Transcript Who Are They and What Do We Do With Them?

Normal Infant Trust Cycle
• Parent responds
Unpleasant Arousal
Trust
Development
Need
Satisfied
Need
Action to Address
Need
with food, comfort,
nurturance, eye
contact, sound,
rocking motion, &
warmth of human
contact
• Child learns adults
can be relied upon
to meet his needs
Infant Trust Cycle
ATTACHMENT DISORDER
• Infant rage
Unpleasant Arousal
Infant’s
Needs Not
Met
• Rigidity
Lack of
Trust
Need
• Extreme
dependency
• Suppressed
abilities
Lack of Adult
Response to Infant’s
Needs
• Lack of
foundation
Early Childhood Trust of
Limits Cycle
Unpleasant Arousal
Needs Never
Totally Met
Reinforced
Arousal
• Unpleasant Arousal
is Continuous
Need
No Trust of
LimitsAttachment
Disorder
Placement of Limits
• Needs = Control
• Action— “I must
take care of this
myself”
Action to
Meet Need
• Limits = Obstacle
• Reinforced
Arousal—“ I knew I
had to do this
myself”
Dynamics of Attachment
Disorder
Attachment Figure
Unavailable
Negative Response
Cycle
Self Protective
Distancing
Loss of Caregivers
Unmet Needs
Lack of Pleasure in
Relationships
Traumatic Stress Leading to
Attachment Disorder
• Denial of pregnancy
• Dislike for father of
child
• Substance abuse
• Prematurity risk
factors
• Variable family support
• Inadequate diet; poor
self-care
• Resentment
Traumatic Stress Leading to
Attachment Disorder
• Lack of parenting skills
• Various caregivers
• Ongoing substance
abuse
• “Mechanical parenting”
• Neglectful/Abusive
parental reactions
• Prematurity factors
• Undetected/Unrelieved
pain in the child
Behavioral Checklist
• Indiscriminate affection towards strangers,
willingness to go with them
• Face to face compliance with passiveaggressive resistance
• Absence of guilt; no remorse; lack of
conscience development
• Provoking of anger in others almost
continually
• Lack of ability to give and receive affection
unless on their terms
Behavioral Checklist
• Chronic, non-sensical lying - “crazy
lying”
• Theatrical displays of emotion
• Stealing or hoarding food; food
refusal or gorging
• Cruelty to animals and/or children,
especially younger children
• Firesetting - “controlled” fires
• Preoccupation with blood, fire, gore
Behavioral Checklist
• Lack of cause & effect thinking - does not learn from
consequences
• Poor eye contact
• Denial of accountability
• Self-injurious behavior
• Refusal to answer simple questions
• Unusual speech patterns or problems
• Poor peer relationships
• Learning disorders
• Theft, vandalism & destructiveness
• Seductive behavior or clothing
• Toileting issues
Attachment on a Continuum
Healthy Attachment-
Trust Development
Unattached Child
0
30
60
80
Attachment Issues
100
Overindulged
Emotional Makeup of
Attachment Disorder
Hopelessness
Loss
Anger
Abandonment
Helplessness
No Trust
Rage
Fear
PROFOUND SADNESS
Parenting a Child With RAD
Post Traumatic Stress Disorder In
Parents
Causes
Repeated rejection
by child—no
reciprocity
Relentless control
battles—constant
self-control
Personal and family
changes out of
control
Primary Symptoms
Avoidance of
thoughts and
feelings
Feeling unlike
others; emotions
out of control
Psychological and
physical distress
Secondary Symptoms
Sleep
problems;
hypervigilant,
irritable, angry
Decreased affect—
detachment from
others
Victim identity;
fatigue and
depression; loss
of security
Hopelessness
Helplessness
ANGER
RAGE
Adult Characteristics for Successful
Parenting of Children With RAD
• Healthy sense of humor
• Consistency with behavior management,
yet flexible
• Ability to handle interruptions to social
schedules
• Understanding that one parents a needy
child, with parent’s personal needs met
elsewhere
• Ability to advocate for child in a
positive manner
• Ability to promote positive growth
• Sense of hope for the future, plus tolerance
and perseverance
Adult Characteristics for Successful
Parenting of Children With RAD
• Support in the marital relationship;
communication and belief in what the
other spouse says
• Ability to react calmly; ability to display
parental control of attitudes and
abilities in the presence of the child
• Ability to accept appropriate confrontation
if it promotes positive changes
• Ability to constantly redefine parental
goals and expectations for the child;
able to redefine “success”
• Ability to withstand criticism &
condemnation from family, friends and
community
ATTACHMENT DISORDER
Parental Response Cycle
• The cycle is
solely dependent
on adult
reactions
Unpleasant Arousal
CONFUSION
Building
Trust
Capabilities
RAGE
Need
• Child’s response
is directly
relevant to
degree of adult’s
commitment &
amount of
consistency in
terms of nonabusive or
rejecting
reactions
Child’s View of Adult-Child
Interactions
• Someone wins; Someone loses
• Adult doesn’t take charge when
child is out of control
• Child senses this and becomes
frightened
• Child continues to set up
opportunities for adult to take
charge
• When adult is unwilling or unable
to take control, child’s out of
control behavior escalates
Adult Attachment Disorder
Progression
Emotional
and
Attention
Seeking
Unstable
and
Impulsive
Self
Absorbed
Disregard
for Others
ANTISOCIAL
PERSONALITY
DISORDER
HISTRIONIC
PERSONALITY
DISORDER
BORDERLINE
PERSONALITY
DISORDER
NARCISSITIC
PERSONALITY
DISORDER
The Child Welfare SYSTEM
State Child
Welfare
Agencies
Local Child
Welfare
Agencies
Courts
Medicaid
Private
Service
Providers
Public
Agencies
Welfare,
Public
Assistance
Substance
Abuse
Treatment
Mental
Health
Counseling
Foster Care Statistics 2001
• 3 Million referrals made to CPS
• 900,000 children found to be
victims of maltreatment
• 290,000 entered the foster care
system
• 800,000 children spent some time in
the foster care system
• 540,000 children in foster care at
any given time*
*The Future of Children
Winter 2004
www.futureofchildren.org
Foster Care Statistics 2001
• Nearly one-third of maltreated
children were under the age of 3
• Forty percent of all child fatalities
due to child abuse were infants
under age 1
• Over the past 10 years, the number
of infants and toddlers coming
into foster care has increased by
110%
• Approximately 1 in 5 of the children
entering foster care for the first
time are infants under age 1*
*The Future of Children
Winter 2004
www.futureofchildren.org
Is Uncle Sam a Good Parent?
When the state
assumes custody of a
child, in effect the
government is stating
that it can do a better
job of protecting and
providing for this child
than his or her birth
parents can.*
*The Future of Children
Winter 2004
www.futureofchildren.org
Assessing the Degree of
Attachment Damage
To uphold the government’s
responsibility to children in
foster care, addressing
children’s needs must begin
at entry with initial health
screening and continue with
regular assessments
throughout a child’s time in
care.*
*The Future of Children
Winter 2004
www.futureofchildren.org
Pay Now or Pay Later
There is clear
evidence that a
significant number of
youth in the juvenile
justice system are
suffering from serious
emotional and
behavioral disorders.*
*Juvenile Offenders With Mental Health Disorders
Who Are They and What Do We Do With Them? By Lisa Melanie Boesky, Ph.D.
Diathesis-Stress Model of Illness
“Diathesis” = Being vulnerable to,
or having a predisposition to,
develop a particular disorder.
Psychopathology is thought to
result when a diathesis interacts
with stressful life events, unless
there are ample protective
factors or resources to offset it.*
*Hakim-Larson & Essau, 1999, Juvenile Offenders With Mental Health
Disorders… Who Are They and What Do We Do With Them?
By Lisa Melanie Boesky, Ph.D.
Diathesis-Stress Model of Illness
Mental health disorders are likely
the result of a combination of
juveniles’ :
• Inherited biological or
psychological vulnerabilities
• Environmental stressors
• Environmental supports
• Particular abilities and coping
skills
Juvenile Offenders With Mental Health Disorders… Who Are They and What
Do We Do With Them? By Lisa Melanie Boesky, Ph.D.
Post Traumatic Stress Disorder
Biological influences =
MR or ADHD
Environmental
influences may be
more significant for
youth suffering from
Post-traumatic Stress
Disorder.
Juvenile Offenders With Mental Health Disorders… Who Are They and What
Do We Do With Them? By Lisa Melanie Boesky, Ph.D.