Something Has To Change

Transcription

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2 Something Has To Change

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4 A Three-Strand Approach 1.Looking In 2. Looking Out 3. Looking At Theory

5 Stress, burnout, depression, anxiety, compassion fatigue, secondary PTSD... It is important to safeguard the health of those facing aggressive outbursts on a daily basis.

6 The Psychology bit. What is Attachment Theory? Attachment/Trust/Resilience Cycle Risk Factors Patterns of Insecure Attachment Associated Behaviours

7 ATTACHMENT THEORY John Bowlby The Father of Attachment Theory Secure Base 'Evidence is accumulating that human beings of all ages are happiest and able to deploy their talents to best advantage when they are confident that, standing behind them, there are one or more trusted persons who will come to their aid should difficulties arise. The person trusted, also known as an attachment figure, can be considered as providing his or her companion with a secure base from which to operate.' (Bowlby, 1979)

8 The cumulative impact of events in the child s life may have led him to: feel unable to trust adults to provide for his needs, even at the most basic level (Maslow, 1970) feel safest when he exercises control over every situation feel, not free to focus his attention on things other than survival, (Van Gulden and Bartels-Rabb, 1993).

9 The Attachment Cycle When all is well... Child begins to trust carers to meet needs Trust Need Rage Child has needs and feels: Helplessness Hopelessness Anger Relief Child relaxes as needs are met Responsive carer offers: Eye contact Touch Lactose Smiles/affection

10 INTERRUPTION OF THE ATTACHMENT CYCLE - 1 Child develops unhealthy survival strategies in attempt to make carer meet his needs Need Child has needs and feels: Helplessness Hopelessness Anger Unable to trust Child either... Withdraws becomes over compliant or increases rage...as needs are not met No Relief/unreliable relief Rage Unresponsive or unreliable carer offers: Poor eye contact Touch without affection Anger/irritation

11 INTERRUPTION OF OF THE THE ATTACHMENT CYCLE CYCLE - 2 Child develops unhealthy survival strategies, either: does not trust anyone else to meet needs OR Cannot cope when limits ARE set Need Child has needs and feels: Helplessness Hopelessness Anger Child either... Withdraws becomes overdependent OR Unable to trust Smothered or lacks containment Rage increases rage & expects every demand to be met Over-anxious or over-protective carer: Is intrusive Is poor at limitsetting Imposes own insecurities on child

12 DON T GET SUCKED INTO A BLAME GAME! When things go wrong...risk Factors Pre-birth stress, eg. mother s self-harm or domestic violence Alcohol and/or drug taking during pregnancy Parental illness before/after birth Ante- or post-natal depression Being a premature baby separation in incubator Medical complications - in the womb, at birth, during the early years Illness/Bereavements in the family

13 The baby having a disability Neglect and/or abandonment Emotional, sexual and physical abuse, domestic violence Home and family instability/breakdown Poverty Mental health difficulties in caregivers Multiple home and school placements during the child s early years (based on Bomber, 2007)

14 INSECURE ATTACHMENT PATTERNS Secure Resilient Attachment/Resilience Continuum Insecure Anxious Secure Attachment Weakened or compromised Attachments Avoidant/Ambivalent Dis-organised Internal Working Model Trust of self Trust of others Trust of humanity (Cline 1992) Internal Working Model Unable to trust Shamed-based Identity Toxic Shame Lacks constancy

15 CHANGES IN DSM-5 The fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) updates disorder criteria to more precisely capture the experiences and symptoms of children: (2013, American Psychiatric Association) Reactive Attachment Disorder is now divided into: Reactive Attachment Disorder (RAD) Disinhibited Social Engagement Disorder (DSED)

16 DIAGNOSIS LEAVE IT TO THE PROFESSIONALS! Clinicians and families often were frustrated that DSM- IV did not define or describe some of the clinically significant behaviours and symptoms they observed in children. (2013, DSM-5 and Diagnoses for Children, American Psychiatric Association) Social Communication Disorder (SCD) Disruptive Mood Dysregulation Disorder (DMDD) Post Traumatic Stress Disorder (PTSD) Pre-School Subtype Separation Anxiety Disorder Oppositional Defiant Disorder (ODD) Conduct disorder Intermittent Explosive Disorder Attention Deficit/Hyperactivity Disorder (ADHD) etc, etc, etc.

17 The Brain Science Bit. The Brain in 3 Parts Hardwiring Startle Reaction New Neural Pathways = Change in Behaviour

18 THE BRAIN IN 3 PARTS Higher brain = rational thinking Lower/reptilian brain = instincts Mid/mammalian brain = early warning system

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20 Amygdala alerted by real/perceived threat Stress hormones (Cortisol & Adrenalin) are released Rising levels of glucose in blood, heart & breathing rates increase What happens next? Distress not relieved Stress hormones reach toxic levels Prolonged exposure = brain cell damage & cell death Impairment of heart, digestive, respiratory and immune systems Distress relieved Levels of stress hormones fall Opioids and Oxytocin released Vagus nerve restores function of heart rate, breathing, digestion, immune system

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22 The Cornfield Model The Staircase Model Think Toddler First, Calm the Body Behaviour Management Cycles

23 New neural pathways = changes in behaviour

24 Emotional Age Versus Chronological Age: Brain Responses Adapted from Perry, 2002

25 Think Toddler (Based on Archer: 2002)

26 First, calm the body

27 Traditional Behaviour Management Cycle

28 Classroom Nurturing Cycle

29 Classroom Nurturing Cycle

30 Held in Mind Routines and Relaxation Permission to Fail Rewards & Sanctions Behaviour Management Cycles Observing: ABC & the three strand approach

31 Held in Mind The child exists for the teacher when he is not immediately with her. The teacher conveys this sense... by perceiving a need and offering something to him before he had directly indicated that he wanted it. (Pawl, 2006)

32 Routines and Relaxation Change and uncertainty cause anxiety. Uncertainty can be felt as overwhelming anxiety, and tolerating the uncertainty of not knowing becomes an unbearable threat. (Geddes, 2007)

33 Permission to Fail The emotion of shame plays an important role in healthy identity formation. In its healthiest form, shame teaches the child that he is human, with limitations and fallibility. Taken to an extreme, however, shame can lead a child to feel flawed as a human being, even to the point of being somehow less than human. (Van Gulden & Bartels-Rabb, 1993)

34 Rewards & Sanctions Empathy will support the child to experience discipline for its intended purpose rather than as abuse or rejection. (Bombèr, 2007) We may feel that praising a child will help to make him feel more positive about himself, while the child may view praise as a threat to his sense of self. (Family Futures, 2008)

35 Stress, burnout, depression, anxiety, compassion fatigue, secondary PTSD... It is important to safeguard the health of those facing aggressive outbursts on a daily basis.