Stress: The Good, Bad, and the Ugly Part Three: Intervention. Catherine Nelson, Ph.D. University of Utah

Transcription

1 Stress: The Good, Bad, and the Ugly Part Three: Intervention Catherine Nelson, Ph.D. University of Utah

2 Session Three Overview Review Intervention with Children and Youth Behavioral State Responsive Environment Communication Predictable Environment Social Relationships and Attachment

3 Session Three Overview Families Research Intervention Your Own Stress

4 Magnitude of Stress Response Novelty of threat Unpredictable nature Threat to person or ego Sense of lack of control (Guilliams & Edwards, 2010) M

5 Review of Protective Factors Secure attachment Good physical health Strong social network Responsive environment Feelings of competence Clear patterns of arousal and relaxation Physical exercise Relaxation opportunities Temperamental characteristics

6 Questions

7 Coping With Stress If resources are deemed adequate: Problem-focused coping behavior Emotion-focused coping behavior

8 Stress and Intervention Think about possible health issues first Feeling ill or being in pain can cause stress and intensify stressful feelings Look at the child s sleep/wake cycles- if child is not getting enough sleep, stress response could be altered Look at patterns of arousal and relaxation

9 Stress Intervention: Biobehavioral Quiet sleep States Active Sleep (REM) Drowsy Quiet Alert Active Alert Crying/Agitated

10 Stress intervention: Biobehavioral state Variety awakens Repetition soothes Calming stimuli Arousing stimuli Provide opportunities for physical exercise Provide opportunities for relaxation

11 Stress Intervention: Responsive Environment Avoid the good fairy syndrome Make sure individual is do-er not done-er Involve individuals in all phases of activities Pausing techniques to encourage independent behavior Provide choices at each activity phase Give amount of control that a child without disabilities has Structure activities for success

12 Responsive, Communication Rich Environment Ensure a nurturing environment Take time to establish relationships Enhance sensitivity to all communications Increase opportunities and motivation to communicate Integrate conversations throughout the day

13 Nonsymbolic Communication Examples Movements and changes in muscle tone Vocalization Facial expressions Orientation Pause Touching, manipulating or moving with another person

14 Nonsymbolic Communication Examples Acting on objects and using objects to interact with other Assuming positions and going places Conventional gestures Depictive actions Withdrawal Aggressive, self injurious behavior

15 GkMLyg Video of Bob Shumaker, a Vietnam veteran talking about resilience and the importance of communication and social supports: From PBS Series This Emotional Life

16 Questions

17 Predictable Environment Provide multiple ways for the individual to understand what is going to happen and when it is over Use cues Use consistent routines Use calendaring or scheduling system

18 Routines Repetition of same sequence of events in the same manner Enhances anticipation Stimulates growth of neural pathways Provides sense of security

19 Russia Kiril Fetal Alcohol Syndrome Severe hearing loss Very low vision Reactive attachment disorder Video clip 1 Video clip 4 Video clip 5

20 Activity: Kiril What did you see that Kiril s teacher did well to bring down his stress? Can you think of ways you can or do use these techniques in your class already?

21 Schedule Systems or Calendar Boxes Objects or pictures represent activities of the day Provide children with a visual, tactual method to know what is coming up Gives child time to assimilate information and prepare him/her self for what is coming Provide for order and predictability in the child s life Review symbols (and activities) during the day to build memory and reinforce left to right progression

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24 Masha (Maryana) Very little hearing or vision Russia Maryana 1 Maryana W in greenhouse with schedules

25 Activity Masha What seemed to upset Masha in the first video? What strategies were used in the 2 nd video?

26 Social Relationships Take time to develop a relationship with the child Assist the child to develop relationships with others including peers Circle of Friends Plan for times when individuals with whom child is attached are not available Help establish secure attachment with caregivers

27 Stress and Attachment Secure attachment is at risk, disorganized attachment is more prevalent when child has neurological impairment or autism (Van Ijzendoorn et al., 1992) Secure attachment involves Co-regulation of emotions Joint attention Mutual responsiveness of signals Precursors to insecure attachment Parental Stress (Stolk & Kars, 2000) Ineffective parenting Lack of cognitive skills (Cassidy, 1999; Janssen, et al., 2002). Time spent away from caregiver

28 Stress and Parents of Individuals with Severe Multiple Disabilities Studies have shown that parents of children with disabilities experience significantly higher levels of parental stress (Pottie & Ingram, 2008). Stress increases with mismatch between stressor (e.g., difficult child) and coping response Coping responses may include specific techniques to manage challenging behaviors or seeking out social supports

29 Research and Parents Midlife parents (mean age = 57.4) of children with disabilities (Selzer, et al., 2009). 82 in each group Parents of children with disabilities when compared to control group used their time in similar ways, had similar # positive events Had daily elevated levels of stress, negative affect, and physical symptoms

30 Midlife parents cont. Afternoon and evening cortisol had lower decline in disability parent group More time spent with children = higher level of negative affect but fewer physical symptoms Marginally less pronounced daily decline of cortisol with increased time spent with child

31 Parents Maternal cortisol levels and behavior problems in adolescents and adults with ASD (Seltzer, et al., 2009). 86 parents of children with autism, 171 in control group- assessed 4 times over 4 years Mothers of children with ASD had significantly lower levels of cortisol throughout the day (akin to PTSD)

32 Parents and ASD cont. For mother s whose children had infrequent behavior problems, a large rise in morning cortisol was seen the day after a problem behavior occurred For mother s whose children had clinically significant behavior, bad behavior days did not result in increased AM cortisol

33 0oDucQ Video of SallyThibault, mother of a child with autism and author of David s Gift

34 Stress and Parents of Individuals with Severe Multiple Disabilities Long term stress Same long term impact Need our understanding, support Help them understand behavior of their children Help them learn positive strategies to cope Help with ID of resources, but let them feel they are in charge

35 Stress and families Addressing the stressors affecting a child requires addressing the stressors on his or her family in order to ensure that the critical environment of relationships can be maximally supportive National Scientific Council on the Developing Child, 2007

36 Questions? Do you all have ideas for how you support families?

37 Video of Dr. Robert Sapolsky talking about stress and how to cope with it: From PBS series This Emotional Life shqpcc

38 Activity How do you keep your own stress under control?

39 Controlling Your Stress Address the stressors in your life Eat a healthful diet Get enough sleep Exercise Practice Relaxation Techniques Foster relationships Have a sense of humor Seek counseling if and when needed

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41 Questions

42 References Cassidy, J. (1999). The nature of the child s ties. In: Handbook of Attachment Theory, Research and Clinical Applications (J. Cassidy & P.R. Shaver, Eds). Pp Guilford, New York, NY. Excessive stress disrupts the architecture of the developing brain (2005). National Scientific Council on the Developing Child, Working Paper No. 3. Retrieved 1/28/09 from Janssen, C.G.C., Schuengel, C. & Stolk, J. (2002). Understanding challenging behaviour in people with severe and profound intellectual disability: a stress-attachment model. Journal of Intellectual Disability Research. 46: Lee, A.L., Ogle, W.O., & Sapolsky, R.M. (2002). Stress and depression: Possible link to neuron death in the hippocampus. Bipolar Disorders, 4; Mental health problem in early childhood can impair leaning and behavior for life (2007). National Scientific Council on the Developing Child. Working Paper No. 6. Retrieved 1/28/09 from Pottie, G. & Ingram, K.M. (2008) Daily stress, coping, and well-being in parents of children with autism: A multillevel modeling approach. Journal of Family Psychology, 22: Seltzer, M. M., Almeida, D. M., Greenberg, J. S., Savla, J., Stawski, R. S., Hong, J., & Lounds T. J. (2009). Psychosocial and biological markers of daily lives of midlife parents of children with disabilities. Journal of Health, Social Behavior, 50(1), Seltzer, M. M., Greenberg, J. S., Hong, J., Smith, L. E., Almeida, D. M., Coe, C., & Stawski, R. S. (2009). Maternal cortisol levels and behavior problems in adolescents and adults with ASD. Journal of Autism and Developmental Disorders. doi: /s Van Ijzendoorn, M. H., Schuengel, C., & Bakermans-Kranenburg, M.J. (1999). Disorganized attachment in early childhood: Meta-analysis of precursors, concomitants, and sequelae. Development and Psychopathology, 11,

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