Intensive in-patient treatment for children with severe traumatization in infancy

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1 Intensive in-patient treatment for children with severe traumatization in infancy Karl Heinz Brisch Ulrike Paesler, Kathrin Zeber, Anne Budke, Ludwig Ebeling, Julia Quehenberger Dept. of Paediatric Psychosomatic Medicine and Psychotherapy Dr. von Hauner Childrens Hospital Ludwig-Maximilians University of Munich Munich, Germany

2 Outline Model of therapy of an intensive psychotherapy unit Study Moses Case example Conclusions

3 Attachment traumatization with beginning in infancy Chronic early maltreatment by caregivers Threatening living conditions Changing care systems Loss of caregivers Inadaquate care Physical and emotional deprivation Abuse and violence by caregivers

4 Symptoms of attachment traumatization Disorders in Delay in physical growth Delay and disorders in neural networking and brain development Psychosomatic symptoms Attachment Affect regulation Attention Cognitive functioning Mentalization and empathy Interpersonal relationships with aggression Dissociation

5 MOSES Therapy Model Pediatric Intensive Care Unit of Psychotherapy Components of treatment Somatic treatment Social work Milieu therapy Individual psychotherapy Group-psychotherapy Trauma-therapy (EMDR) Education

6 Milieu-therapy Safty and structure New attachment figures individual attachment nurse and 2 therapists Psychodynamic and attachment-based understanding Affect and stress regulation Developmental support New group experiences with peers

7 Individual Psychotheray Psychodynamic attachment based play therapy 4-5x /week Traumatherapy Parent- Counselling/Education Familiy-Therapy 1x/week External individual therapy for mother/father

8 Creative Therapy Art Therapy Musik Theray Movement Therapy Individual sessions (individual frequency) Group sessions, 3 x /week

9 B.A.S.E. - Babywatching 1x a week observation of mother/father baby interaction Promotion of sensitivity, empathy, mentalization Decrease of aggression Decrease of anxiety

10 Schooling Mon Fri 8:30-12:00 a.m. Max. 6 students Individual teaching Group teaching 3 Teachers are team members Team-supversion Case-supervsion

11 External supervision and training Team-Supervision (every 2nd week) Case-Supervision (3x/week) Nurses Therapists All staff members Training and supervision in psychotraumatology and attachment

12 CAMPUS INNENSTADT KINDERKLINIK UND KINDERPOLIKLINIK IM DR. V. HAUNERSCHEN KINDERSPITAL Evaluation of a treamtent model Intenvive Care Unit of Psychotherapy for early traumatized children aged 6-13 years MOSES Study

13 Sample Children age 6-13 years Intervention group, waiting control group, healthy control group Sample size 3 x N = 24 (total sample size N = 72) Inclusion criteria: Severe early traumatisation with violence, abuse, neglect by primary caregivers Chronification of posttraumatic stress disorder PTSD Attachment disorder Exclusion criteria: Previous inpatient treatment Severe autism, addiction, mental disability (IQ < 85) Treatment of 6 children in a group setting Duration of in-patient treatment: 6 months

14 Study design 4 points of measurement T0= 6 months before in-patient treatment (only waiting group) T1= Admission to in-patient treatment T2= Discharge T3= Follow-up: 6 months after discharge Methods Questionnaires and test Attachment interviews und behavioral observations (f)mri Oxytocin and cortisol in saliva and in blood (1x at T1)

15 Methods 1 Questionnaires (e.g. PTSD, CBCL 4-18, depression, anxiety) Outcome and process (6-weeks intervall) Tests: e.g. intelligence Attachment Interviews with parents and children: Adult Attachment Interview- AAI (George, C., Kaplan, N. & Main, M., 1985/2001) Adult Attachment Projective Picture System-AAP (George, C., West, M. & Pettem, M., 2012) Child Attachment Interview-CAI (Shmueli-Goetz,Y., Target, M., Fonagy, P., & Datta, A., 2008) Story Stem Completion Task (Gloger-Tippelt & König, 2009) Parent-child play interation (video) Parental Sensitivity (Ainsworth Maternal Sensitivity Scales- AMSS; Ainsworth, 1969)

16 Methods 2 Structural and und functional fmri alt all points of measurement Diffusion Tensor Imaging (DTI): micro-myelinisation Functional connectivity Anatomy of hippocampus Paradigm associated (f)mri sequenz (stimulus: 60 picture of the International Affective Picture Systems IAPS; 20 pictures each pleasure, distress, neutral) fmri with matched-pair healthy control children

17 Methods 3 Oxytocin und Cortisol in saliva pre- and post attachment interviews 4 points of measurements: before, after, 15 min. and 30 min. post interview

18 Questions and aims 1 Global aim: Evaluation of the treatment programme of the intensive care unit of psychotheray for early traumatized children with attachment disorders What kind of attachment representation do these children present? Can we change their attachment respresentation to earned secure? How does the attachment representation influence the HPA axis and oxytocin secretion? Can we develop and optimize ressources like intelligence, social competence in groups?

19 Questions and aims 2 Can we influence psychopathology (PTSD symptoms, dissociation, anxiety, depression) Can we observe changes in neural structures, function and connectivity of the brain?

20 Conclusion Treatment should start early Intensive treatment In-patient with new intensive positive sensitive attachment experiences Affect and impuls control Stress regulation Social integration Healthy bio-psycho-social development

21 DVD DVD "Embracing Closeness" DVD "BASE Babywatching" DVD SAFE-Programme DVD Strange Situation Procedure DVDs available for sale via our website! Copyright Karl Heinz Brisch Munich/Germany All rights reserved.

22 Reference Brisch, Karl Heinz (2012) Treating Attachment Disorders. From Theory to Therapy. 2nd Edition Guilford Press, New York, London Copyright Karl Heinz Brisch Munich/Germany All rights reserved.

23 International Conference Munich, October 10-12, 2014 ATTACHMENT and MIGRATION Information und Programme Copyright Karl Heinz Brisch Munich/Germany All rights reserved.

24 Thank you for your attention!

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