A Missing Link. Where are the speech & language pathologists in attachment trauma therapy?

Transcription

1 A Missing Link Where are the speech & language pathologists in attachment trauma therapy?

2 Presented by Susan Ward, LPC Carole Soucaze, SLP

3 Who s here? Parents? Psychotherapists? Respite providers? Occupational therapists? Educators? Speech & language pathologists?

4 Goals -Bring new understanding of the role of language within attachment-trauma healing -Bring new understanding of the importance of language within all attachment relationships -Suggest new ways to integrate SLPs into attachment-trauma treatment -Suggest new ways to look at the overall attachment-trauma treatment team

5 Past, Present, Future of Attachment-Trauma Therapy Ever changing

6 History of attachment trauma therapy Past Moving forward Diagnoses PTSD, RAD Developmental Trauma Disorder, Complex Trauma, RAD, PTSD Causes Issues Treatment Neglect, abuse, inconsistent caregiving, illnesses Defiant, non-compliant, control, manipulation, pushing people away, poor self regulation, jabbering/nonsense questions Holding, high structure/high nurture, parents in charge, limited choices, consequences, strong sitting, EMDR ACEs, illnesses, natural disasters, NICU, big T, little t, in utero issues, difficult birth Relationship deficits, shame, sensory issues, trauma held in body, changes in brain structure, poor self regulation, language gaps High structure/nurture, neuroscience, repair/restitution, emotional IQ, mindfulness, neurofeedback, EMDR, language considerations/treatment Team Parents, therapist, respite provider Parents, therapist, OTs, educators, respite providers, SLPs

7 Do you know a child who Talks off topic? Is silent when you say, Use your words? Communicates well with adults but not peers? Never quite exactly follows directions? Rambles on and on when asked a simple question? Gets anxious in social situations? Can t seem to wait their turn? Accuses you of yelling at them?

8 It all relates to language! Bring in the speech & language pathologists!

9 Trauma impacts speech

10 What is speech and language pathology? An overview

11 Did you know? Reciprocity is largely learned through language Attachment & language develop at the same time Parents language skills may impact a child s healing Cause and effect is rooted in mother's language to baby Language centers are programmed to work in calm Self-regulation is rooted in mother's verbal and non-verbal reflections on baby's internal state

12 Communication pieces

13 Aspects of speech therapy

14 Aspects of language therapy

15 Auditory processing disorder (ADP) Difficulty in decoding spoken language 7-20% is estimated prevalence in children Probably higher in kids from a trauma background

16 Children with APD may demonstrate Difficulty working in groups Struggle to answer questions Cannot remember instructions Startle to loud sounds Seem lost in conversation Often say, huh Use a loud tone of voice Distracted by background noise

17 What we say isn t what they hear We say Meet me at the front door. They hear Beat me to the front door.

18 Auditory misperception

19 Pragmatics issues Social use of language What we say How we say it Body language, eye contact Appropriate to situation & listener

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21 Children with pragmatic language disorder may demonstrate Difficulty in introducing topics Struggle to stay on topic Tell stories in a disorganized way Have little variety in language use Unable to reappraise when misunderstood Struggle with use of non-verbal signals Difficulty with facial expression and eye contact

22 Examples of how SLPs can help Identify communication deficits that are impacting the healing process Teach vocabulary to the traumatized children Build reciprocity skills Improve social skills through language development Reduce apparent non-compliance by improving auditory processing Improve vague/ambiguous language formulation Address speech/language issues with internationally adopted children

23 Expanding attachment & trauma treatment to include speech & language therapy

24 A new perspective Upon reviewing 25 client families in consistent, committed therapy for at least 6 months Approximately 20 may have speech or langauge deficits within the family. Family with the fastest healing: parents involved in acting, singing, writing, teaching. Might the parents strong speech & language skills be a factor?

25 Case study Jessica, age 11, adopted at age 4 Psychological issues? Sensory issues? Language issues? Kinship adoption by grandmother At home and school doesn t do what s asked of her or does it slightly wrong Big gaps in talking about feelings Physically aggressive towards sister Wears heavy clothes in all seasons Grandmother had traumatic childhood, angry/sarcastic voice

26 Case study Jane, age 36 Psychological issues? Sensory issues? Language issues? Individual adult in therapy Quite good about discussing basic feelings At times feels disconnected from her 2 pre-school aged children Uses way too many words/hard to follow Significant anxiety after second child s birth Highly impacted by sounds and smells Significant abuse as a child

27 Changing OUR Language What if therapy words became more positive?

28 Instead of: Use your words Are any of these helpful? Would you like some help? Other people might think... Other people might feel...

29 Instead of: Controlling Managing environmental influences

30 Instead of: Oppositional Defiant Disorder Maladaptive self preservation

31 New Possibilities in Treating Language Issues EMDR?

32 EMDR: Example #1

33 EMDR: Example #2 Avg. Errors Per Minute Totals Pre-Screen Post-Screen Low Stress 3 0 High Stress 8 0

34 Looking at the whole child? or part of a child?

35 The psychotherapist leaf Build attachment Reduce trauma triggers Practice feelings words Improve coping skills Increase compliance

36 The occupational therapist leaf Address hyper sensory issues Address hypo sensory issues Help with gross motor skills Help with fine motor skills Proprioceptive awareness

37 The speech & language leaf Build language skills Address speech deficits Improve overall communication Grow reciprocity skills Expand social connectedness

38 Are we missing the tree?

39 Just for fun!

40 Strain the Brain!

41 1 Relationships are the key to therapeutic success. underlies successful therapeutic relationships in every setting with every child. -Suzanne M. Ducharme Options speech & language pathologists, speech, language, communicating, words, communication

42 2 "Relationships are carried by. -Mary Davis Options speech & language pathologists, speech, language, communicating, words, communication

43 3 The essence of a therapeutic relationship is finding where were absent before and, as a result, being able to share your deepest pain and deepest feelings with another human being. -Bessel van der Kolk Options speech & language pathologists, speech, language, communicating, words, communication

44 4 " is the inventory of human experience. -L. W. Lockhart Options speech & language pathologists, speech, language, communicating, words, communication

45 5 " are the physicians of the mind diseased. -Aeschylus Options speech & language pathologists, speech, language, communicating, words, communication

46 6 You might think it s an attachment-trauma issue, but in fact it may be due to a or deficit. -Susan Ward Options speech & language pathologists, speech, language, communicating, words, communication

47 7 In the same way that occupational therapists have significantly impacted the treatment of the children with attachment & trauma disorders through their knowledge of sensory integration & self-regulation, so too must bring their knowledge and skills to bear. -Carole Soucaze Options speech & language pathologists, speech, language, communicating, words, communication

48 Wrap up Apply your new awarness

49 Thoughts? What s a potential language gap that should be assessed by a speech language pathologist?

50 Thoughts? What is a pragmatic language skill that might relate to a child s behavior, affect, and treatment?

51 Thoughts? How might speech pathologists augment a child s attachment to their caregiver while providing speech therapy?

52 Thoughts? What are some strategies to improve a child s communication in psychotherapy sessions?

53 Thoughts? How can psychotherapists and speech and language pathologists collaborate when working with a child with trauma/attachment issues?

54 Resources Communicating Trauma: Clinical Presentations and Interventions with Traumatized Children by Na amayehuda, Routledge, Language and Connection in Psychotherapy: Words Matter by Mary Davis. Rowman and Littlefield, Acquiring Knowledge in Speech, Language, and Hearing, 11(3), , Mental Health. [Australian] The Body Keeps the Score by Bessel van der Kolk. Viking, 2014.

55 Contact info Susan Ward, MA, MS, LPC Carolina Mountain Counseling Carole Soucaze, SLP Evergreen Community Charter School , ext. 1242

56 May we go forth armed with new ways to help hurting children! A Missing Link: Language as Part of Trauma Healing