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2nd International NMT Symposium

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Peter Smyth

on 6 June 2016

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Transcript of 2nd International NMT Symposium

The Critical Need to Understand Trauma, Attachment and Brain Development
Peter Smyth and Heather Peddle
Edmonton & Area Child and Family Services
High Risk Youth Initiative

“Simply stated, traumatic and neglectful experiences during childhood causes abnormal organization and functioning of important neural systems in the brain.” 

Relationship-Based Intervention
"...those who experience problems recognizing, experiencing and regulating their emotions are likely to benefit from forming relationships with people who are emotionally available and responsive, intelligent and psychologically-minded. If poor relationships are where things emotionally go wrong then healthy relationships are where things can be put right.”
For this type of child, punishment is not an effective learning tool. The terrorized child has had experiences of extreme violation and horror.
There is nothing more one can do to them which would frighten them into behaving better….The violated child is emotionally too disorganized to make the necessary connections and learn from the infliction of punishment.

The violated child lives in a different emotional universe from the rest of us. Their sense of personal damage is so profound that mild threats of damage like punishment do not register with them….
Punishment is experienced as rejection, which deepens the child’s resentment…
.Once these children feel contained and consistent love, they will not want to lose it.
Camila Batmanghedidjh (2006)
Psychologist and founder of Kids Company
Howe 2008
Perry, 2006
Video #1: Brain Architecture
Abuse, neglect, violence, and disruption of secure bonds evoke terror and utter helplessness in children who totally rely on adults to calm their emotions.

Only as their brains mirror comforting caregivers can children gradually learn to calm themselves.
(Brendtro, Mitchell & McCall, 2009)

Video #2: Serve and Return
But...traumatized children have not yet developed such emotional self-regulation.

They experience pervasive distress shown by anxiety, fear, rage, guilt, depression, attention deficits, impulsivity, explosiveness oppositional behaviour and conduct problems.
(Brendtro, Mitchell & McCall, 2009)

As Sandra Bloom says, it’s not what’s wrong with you? But what happened to you?

The most destructive abuse comes not from stranger danger but from the very individual’s children have learned to love. No brain programs exist to deal with terror of abuse from a trusted person.
(Brendtro, Mitchell & McCall, 2009)

“In order
to function
children depend
on attachments.”

(Neufeld & Maté, 2004)
Why do we continue with traditional practices when the youth are telling us it is not effective?

Why do we look for ways to push youth away when what they are looking for is connection?

Why do we focus on problems in youth when they already feel like they have failed in life, and carry around a sense of shame and guilt?

Why do we expect compliance from youth before we have even established a relationship?

Why are we looking to push youth out of various systems when they are not ready?
Questions to consider during this workshop
Overall Caregiving
Frightening and dangerous: Parents can be confusing and dangerous (abusive), emotionally unavailable (psychotic, depressed, heavy drug or alcohol abusers), or fail to offer protection in times of danger (neglect).
Internal Working Model
Frightened, alone, ignored, dangerous and even bad.
Insecure attachment: Disoriented/Disorganized (Type D) cont…
Key Behaviours of Child
Attachment behaviours can sometimes appear incomplete, contradictory or odd. Children’s attachment behaviour becomes increasingly incoherent and disorganized showing confused, alternating mixes of avoidance, angry approaches responses, behavioural disorientation, apprehension or inertia. In cases where the fear escalates to traumatic levels, children might freeze, physically and psychologically (dissociate).
Perception of Others
Unavailable and unpredictable, confusing and contradictory, frightening and frightened, hostile and helpless, dangerous and unreliable.
Organization of AttachmentBehaviour
Disorganized: Children find it difficult to organize any attachments strategy that results in either increased caregiver availability or increased responsiveness.

Disorganized/Disoriented Attchment

Prolonged and frequent episodes of intense and unregulated stress in infants and toddlers have devastating effects on the establishment of psychophysiological regulation and the development of a stable and trusting attachment relationships in the first year of life. This attachment pattern…predicts later chronic disturbances of affect regulation, stress management, and hostile-aggressive behaviour.
(Solomon & Siegel, 2003)

Disorganized/Disoriented Attachment

Helpless and hopeless stressful situations in which the child becomes inhibited and strives to avoid attention in order to become “unseen”.
If early trauma is experienced as “psychic catastrophe”, dissociation can be “a last resort defensive strategy”; “detachment from an unbearable situation”; “the escape when there is no escape”.
“Profound Detachment”
Fixed, frozen, absence of facial expression, total avoidance of eye contact, absence of vocalization, absence of relationship to others, and the impression that the child is beyond reach.
(Solomon & Siegel, 2003)
Disorganized/Disoriented Attachment

“If the parent does not participate in reparative functions that reduce the stress…the limbic connections that are in the process of developing are exposed to a toxic chemical [such as cortisol] that negatively impacts a developing brain.”

(Solomon & Siegel, 2003)

Video #3: Toxic Stress
Attachment Types
Reasearch suggests that approximately 62% of infants display a secure attachment pattern, while 15% exhibit insecure-avoidant; 9% an insecure-resistant, and 15% an insecure-disorganized pattern
(Allen, 2011)

“Little surprise therefore that so many of those involved in domestic violence , depression, substance abuse, child maltreatment, and violent offending behaviour have had sad, distressed and painful childhoods.”
(Howe, 2008)

“Abused and neglected children suffer unpredictable danger. Worlds in which you have no idea when the next assault or hurt will take place leaving them feeling utterly helpless.”

(Howe, 2008)

“…in the case of extreme emotional neglect and deprivation the brain will fail to develop the relevant neurological architecture even to begin to handle social and emotional experience in anything like a competent fashion.”

(Howe, 2008)

*Simple circuits to complex circuits.

“Their survival is under threat….If you are unable to control these key elements of their environment, you have no choice but to be in ‘survival mode’ all of the time—watchful, vigilant, anxious, frightened. Stress levels therefore remain permanently high.”
(Howe 2008)

“Not surprisingly, children with attachment disorders tend to see adults who try to exercise authority as untrustworthy, dishonest, self-centered, rejecting, inconsistent, stupid, and not really caring. These children have learned to expect parents, foster parents, relatives, teachers, and other authorities to become rejecting or abusive.”
(Kagan 2004)

There is hope...
“Most emotionally neglected or traumatized children do not turn into violent criminals or sociopaths. Usually, if these children have some positive relationships, they will manage to function, even prosper. However, those not so lucky will most likely suffer a sense of emptiness and loneliness, because they are unable to connect with others.”

(Solomon & Siegel, 2003)

“The brain remains ‘plastic’ throughout life, that is it can ‘re-structure’ itself in the light of new experience.…”

Howe, 2008
“Helpers "need skills to avoid to being drawn into conflict cycles marked by power struggles, counter aggression, and avoidance. Nor can they indulge or enable the child in a role as helpless victim. Instead, these children need adults who will walk with them through the storms of life until they break free of the pain of the past."
“Indeed, our survival as a species is dependent on our ability to form and maintain successful relationships with others….The most powerful reward and the most intense pain come from relational experiences.”
Szalavitz & Perry, 2010
Allen, B. (2011). The use and abuse of attachment theory in clinical practice with maltreated children, part 1: Diagnosis and assessment. Trauma, Violence & Abuse, 12(1): 3-12.
Brendtro, L., Mitchell, M., and McCall, H. (2009). Deep brain learning: Pathways to potential with challenging youth. Circle of Courage and Starr Commonwealth. Albion, Michigan: Starr Commonwealth.
Howe, D. (2005). Child abuse and neglect: Attachment, development and intervention. New York, N.Y.: Palgrave, McMillan.
Howe, D. (2008). The emotionally intelligent social worker. New York, N.Y.: Palgrave, McMillan.
Kagan, R. (2004). Rebuilding attachments with traumatized children: Healing from losses, violence, abuse, and neglect. Binghampton, N.Y.: The Haworth Maltreatment and Trauma Press.
Levy, T.M., Orlans, M. (1998). Attachment, trauma and healing: Understanding and treating attachment disorder in children and families. Washington, D.C.: CWLA Press.
Neufeld, G., Maté G. (2004). Hold on to your kids: Why parents matter. Canada: Alfred K. Knopf.
Perry, B., Szalavitz, M. (2006). The boy who was raised as a dog and other stories from a child psychiatrist’s notebook. USA: Basic Books.
Perry, B (2006). Applying principals of neurodevelopment to clinical work with maltreated and traumatized children: The nuerosequential model of therapeutics, in Working with traumatized youth in child welfare, Nancy Boyd Webb (ed.), Guilford Press, New York, N.Y.
Perry, B. (2009). Examining child and maltreatment through a neurodevelopmental lens: Clinical application of the neurosequential model of therapeutics. Journal of Loss and Trauma,14: 240-255.
Solomon, M.F., Siegel, D.J. (2003). Healing trauma: attachment, mind, body, and brain. New York, N.Y.: W. W. Norton & Company, Inc.
Szalavitz, M., Perry, B. (2010). Born for love: Why empathy is essential—and endangered. USA: William Morrow, Harper Collins.
Smyth, P., & Eaton-Erickson, A. (2009). Making the connection: Strategies for working with high-risk youth. In S. McKay, D. Fuchs, & I. Brown (Eds.), Passion for action in child and family services: Voices from the prairies ) pp. 119-142). Regina SK: Canadian Plains Research Centre.
Ungar, M. (2013). Resilience, trauma, context, and culture. Trauma, Violence, and Abuse, 14: 255-266.
Brendtro, Mitchell & McCall, 2008
Perry et al. showed that while children are “malleable,” they are not independently able to overcome adversity….Children adapt to their environments and grow up psychologically healthy if they are provided with the resources necessary to modify neurological functioning.

(Ungar, 2013)

Ineffective approaches:
Three Strikes
Zero tolerance
Tough Love

VIDEO: First Impressions...Exposure to Violence and A Child's Developing Brain with Dr. Bruce Perry
The 2nd International
Neurosequential Model Symposium

June 8 - 10, 2016
"I have a liitle brain that is tucked safely in my head...and another that's in the air nstead! That one follows me a plays with me in bed. The other one confuses me...that's the one in my head."
Anonymous 13-year-old Ugandan Girl
(Levine and Kline, 2007
Strategies for helping our youth...
Youth are valued and worth the effort
Be available
Be aware of judgments
Consistent message: I will not give up!
Gaining TRUST is not the main goal
Intentional interaction--everything has a purpose
Inspire hope
Focus on strengths
Strategies continued...
Expect to be tested
Explore the motivation to change
Create healthy confusion
Go the extra mile
Be patient
Be open to learning from the youth
Full transcript