Help! What Can I Do to Help This Kid and What Do I Do First?. Mershona Parshall LISW-S ATR-BC private practice Andrea Hauserman MBA adoptive parent. WHAT YOU WILL LEARN TODAY. Understanding Developmental History Symptoms and Diagnoses Interventions - PowerPoint PPT Presentation
1Help! What Can I Do toHelp This Kid and What Do I DoFirst?Mershona Parshall LISW-S ATR-BC private practiceAndrea Hauserman MBA adoptive parentWHAT YOU WILL LEARN TODAYUnderstanding Developmental HistorySymptoms and DiagnosesInterventionsHow to choose and prioritize treatment.2RIGHT TO THE POINTMedical
Explicit Training3DEVELOPMENTAL INSULTSA developmental insult is anything thatmay interfere with a child reaching his or her full potential.
The most detrimental insults occur in thefirst three years of an infant/childs life.
4INTENTIONAL AND UNINTENTIONALDEVELOPMENTAL INSULTSPrenatal:Fetal exposure to neurotoxins.Maternal stress such as poverty, domestic violence, unstable housingPoor nutritionEnvironmental toxic exposures: mercury, lead, pollution, radioactivity
Postnatal:Neglect: Sensory and relational deprivationPhysical, sexual, and emotional abuseEnvironmental toxic exposuresChaotic and violent environmentsMedical problems
5ADDITIONAL FACTORSGENETICSFAMILY HX:MENTAL ILLNESSLEARNING DISABILITIESMEDICAL CONDITIONSTEMPERAMENTSOCIAL FUNCTIONINGINTELLIGENCE6DEVELOPMENTAL INSULTS AND CHRONIC STRESS STATESThe immature nervous system of an infant is highly vulnerable to stress states. An infant relies on the mother for external regulation before it can regulate itself.Social stressors (relational trauma) are the most detrimental to the developing infant/child.Chronic stress causes permanent changes to the infants brain. The infants brain is experience-dependent and chronic stress states become TRAITS.
7Stress StatesTwo primary responses to overwhelming stressHyperarousalFear-terror observed as hypervigilance, anxiety, hyperactivity, impulsivity, sleep problems.Sympathetic overarousal reflects excessive levels of the major stress hormone cortisol. Excessive stress hormones are neurotoxic and cause cell death in the affective centers in the limbic system. Fight/flight response, energy expendingDissociationFreezing response, energy conservingParasympathetic regulatory strategy to cope with helpless, hopeless situation.Ultimate survival strategy to become invisible.Involves numbing, avoidance, compliance, passivity, restricted affect.
Child unable to adapt, cope, regulate affect, feel secure, attach.8STRESS AND AROUSAL STATESHYPER
Common symptoms of PTSD and Complex PTSD
Alterations in Regulation of Affect and ImpulsesAffect Regulation, anger modulation, self-destructive, suicidal , excessive risk taking.Alterations in Attention and ConsciousnessAmnesia, Transient dissociative episodes and depersonalizationSomatizationDigestive system, chronic pain, conversion symptomsAlternations in Self-PerceptionIneffectiveness, guilt, shame, nobody can understand, minimizingAlterations in Perception of the PerpetratorDistorted beliefs, idealization of the perpetratorAlterations in Relations with OthersInability to trust, revictimization, victimizing othersAlternations in Systems of MeaningDespair and hopelessness, loss of previously sustaining beliefs10Developmental Trauma Single catastrophic traumatic event
Children here will have the most internal resources to recover from trauma.
Securely attached Unattached
These children are the most severely traumatized children with the least resources to recover from trauma.
Chronic, ongoing abuse11RIGHT TO THE POINTMedical12Diagnoses describe a cluster of symptoms.
Symptoms are complex and overlap many diagnoses.
Determining etiology may be difficult when history is not known.
REFER TO HANDOUT13 SYMPTOMS AND DIAGNOSES1314Matrix
SYMPTOMS AND DIAGNOSESPHYSIOLOGICALLeaky gutCompromised immune systemAllergiesYeast DysbiosisSleep disturbanceUnable to self-regulate
15SYMPTOMS AND DIAGNOSESEMOTIONALUnable to self-regulate affectUnable to cope with normal stressLabile Unstable moodsUnable to trust and form relationships TYPICAL DIAGNOSES: BiPolar DisorderPTSD Post Traumatic Stress DisorderRAD Reactive Attachment DisorderDepressionAnxiety16SYMPTOMS AND DIAGNOSESCOGNITIVEMental retardationLearning DisabilitiesLower IQUnable to concentrate and focusTYPICAL DIAGNOSES: ADHDPTSDEXPRESSIVE AND RECEPTIVE LANGUAGE DISORDERS
1717SYMPTOMS AND DIAGNOSES BEHAVIORALDefianceActing outAggressionTYPICAL DIAGNOSES: ODDCDRADADHDBIPOLAR
18This 18EVALUATING THE CHILDMedical: Use an appropriate healthcare provider toevaluate the child for health and developmental milestones
Follow American Academy of Pediatrics guidelines forincoming foreign children.
It is important for healthcare providers to avoid giving "standard parenting advice to adoptive families as these children may have experienced loss, deprivation, separation, and instability in their countries of origin. The adoptee will require careful developmental, behavioral, and attachment evaluations, and progress-monitoring over time will help ensure positive developmental outcomes in the future. Dr. Stanley Grogg D.O. http://www.jaoa.org/cgi/content/full/107/11/481
19Often parents only go to the pediatrician and rely on him/her to direct everything for the child. This is inappropriate and depends on the Dr to identify behavioral issues they wont see in person in the space of an office visit.Second, many Drs are not familiar with interventions for delayed neurological development as pertains to motor skills, coordination, language, sensory integration disorder, self regulation. These need to be referred out to SLPs, OTs, Developmental Movement Specialists. Local parent groups are good resources to start with or adoption groups19
IA MEDICAL EVAL CHECKLISTAmerican Academy of Pediatrics Anti-HCV Hepatitis CUrinalysis Audiological Assessment Stool Culture Blood Lead TestLiver Panel Complete Blood Count Tuberculin Skin TestOva and Parasite Exam Renal Function StudiesSyphilis Detection TestIodine & Vit D Thyroid Function Tests Chemistry Panel Eye and Vision Examination Vaccine Titers Hepatitis B Surface AntibodyHuman Immunodeficiency Virus (HIV) Antibody Test Use for Domestic Adoption20EVALUATIONS, cont.Parents should be familiar with basic attachment parenting techniques and watchful for symptoms of PTSD and RAD which can masquerade as ADHD, OCD, rages, irritability, depression
Occupational Therapist eval for balance, coordination, visual and auditory systems
Speech Pathologist for language eval and screen for auditory processing issues
If there are too many developmental delays, dont wait, go get a full Neuropsychological evaluationEarly Intervention is Important!
21My children tell about how frightened they were when they came here. They thought for years that we were going to hurt them or leave them somewhere if they werent good. They also thought the caregivers from the orphanage could come for them anytimeManifested as sleeplessness, nightmares, crying when spoken to, irritability, severe ADHD, suppressed cognition, severe expressive language disorder,
Despite a full neuropsych and seeing several pediatricians, my daughters deafness was not diagnosed for 6 months and then it was by me.Dr Pomeranets talking to them and then concluding that their language was fine.
21ADDITIONAL ASSESSMENTSCSA Complete Stool Analysis for bacteria, yeast, parasitesRed Blood Cell Elements for evidence of heavy metalsTrace minerals such as Boron, Vanadium, Chromium, also CA, NA, Iodine, Vit DDevelopmental Movement Evaluation
22Medical Health GastroIntestinalMany children have compromised GI tracts as result of chronic stress, malnutrition or unbalanced diet, damaged organs, metabolic and hormonal Systems overload, yeast or bacterial overgrowths, genetic conditions such as Celiac Disease and Diverticulitis, overuse of antibiotics, food allergies and sensitivities, gluten sensitivity and over use of processed foods that contain Preservatives
Yeast and bacteria very common problemCreate slime barrier that actually grows into the intestinal wall and damages it. Creates Leaky Gut syndromeYeast and bacteria grow on stagnant substrates and produce foul smelling gas, diarrhea and or constipation, jaundiced looking whites of the eyeYeast can cause constipation, bacteria can cause diarrhea. The behavioral symptoms are hyperactivity, attention deficit, irritability, heightened sensory reactions esp to noise, auditory processing difficulty looks like APD but prob just attentional, difficulty falling asleep, staying asleep, all the way to screaming and very poor self regulation.
23The issue wi gluten being a problem for people who don't have the truecondition of celiac is actually associated with a immune disorder. Glutenprovides a substrate for bacteria and yeast to grow on, gunk builds up inthe GI tract providing a better and better environment for the bad guys tolive in . Before long the intestinal lining begins to get inflamed. Yourdigestive enzymes are compromised and improperly digested gluten peptidesslip thru the 'cracks' so to speak in the intestinal wall - which is calledLeaky Gut syndrome. the byproducts of yeast and bacteria metabolism includesome awful aldehydes and ethanol which are just poisons - stressing yourlivers capacity to clean and detoxify the blood - thats why the dark circlesunder the eyes - you see that, you know the liver is working overtime toclean something up.
These improperly digested amino acid chains of gluten mimic the shape of anopiate - and attach to opiate receptors in the brain. When these littleamino acid chains come off the opiate receptors is when you feel bad - itslike a hangover. You know the'sugar high" there is some truth to that. Thesugar also feeds yeast, which in turn produces ethanol. I've actually seenmy son begin laughing hysterically and start telling jokes after drinking 2cans of pop in a row - in other words - drunk. He's on a restricted diet soit hits him hard - no tolerance. He got razzed hard at Boy Scout Camp forgetting silly after drinking 3 root beer floats at the cantina first night.They claimed he was 'drunk' on root beer and I believe it - unfortunately hewould rather not manage himself so I know he's going to do what he wantswhen away from home.Phyllis said some people can't eat certain cheeses when on gluten free diet- thats because they have a yeast overgrowth, not anything to do w gluten -the fungus that makes cheeses form is a cousin to the yeast / fungus in theGI. Ditto vinegars.
I have been lactose intolerant since age 17 - related directly in time to ahigh stress incident - and after going gluten free and working on Candida inmy GI - I now can eat small amounts of dairy and use it in cooking with noproblem. The people who wrote in today talked about feeling better, clearerthinking, inflammations clear up - kids will be less irritable andimpulsive. I stopped having joint pain and that was amazing - my ankles,knees, wrists etc all hurt every morning - seems to be gone now but willflare up if i'm not careful2324Biomedical supplements
Zinc Digestive Enzymes5HTPSeleniumLiver SupportEssential Fatty AcidsCalciumProbioticsMagnesiumCholinemulti vitaminWater Soluble vitamins
2425Parent ObservationsEmotional Regulation (for example, anger, aggressiveness, anxiety, tantrums, mood swings, etc)Emotional AttachmentHyperactivitySleep IssuesAuditory ProcessingSensory IntegrationVisual IssuesDifficulty in learning to readDifficulty in mathSocial SkillsLow EnergyAttention/DistractibilityMotor development (balance, ability to participate in sports, etc)Eating DifficultiesLow self esteemSexual Acting Out50 Conditions that Mimic ADHD ADHD is diagnosed by health professionals who form their opinion by observing a child's behavior. There are nobrain scans, blood tests, or anything else definite that is used during diagnosis. The problem with this is there aremany other problems that have the same symptoms as ADHD. For example, any problem dealing with the fuels ofthe body: water, food, blood and air can cause behavior problems. Water, food, blood and air to the body are justlike gas and oil to a car. If you put bad gas or have old oil in your car, it will act up just like a child acts up wheneating foods they are allergic to, drinking or breathing contaminated water or air or having blood disorders.
There are many medical, biological, emotional and mental conditions that mimic ADHD.Here are somepossibilities.
! Conditions most over looked.
1. ! Hypoglycemia (Low Blood sugar) can stem from thyroid disorders, liver, pancreatic problems, adrenal gland abnormalities
2. ! Allergies: 15 to 20 percent of the world has some type of allergy. A person can be allergic to nearly anything. Food is one of the primary causes of allergic reactions.
3. ! Learning disabilities: If the primary place of behavior is at school, learning disabilities(self esteem) may be the cause.
4. ! Hyper or hypothyroidism: An imbalance in metabolism that occurs from an over or underproduction of thyroid hormones. This imbalance may cause a variety of behaviors and affects all body functions.
5. ! Hearing and vision problems including CAPD. 26. CAPD (Central Auditory processing Disorder) history of ear infections and/or PE tubes. Symptoms include distractibility, inability to follow a set of verbal instructions, "space out", etc.
6. ! Mild to high lead levels, research shows that children with even mildly elevated lead levels suffer from reduced IQs, attention deficits, and poor school performance. Lead is the leading culprit in toxin-caused hyperactivity..
13. ! Sleep disorders: Sleep Apnea causes cognitive decline equal to a person with a 0.8 % alcohol level.
49. ! Candida Albicans infestation (Yeast Infection) : Candida infestations cause hyperactivity in children. Most children whodo suffer from Candida infestations have some underlying immune disorder, or a disorder affecting carbohydrate metabolism andthus altering blood sugar levels. Immune disorders can cause same symptoms as ADHD.
7. Spinal Problems: Some spinal problems can cause ADHD like symptoms believed to be due to nerve pressure8. Toxin exposures: Children are more vulnerable to toxins than adults. Pesticides from produce, gasoline fumes, herbicides, foodadditives like xanthan gum and guar gum, disinfectants, furniture polishes and air fresheners that can affect some children'sbehaviors. Beds, carpets and paint are sources. Toxins can cause hyperactivity, attention deficits, irritability, and learning problems.
9. Carbon Monoxide poisoning : Sources include gas heaters, gas appliances: fireplaces, dryers, and water heaters.
10. Seizure disorders: The most overlooked are absence Seizures. The attack lasts for a few seconds and then is over rapidly.May be confused with daydreaming. Some seizure disorders require a 24 hour EEG to properly diagnose.
11. Metabolic disorders: They reduce the...