbal, physical aggression Excessive. unreasonable temper reactions even to small frustrations

Impulsive actions Lies Steals Excessive irritability, sadness, anxiety Deliberate and strategic defiant behaviors Demanding of attention even willing to perform negative behaviors to get attention Doesnt appear to have guilt (may have a high sense of shame) The behaviors can seem very deliberate/calculated!

Sometimes it can seem like the child is doing things on purpose, just to make people mad. Or that they really could control it, but are choosing not to. Seem to turn the bx on/off at will. And can control it sometimes(this seems like proof!). Or like they are doing things the hard way even though they would probably get it if they just asked an adult, or just went about trying to get it in a reasonable way.

They can seem to be cruel, manipulative, inconsistent, childish (for age), unreasonable Inconsistent emergence of symptoms? In reality sometimes the situation feels manageable. Other times, there are things/relationships in the situation (i.e. trauma triggers, untrusted people), or aspects of the situation (i.e. confined space, overwhelming task), which make the situation feel less safe and less capable of holding it together. Combine that with things like how the child slept last night, how

much the child has been in pain/ discomfort, how he has been getting along with others, how many other things have gone well/ wrong lately, etc Sometimes kids can keep it together, and sometimes they cant. And there are a complex set of reasons why each time. Understanding how/why these challenges emerge from trauma And the reasons why these challenges can emerge The traumatized/ attachment-challenged child is often a highly stressed-out child A child who has been through trauma or an ongoing set of high-stress conditions overwhelmed without enough resilience / time/ perceived support to restabilize will end up seeming easily stressed out. Theyre more likely to always

be at a simmer, ready to boil. Making sense of it all When a child has been through traumatic events, periods of long stress, chaotic changes in early life the child forms a different view of the world. The child can then experience severe challenges with: the ability to control emotions the ability to control behavior the ability to think clearly about things the ability to understand self and others the ability to trust others Making sense of it all Controlling emotions The child can develop highly sensitive and intense fight, flight or freeze response

Those internal calming mechanisms didnt develop early and strongly enough when needs werent consistently met or got amped up due to some horrifying experience(s) Fight ~ verbal/physical aggression Flight ~ running away, avoiding things A Freeze ~ defiance, refusal, shut down E F (Going dark) R The fight or flight response can seem like its gone haywire and get triggered by many different things

- even small issues that seem VERY insignificant. Making sense of it all Controlling emotions - continued Regulated = keeping things together Dysreglated = lost it Many challenging behaviors come when people become dysregulated

The child may need external source to help become regulated again Making sense of it all Controlling emotions - continued With all of these emotion control challenges, the child may act out or act unreasonably given the situation. When others respond (naturally) with anger or frustration, to the child, this reinforces negative perceptions of self and others and the way the world works.

The child feels more anxious and angry, acts accordingly Everyone tends to get more escalated and dysregulated. Making sense of it all Controlling Emotions & Sense of Self/ Self Insight Development of insights about ones own internal needs & feelings gets shut down/ stunted Sense of self does not develop cohesively

This can make going through life unsure and even more scary The sense of self that may develop may be largely negative Since the child has such a poor sense of insight about her own emotional state, the ability to express feelings and needs also gets highly diminished This can be very frustrating and invalidating for the child. (And for those who interact with the child!!) Making sense of it all Behavior control Without trust, without self-insight, and with high fight or flight response, impulse control can become very poor

Especially in certain situations (unstructured, unpleasant, unpredictable) Complying with rules, boundaries, expectations is challenging since the child typically has both poor trust and poor impulse control Self-regulation skills are often underdeveloped

Poor or negative self-soothing behaviors Challenges moderating or regulating hunger, sleep, and eating patterns Self-destructive behaviors Verbal and physical aggression Making sense of it all Thinking-related disturbances During times of trauma/ severe loss/change, understandings about self, others, self in relation to others, and how things work in life/ the world can be: underdeveloped, skewed, shaken

*Later learning experiences build on this broken / off- track foundation childs capacity to predict the world gets compromised This makes things even scarier Making sense of it all Thinking-related disturbances Learning and reasoning realistically emerge from a more relaxed state. For learning to occur well, the child needs to have a sense of safe base to relax and explore/ learn about the world High stress states arent conducive to productive thinking. Too much time is spent in fight/flight. Attention during those episodes is compromised.

Attention energies outside of those episodes can be very low (goes back/forth from high stress to fatigue) This impacts attention to instruction at home and school Making sense of it all Thinking-related disturbances These challenges make it difficult to effectively:

process information plan ahead understand object constancy follow through to complete complex (and especially) undesirable tasks So switching from a preferred activity to a non-preferred activity can feel really challenging There are times when we talk ourselves into mustering up the fortitude to do something we really dont like or want to do, or find unimportant. Calm, rational reasoning is necessary to do this, but less accessible during periods of stress. Making sense of it all Relating to others/ Trust

The child may have developed a pervasive uncertainty about others and the world The child may seem controlling and demanding The child cant count on predictability of things in life. because he does not trust others and has learned negative things about how life works . The child may have a very compromised ability to pay attention to the states and viewpoints of others.

(Remember, she isnt even in tune with herself!) Making sense of it all Relating to others/ Trust continued: With poor insights about self, others, what happens in life, and self in relation to others, the child may not be able to effectively understand her own contribution to events in life, over-blaming wrong things and not recognizing actual causes. This causes relationship challenges in all directions.

This makes recreation of events of investigation, or explanations of problematic behavior especially challenging. Relating to others can be very scary and confusing Making eye contact may be difficult This tends to breed mistrust from others Making sense of it all Relating to others/ Trust - continued The child may develop skewed views of relationship connections and limits/ boundaries between self and others.

May be overly disconnected and cold to some, while may be overly connected but on a superficial level to others. Some traumas also break ones understanding of boundaries at all. Example: If a person has been physically or sexually abused, he may have lost the sense of not putting hands on other people without permission. He may even be prone to acting out aspects of his trauma upon others. Making sense of it all Relating to others/ Trust continued The child may lie or steal instead of rely upon relating or communicating needs to others (especially caregivers) Instead of being able to be soothed and calmed by (self or) others, the child may seek food or things to be an external source of feeling good. Things

may seem more important than people. Or, the child may be entirely unable to regulate self or self-soothe, and may be overly reliant on others to help regulate / soothe them. This can come across as needy, clingy, attention-seeking The child is more needy of others kindness while behaviors are often harmful to relationships The vicious cycle unfolds: Even if consistent caregiving and/or stable, safe environment has been in place for a very long time, the childs implicit memory system keeps the child feeling unsafe (and acting accordingly).

When a child is acting out or not doing what hes supposed to do, its common for parents to: Scold the child Raise the voice Give negative consequences Say the child is being/doing bad What else? What does the child keep learning about self, others, and the way things work?

The vicious cycle! This (very understandable) set of responses often ends up causing the child to feel more stress and distress With greater distress, often the childs behavior will escalate even further Being labeled bad creates shame and poor selfesteem. And the child may already have a poor sense of self-efficacy. And many of the common behavior management strategies that work for most children end up not

working for traumatized children. Interacting with a traumatized child A trauma-informed approach Putting a stop to that vicious cycle It is important to foster a compassionate, healing environment for the child to be able to calm down and feel safe **This is tough when the child is frequently behaving in such drastically socially harmful ways! Be sure we see things differently

One of the first things that is helpful to children impacted by trauma is to look at them differently The child may seem very defiant The child may seem manipulative This is often fight flight or FREEZE! The child doesnt feel the world is safe, nor that others are safe to connect to or trust to get needs met. The child may seem like a bad kid

The constant stress about the world, others, self and how things work really cause the child to behave erratically and in ways that are not helpful to those around, but the child has been through something traumatic Traumas shake a persons world and way of interacting with the world. Try to make sense of behaviors Consider if the challenging behavior was coming from a challenge with the childs ability to control emotions ability to control behavior ability to think clearly about things ability to understand self and others

ability to trust others Consider how the child sees the world Danger Goggles activity Select volunteer. Watch this scene, and write feeling words that come to mind. https://www.youtube.com/watch?v=RLGHUe1OxNU Group thoughts? Volunteer thoughts? Seeing them with new eyes Its important to try to see the world through the childs eyes assuming best intentions. Consider that the child may not be being mean, bad, out to get them, etc.

Often, uncertainty, fear, loss and sadness are at the root of the childs behaviors even if the situation has changed and those losses, challenges, changes and scary things are no longer present. Seeing them with new eyes Develop an understanding of the childs unhelpful behaviors as coming from a place of hurt, fear, lack of skills, overwhelm This helps us to give (more) empathy for this hurting child.

Use your professional sense to replace frustration, spite, or anger with empathy and compassion. Recognize the child is in distress (even if the distress is manifested by behaviors which are challenging and harmful) Consider the struggles it must be for the child to just get up each day, interact with family, come to school, pay attention in class, etc. When threatening events have been present in acute or chronic ways, this shifts priorities for the childs brain and rest of body - so the child may not be as invested in tasks which are complex, hard or annoying. Its tough to care about the details of the War of 1812 when youre constantly stressed out about life or youre constantly worried that you arent safe Doing chores or complex math can seem overwhelming. Or at least yucky.

A different understanding of the child With this new way of looking at the child and his intentions, people are likely to say less derogatory things to/ about the child. Previously these things likely only escalated the situation and had the child responding to feel even worse about himself as a person. This can help us to interact with him in more uplifting ways. This may (eventually) set a more positive tone to the relationship, softening it in both directions. A different understanding of the child

When we understand more of what the child is thinking and feeling, we can take that information and look at situations and set them up differently to stave off future behavior challenges. Predictions can be made about how the child may handle certain things. Supports can be put in place to avoid negative reactions or to ensure that the child is not placed into a situation where expectations are not exceeding the childs current functioning level. Setting a structure that facilitates healing

Promoting feelings / environments of safety Note any known trauma triggers and have a plan for how to handle avoiding/ responding to child if they are encountered. Be sensitive to your physical presence/ stance. For instance, if someone has been sexually abused, you blocking them in may cause them to feel vulnerable or trigger abuse flashbacks, which can bring about unsafe behavior responses. Setting a structure that facilitates healing Establish a pre-approved go-to safe zone/

person for the child to use in times of distress Collaborate with key individuals in various environments (different classes, activities) to ensure the child always has a safe zone to go to Ensure the child knows how to access this without getting into trouble, and that other impacted individuals know the childs safe haven limits/ setup If the child uses it too much, wean the child slowly from such frequent use; taking it away altogether can create chaos, anxiety, angst Setting a structure that facilitates healing

Increase predictability for the child of your behavior the situation the daily routine Communicate with the child clearly, simply, succinctly Setting a structure that facilitates healing Set

a realistic structure Dont set expectations that feel insurmountable/ unrealistic given their current functioning level Establish where child is functioning in each skill and expect that, working towards a bit more Recognize attempts and incremental progress with subject knowledge/ skill gains and behaviors Nurturing but still structured

Make desired objects/ events attainable through reasonable, realistic effort (for that child). But require the effort before it is obtained. Children need incremental tastes to keep motivation stirring. Allow natural consequences while avoiding having the child feel hes fallen in a hole so deep he will never see the light of day. And traumatized children can be very short-sighted. Dont take away systems of earning for tasks because of an outburst that happened yesterday unless there is a logical reason for that (e.g. broke video game controller, cant earn video game

time) Its common to lose that professional detachment and get to a point where its hard to see the child enjoying anything because of how badly the child acted out. But , really, the child is miserable enough. Setting a structure that facilitates healing Recognize the childs strengths Increase positive experiences Identify and increase activities where the child can be successful, feel safe, and feel positive emotions FYI: Treatment and coping skills may (will!)

incorporate elements which seem fun, but are necessities Remember - Vulnerability is tough People They fear their freedom or something precious to them may be lost/ taken away Theyve been caught doing something wrong/ embarrassing or suspected of such They feel forced to do something theyd rather not do Children with trauma/attachment challenges are often

highly uncomfortable with vulnerability feel vulnerable when May shut down, act out, posture or launch attacks to those who make them feel vulnerable May not feel safe to be honest/ open when they feel vulnerable Some situations themselves may bring about a sense of vulnerability Connection and safety reduce the sense of vulnerability

Pointers for successful engagement Avoid power struggles. Hold limits and expectations in a firm but matter of fac way. State expectations of what is needed and what you or others will do, and follow through. Allow natural consequences. Children with trauma histories may call threats bluff and toy with extreme options, so dont threaten something you cant follow through on. It can often help to still provide some empathy when a

poor choice has an undesired outcome for the child. Pointers for successful engagement If possible, dont set them up to lie Just state the fact that this was found/ this occurred if it is known as fact. Dont ask Did you do this? when you know they did. Pointers for successful engagement Often, avoid asking "why?

A child with a trauma history often has that poor insight/ impulse/ emotion control/ trust challenge. If the child has behaved in a problematic way during a time of fight /flight /freeze distress, avoid shaming/ blaming language. The fight/flight response can be primal and overshadowing of reason. Remember that implicit/ explicit memory system? If the behavior was an automatic fight/flight response, it launched from the implicit memory system, which doesnt

have language skills to fully explain itself. So, if you ask why, youre likely to get a changing story that is inconsistent or seems totally made up. Pointers for successful engagement It helps more to find out what had the child feeling unsafe /bad/ not okay, and to encourage involved parties to figure out how to support the child to feel safer next time. Deescalate and connect Safer/more reasonable behaviors and

openness typically come when a person feels safe and connected. Be sure the person is deescalated / becomes regulated before trying to reason with him/ process events/ get info *Helpful tip for all relationships: Saying Calm down doesnt typically help anyone calm down Specific interventions to help the child become regulated Grounding techniques 4-3-2-1

Name 4 things you can see in the room with you. Name 3 things you can feel (chair on my back or feet on floor) Name 2 things you can hear right now (fingers tapping on keyboard or tv) Name 1 thing you can smell right now (or 2 things you like the smell of) http://www.psyke.org/coping/coping_skills/ (ADAPTED) Specific interventions to help the child become regulated Breathing exercises Belly breathing

Sit upright Take breath in through nose, take in and let belly expand (~4 seconds) Hold your breath for a couple of seconds Exhale slowly and fully (~4 seconds) Pause a bit before taking in the next breath * Mindfulness habits can help to promote regulation capacities in self and children Specific interventions to help the child become regulated Changing the scene

Help child do something else to feel differently and bring about different sensations / feelings/ thoughts Go for a walk (if safe/ appropriate) Give the child something to color (adult coloring books, mandalas) Let child listen to music Trashcan basketball Squishy ball for child to play with Watch for challenging mood onset, and proactively change the dynamic of what the child is doing/

thinking/ focusing upon. Engage different senses/ different parts of the brain. Creating a safe space It may be necessary to be or find an external regulator for child. become Maintain a calm, kind yet together demeanor

Be the calm for them until they can calm themselves Being in charge Ive got this but in a compassionate way In general, and also if the child becomes dysregulated This can require self care to be able to be fully present in the moment and calm in the face of a storm Strategies to create a safe space/ connect See if you can muster and give deep, substantial and genuine empathy for how much pain, sadness, hurt, fear the child must be in.

https://www.youtube.com/watch?v=1Evwgu36 9Jw Many challenging behaviors are really coming from a dark place of human misery instead of being a bad person. Strategies to create a safe space/ connect Traumatized children often respond well to PLACE-based attitudes Playful (but not mocking)

Loving/Caring/Compassionate Accepting (of the personhood of the child, not the behavior) Curiosity Empathy Respond with curiosity, acceptance, compassion, playfulness instead of frustration, anger, annoyance Genuinely exude like of the child http://www.danielhughes.org/html/PLACE.html Strategies to create a safe space/ connect Types of validations

Fully present/ actively observing to attune Accurately reflect what the child is experiencing Guess what the child may be feeling if feelings not stated/ obvious. Understanding for that childs history and biology it would be expected that she would respond that way. It totally makes sense based upon her dx/ history.

Normalize the response as typical. Any human would have that response. Statements which exude radical genuineness, acceptance of the personhood of the child. https://www.youtube.com/watch?v=uvIWipFFQto VIDEO Validations are *not* saying the behavior was okay. Strategies to create a safe space/ connect Open-ended questions posed with a curious spirit Affirmations

Catch them being good! Look for anything that can be affirmed. Examples: You dont want to get kicked out of school. You ran out of the home so you could stop being unsafe to your family, because you love your family. Reflections This helps the child feel heard /validate the childs reality

Self-care Its critical to be in a good place when working with people who have trauma responses Find times and activities to practice substantially fulfilling self care People. who connect to happy, energetic, positive feelings on a regular basis will be in a better place to stay regulated and provide positive, empathetic approaches Examples:

Exercise, reading, bath, time out with friends, date night Safe place reminders/ tips Consider fears/pain may be behind the behaviors Use of a calm, soothing voice can help the child to calm Stay calm yourself (this is hard!) Assume the best intentions of the child (this is also hard!) Use encouraging words Relate to the child at the level that he is acting without being condescending Recognize attempts to calm, make amends, get in a better place, etc. (even if they arent sufficient or a solve) Encourage the child to calm down before processing an issue/ event or trying to reason with the child Understanding the parents

plight Its a tough road. Every day. Common parental responses Parents may seem checked out, overly excusing of their child, mad at you for the problems you reported about their child, etc. They may not trust you or the system. And Common parental responses

Parents themselves may become traumatized Living in an unpredictable world where nothing seems to work to help the child be/feel safe is very difficult. Parents may have been attacked and harmed. Items parents worked hard to obtain may have been destroyed. Crushed home, crushed dreams

Parents may need to be on guard (HIGH ALERT!!) at all times for years. Parents prior trauma/stress history can emerge when dealing with the new threats and stresses from the child. Common parental responses Parents feel overwhelmed and hopeless

Parents resolve or energy can be very low when they encounter you. Being on high alert all the time is exhausting. Dealing with the constant challenging behaviors can be frustrating and draining. Parents may feel like giving up. They may have made mistakes in the past in managing challenging behaviors, and now things have gotten out of hand. Self care goes out the window, which makes things worse. Common parental responses Parents feel embarrassed.

Going out in public requires nerves of steel. Going to Parent Teacher Conferences comes with a big gulp. Neighbors talk about that family who has that one kid. Cant even go to church anymore cause Billy got kicked out of child church. Cringe when the phone rings whats it going to be now? Theyre annoyed and ashamed that police and Childrens Division know them too well. Parents feel like failures.

It must be a mistake I made way back when. Now things are unmanageable. I am such a bad parent to not be able to handle this. Additional resources Resources for more insight http://www.traumacenter.org/ (Bessel van der Kolk) Beyond Consequences, Logic and Control & Help for Billy (Heather Forbes) Building the Bonds of Attachment (Dan Hughes) http://childtrauma.org/ (Bruce Perry) http://www.attachmenttrauma.com (Shirley Crenshaw look for the reading list) http://danielhughes.org/ (Dan Hughes)

Resources for more insight Videos: Dan Siegel: Neurological basis of mind, behavior https://www.youtube.com/watch?v=B7kBgaZLHaA Dan Siegel Mindsight and Neural Integration: https://www.youtube.com/watch?v=gyq3NZAULc4 Relational DBT Validations: https://www.youtube.com/watch?v=HANLHwZ47Hc Brene Brown On shame: https://www.youtube.com/watch?v=psN1DORYYV0 On Vulnerability : https://www.youtube.com/watch?v=iCvmsMzlF7o On empathy - https://www.youtube.com/watch?v=1Evwgu369Jw

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    Studio 13b: Activity Series Redox Reactions 2 Fe(s) + 3 Cl2(g) 2 FeCl3(s) Fe0 Fe+3 Cl0 Cl- A species is said to undergo REDUCTION if it GAINS electrons A species is said to undergo OXIDATION if it LOSES electrons Electrochemistry...