WHAT IS ATTACHMENT, ANYWAY

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WHAT IS ATTACHMENT, ANYWAY?

• DEENA MCMAHON MSW LICSW
• COUNSELING AND CONSULTATION SERVICES LLC
• dmcmahon_at_mcmahonccs.net
• 651-210-0335

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THEY NEED YOU

• Children who do not have a secure attachment
  figure suffer neurological and physiological harm

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HOW LONG TILL TOMORROW?

• Children have limited life experience on which to
  establish their sense of self. Their sense of
  time focuses exclusively on the present and
  precludes meaningful understanding of temporary
  versus permanent or anticipation of the future.

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LEARNING TO LOVE

• As we are born, we learn to listen for the sound
  of our mothers voice because we know it to be
  the source of our pleasure and comfort that she
  will satisfy our hunger and take away our pain.
• It is the first lesson in learning to love.

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OLD NEWS

• The recent discovery of the power of community
  to shape physical, social, emotional and
  spiritual health by Western researchers is a
  belief that has always been a part of the wisdom
  of aboriginal peoples.
• Bruce Perry

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WHAT CAUSES ATTACHMENT DISORDER?

• Prenatal exposure to drugs, alcohol, violence
• Early chronic pain or hospitalization
• Maternal depression
• Early trauma and abuse
• Neglect

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IGNORANCE

• Ignorance about emotional development permeates
  our culture and emotional neglect cuts across
  cultural and social class

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THE CHILDS EXPERIENCE

• Children with attachment wounds do not trust.
• They do not view the world as safe
• They assume all adults will hurt them
• They are in survival mode most of the time. They
  are charming and disingenuous.

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WHAT IS ATTUNEMENT?

• Reading and responding to the cues of another
• Synchronous and interactive
• Can be taught reading the non-verbal, language
  of another

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ATTUNEMENT/PLEASURE

• Children want the attention and approval of
  people
• Healthy and early care giving by healthy people
  teaches children the pleasure of relationships

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WHY DOES ATTUNEMENT MATTER?

• It is what causes positive attachments to develop
  between parent and child.
• It is the ability of the parent to understand the
  childs emotions and needs.
• It gives the child a sense that someone
  understands how to meet their needs.

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The Brain Dictates All Human Behavior
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0-3

• Attachment is a brain function and is determined
  by the neurological makeup and the experiences a
  child has in the first few years of life

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0-3

• During the first three years of life, the brain
  develops to 90 of size and establishes the
  majority of systems and structures that will be
  responsible for all future emotional, behavioral,
  social and psychological functioning for the rest
  of life.

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FIVE KEY PHENOMENON
Perry

• The neurons that fire together wire together
• Use it or lose it
• Blossoming and pruning sequence
• The branches that fire get wired into the network
• Growth spurts and experiences during that time
  are critical

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NEUROBIOLOGICAL

• The brain is an experience dependent organ
• It forms and shapes based on what it is exposed
  to
• The early experiences have greater influence than
  the later ones

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MISSED OPPORTUNITY

• What happens when the right things at the right
  times are missed?

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MISSED OPPORTUNITY

• Children can lose the capacity to form meaningful
  relationships for the rest of their lives.

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REACTIVE ATTACHMENT

• Attachment develops on a continuum
• RAD is the most severe
• It is recognized in DSM-IV R
• Sometimes it does not capture the whole story

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NEW LANGUAGE

• Develpmental trauma disorder
• It is a developmental delay, that the child
  experiences, as a result of develpmental insults
• It is seen as different than RAD

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Caregiver-induced trauma is qualitatively and
quantitatively more potentially psychopathogenic
than any other social or physical stressor
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INFANT BRAIN

• Neglect is devastating

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• Children can lose the capacity to form meaningful
  relationships for the rest of their lives.

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IT IS NEVER TOO LATE TO MAKE A DIFFERENCE

• Older kids CAN and DO get better.
• They deserve and need services.
• The brain is experience dependent. It will use
  whatever comes its way to manage the world, it
  will compensate.

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PREFRONTAL CORTEX

• The CEO of the brain
• It is the last lobe of the brain to be wired
• It is not completed until the early 20s.
• It is a major aspect of teenage brain development

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A HEALTHY CEO

• Good planning
• Ability to consider consequences of actions
• Self reflection and introspection
• Impulse control
• Ability to stop, look. listen

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KNOW FACT FROM FICTION

• Fact It is never too late for a child
• Fiction Early attachments will repeat
  themselves
• Fact Attachment wounds do heal
• Fiction Little children are not very effected
  by moves

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LOVE HURTS

• Children are so deeply harmed by breaking their
  attachments that they may not want to attach
  again. There is a myth in some child welfare
  offices that attached children can be moved with
  the assumption that the future placement will be
  a reflection of the past. The fact is that every
  time that attached children are moved, they learn
  that attachments are ultimately painful. D Gray

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CHANGING THE BRAIN

• The earliest insults cause the greatest harm.
• Changes at the brain stem are very hard to make
• Therapy is usually based on teaching regulation

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A LEAKY BASEMENT

• A child can do OK in times of low stress
• When the stress response is triggered the child
  goes into default mode
• The survival mechanisms take over
• The lack of solid foundation leaves the child
  vulnerable

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REGULATION

• This is the childs ability to have their brain
  manage their body
• The emotions they feel are unmanageable or
  manageable, based on their coping skills
• They know how to calm themselves

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CO-REGULATION

• They use the adult care giver to help them cope
• They can trust the adult to be safe, predictable,
  and lend them skills they do not have

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ATTACHMENT FIGURE

• This is what a good parent is
• They are the rock of gibrallter
• They are always there
• They are predictable
• They never change from cheerios to fruit loops

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Observing the childs behavior can tell us about
who they trust and who they fear
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WOW

• The best predictor of positive outcomes for a
  child protection client (child) is the health and
  relationship care of the staff and environment of
  the helping agency

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Resiliency is a critical component in
understanding which children can tolerate more
extreme circumstances. Some children have
significantly diminished ability to manage and
survive negative parental relationships.
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KNOW IF THE CHILD IS RESILIENT OR FRAGILE?
Resilient children can tolerate more extreme
circumstances. Fragile children have diminished
ability to manage and survive negative parental
relationships.
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ASPECTS OF RESILIENCY

• Prenatal experience
• Genetic make up
• Attachment relationships
• Cognitive functioning
• Physical features
• Community resources

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RESPECT

• We always need to try to work with the values and
  structure that the family has established in the
  home.
• Respect the family roles, hierarchy and value
  systems.

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ATTACHMENT REPAIR

• It is about constancy
• It is about consisten, positive, repetative,
  patterned experiences
• It is about relationships
• It is about the parent
• It happens with a family

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DISTURBED ATTACHMENTS

• A child trying to feel safe
• A child to feel in control
• A child trying to feel lovable
• A child trying to fool people
• A disconnected child

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HOW THEY VIEW ADULTS

• Adults are a means to an end
• Adults are not trustworthy
• Adults hurt children
• Adults do not follow through
• Adults are not safe when in charge
• Adults are to be manipulated and managed

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HOW THE CHILD VIEWS THEMSELF

• They are bad and faulty
• They are ashamed and unlovable
• They are always vulnerable
• They are responsible for the things that have
  happened to them
• They believe rejection is inevitable
• They much be in charge
• They must always be on guard

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WHAT THEY FEEL

• Guilt
• Shame
• Fear
• Anger
• Confusion
• Terror
• Loneliness

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HOW THEY BEHAVE

• Falsely
• Defensive
• Sneaky
• Dishonest primary process lying
• Steal, hoard,
• Hurtful to others
• Falsely friendly or charming to strangers

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GET GOOD HELP

• They are experienced
• They understand attachment
• They will support the family
• They will listen
• They wont talk too much

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BE PROACTIVE

• Get help before it gets ugly.
• Therapy should not be used to help the naughty
  bad kid in the home
• It is about all the people in the home.

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STAND FIRM

• Adults must not bend the rules or lower their
  expectations because the child is having a
  difficult time adjusting. The child will only
  change when there is no other choice. Change is
  hard. Change is scary
• Adults must be in charge, which is not the same
  as in control.

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BE REALISTIC

• Have parents talk to other parents
• Help them understand what they are/were hoping
  for.
• What do they think the impact of the child will
  be on other children.

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GOOD HELPERS KNOW

• That the child is afraid
• That the parent is embarrassed by their own
  ambivalence
• How to address conflict
• How to manage intense emotions
• That managing hard choices is their job
• That there is no bad guy.

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BEST PRACTICE

• Asking for help or advise is usually a good idea
• Take time off

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WHEN THINGS DONT WORK OUT

• Care about the family and the child
• Dont judge
• Children and adults need a safe place to vent and
  process their feelings
• Figure out what went wrong and learn from it

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TRANSITIONS ARE HARD

• Any child in transition, is a child in pain
• Nancy Thomas

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STRATEGIES

• Nurture these children and use lots of structure
• Be consistent, repetitive and predictable
• Be a good role model for social behaviors
• Take care of yourself
• Be realistic

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SOME RULES OF THUMB

• Stop activities that are either too intimidating,
  scary, activating, or disregulating
• Use words to teach, identify the emotion and
  behavior
• Dont ask why, ask what, who, how

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MORE IDEAS

• Be consistent
• Children usually want attention and do not care
  about negative or positive, it is all attention.
• When giving consequence, look at the child in the
  eyes, touch the child, and be sad for the child

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PARTS LANGUAGE

• Help a child to understand that they have many
  different parts.
• Their hands can have mittens on, to help that
  part of them soft.
• Feet can have on fuzzy slippers
• Mouths can make people laugh or cry
• They have an angry part and a happy one

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GET PARTNERSHIP

• Ultimately, the parent must get engaged and give
  the child consistent messages. We do not want
  the child to be punished by the parent, but
  consistent messages in very important.

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PARENTS HAVE THE FINAL SAY!!!

• You set the rules
• You cant have lots of different rules for
  different children. You can customize and
  accommodate only to a point.
• Having home and day care as consistent as
  possible benefits the child

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ASK FOR HELP

• When what you have tried does not work, and when
  you have run out of good ideas
• When is seems like a persistent problem and not
  just a phase or adjustment time
• When your instinct tells you the child needs more
  help

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KNOW YOUR RESOURCES

• Find out who has good answers to your questions.
  Talk with and share ideas with other
  professionals who do what you do.

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OUCH, SHE BIT ME!!!

• Biting, hitting, hurting, and other aggression
  needs to be dealt with in a serious and immediate
  fashion.

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LOOK FOR TRIGGERS

• Look for patterns, time of day, is the child
  tired, hungry, frustrated
• Reinforce the time he is not biting with extra
  attention
• Teach gentle touch
• Offer calming activities
• Give the child a space to calm themselves

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GIVE FEWER CHIOICES

• Try to figure out the trigger and modify the
  situation if possible, small group work, rather
  than large, less flexibility to make choices,
  more directed play than free play, separate the
  child from the person (people) they hurt, if
  possible

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TEACH EMPATHY

• If possible, help the child to care for the
  pain/wound of the child harmed.

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THE SHY CHILD

• Childhood anxiety is real.
• Shy children are anxious and fearful most of the
  time.
• They cant do many things that other children
  make seem easy
• It may be temperament, it may be life experience

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FIND THE CORE ISSUE

• As with anything else, find out what situations
  or circumstances are most difficult
• Plan ahead
• Practice situations that might be hard
• Identify strengths and competencies
• Give them opportunities to shine

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GIVE THE CHILD A BUDDY

• Enlist the help of another child who can
  empathize, who is competent and who can
  demonstrate compassion
• Find things for this child to do in partnership
• Let the child have alone time, when needed
• Ask the shy child to help someone out

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STOP WHINING!!!!

• What is this behavior really about
• Is the child scared, spoiled, entitled,
  manipulative, insecure, neglected at home, tired,
  hungry, overwhelmed
• Modify play, snack, nap or rest time, social time
  and have some directive play time

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IS THE CHILD ANXIOUS?

• Understand object permanence and use pictures,
  calls, objects of parent
• Know how consistent their caregiver is at home,
  does the child get consistent care giving and
  have confidence in adults to meet their needs or
  are they trying to stay front and center in you
  space

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IS THE CHILD NEGLECTED?

• Give this child some extra one-on-onetime if at
  all possible to let them know they matter, you
  understand they need you, and you can help them
  feel better sometimes
• Give the child a sense of mastery over some
  activity
• Catch them getting it right

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YIKES, ITS THE HIGH ENERGY KID, LOOK OUT!!!

• Hyper activity usually emerges as a diagnosis
  when children reach school age.
• They need consistency and structure
• They need things broken into one at a time steps
• They need to think they are good at something

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ADD/H

• I CHILDPROOFED MY HOUSE, BUT THEY STILL GET IN!!!

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REDUCE STIMUATION

• Modify or skip some activities
• Recognize that transitions will be very difficult
• Give them extra time to calm down from an
  activity,
• Find novel and interesting ways to get the same
  thing done differently

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LIMIT THEIR CHOICES

• Touch the child, look at the child, show, do and
  be with the child, spoken language will be less
  effective, as they are not good auditory
  learners.
• Teach them relaxation and make some things
  mandatory, like blowing bubbles, staying by your
  side at recess, taking big breaths, having a
  fidget toy

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USE SENSORY EXPERIENCES

• Try a weighted blanket a rest time, pay attention
  to light, sound, change, taste.
• They dont mean to be rude, but their social
  skills will need some work
• Have them practice getting it right
• Hold the child on your lap during story time

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TV IS NOT SENSORY

• Play Dough
• Sand and beans
• Smelling shakers
• Swinging and bouncing
• Fidget toys
• Walks
• Wild time

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THEY WOULD IF THEY COULD

• Children with ADD/H have neurological impairments
  that do not let them get it right, even when they
  want to.
• Dont punish them for something they cant help,
  but do coach them to get it right next time.
  They will have good days and bad days. So will
  YOU.

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Respect and dignity

• Too often in the process of getting the job done,
  people in the system get hurt by the very people
  who are supposed to support them.
• We then become wounded helpers

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PARALLEL PROCESS

• We walk the walk
• It is a guided tour
• We are the tour guide

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RELATIONSHIPS MATTER

• Like the child
• Help the parent like the child
• Help the child like themselves

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FIND JOY

• Help the child find a place of joy
• Help the parent experience the joy
• Redefine success
• One day at a time