Something Has To Change

1.Looking In

2. Looking Out

3. Looking At Theory

A Three-Strand Approach

Stress, burnout, depression, anxiety, compassion fatigue, secondary PTSD...

It is important to safeguard the health of those facing aggressive

outbursts on a daily basis.

The Psychology bit….

What is Attachment Theory?

Attachment/Trust/Resilience Cycle

Risk Factors

Patterns of Insecure Attachment

Associated Behaviours

'Evidence is accumulating that human beings

of all ages are happiest and able to deploy

their talents to best advantage when they are

confident that, standing behind them, there

are one or more trusted persons who will

come to their aid should difficulties arise. The

person trusted, also known as an attachment

figure, can be considered as providing his or

her companion with a secure base from which

to operate.' (Bowlby, 1979)

ATTACHMENT THEORY

John Bowlby ‘The Father of Attachment Theory’

Secure Base

The cumulative impact of events in the child’s life

may have led him to:

feel, ‘not free to focus his attention on

things other than survival,’

(Van Gulden and Bartels-Rabb, 1993).

feel safest when he exercises control over every

situation

feel unable to trust adults to provide for his needs,

even at the most basic level (Maslow, 1970)

The Attachment Cycle

Child begins to trust carers to meet needs

Child has needs and feels: Helplessness

Hopelessness

Anger

Responsive carer offers: Eye contact Touch Lactose Smiles/affection

Child relaxes as needs are met

When all is well...

Need

Rage

Relief

Trust

Child has needs and feels: Helplessness

Hopelessness

Anger

Need

Rage

No Relief/unreliable relief

Unable to trust

Unresponsive or unreliable carer offers: Poor eye contact Touch without affection Anger/irritation

Child either... Withdraws becomes over compliant or increases rage ...as needs are not met

Child develops unhealthy survival strategies in attempt to make carer meet his needs

INTERRUPTION OF THE ATTACHMENT

CYCLE - 1

Child has needs and feels: Helplessness

Hopelessness

Anger

Need

Rage

Smothered or lacks containment

Unable to trust Over-anxious or

over-protective carer: Is intrusive Is poor at limit-setting Imposes own insecurities on child

Child either... Withdraws becomes over-dependent OR

Child develops unhealthy survival strategies, either: does not trust anyone else to meet needs OR Cannot cope when limits ARE set

INTERRUPTION OF THE ATTACHMENT CYCLE INTERRUPTION OF THE ATTACHMENT CYCLE - 2

increases rage & expects every demand to be met

Pre-birth stress, eg. mother’s self-harm or

domestic violence

Alcohol and/or drug taking during pregnancy

Parental illness before/after birth

Ante- or post-natal depression

Being a premature baby – separation in incubator

Medical complications - in the womb, at birth,

during the early years

Illness/Bereavements in the family

When things go wrong...Risk Factors

DON’T GET SUCKED INTO A BLAME GAME!

The baby having a disability

Neglect and/or abandonment

Emotional, sexual and physical abuse, domestic

violence

Home and family instability/breakdown

Poverty

Mental health difficulties in caregivers

Multiple home and school placements during the

child’s early years (based on Bomber, 2007)

INSECURE ATTACHMENT PATTERNS

Dis-organised

Attachment/Resilience Continuum Secure Insecure Resilient Anxious

Weakened or compromised Attachments

Avoidant/Ambivalent

Secure

Attachment

Internal Working Model

Trust of self

Trust of others

Trust of humanity (Cline 1992)

Internal Working Model

Unable to trust

Shamed-based Identity

Toxic Shame

Lacks constancy

‘The fifth edition of the Diagnostic and Statistical Manual

of Mental Disorders (DSM-5) updates disorder criteria to

more precisely capture the experiences and symptoms

of children:’ (2013, American Psychiatric Association)

CHANGES IN DSM-5

Reactive Attachment Disorder is now

divided into:

Reactive Attachment Disorder (RAD)

Disinhibited Social Engagement Disorder

(DSED)

‘Clinicians and families often were frustrated that DSM-

IV did not define or describe some of the clinically

significant behaviours and symptoms they observed in

children.’ (2013, DSM-5 and Diagnoses for Children, American Psychiatric Association)

Social Communication Disorder (SCD)

Disruptive Mood Dysregulation Disorder (DMDD)

Post Traumatic Stress Disorder (PTSD) Pre-School Subtype

Separation Anxiety Disorder

Oppositional Defiant Disorder (ODD)

Conduct disorder

Intermittent Explosive Disorder

Attention Deficit/Hyperactivity Disorder (ADHD)

etc, etc, etc….

DIAGNOSIS – LEAVE IT TO THE PROFESSIONALS!

The Brain Science Bit….

The Brain in 3 Parts

Hardwiring

Startle Reaction

New Neural Pathways = Change in

Behaviour

THE BRAIN IN 3 PARTS

Higher brain =

rational thinking

Lower/reptilian

brain = instincts

Mid/mammalian brain = early

warning system

Amygdala alerted by real/perceived threat

Stress hormones (Cortisol & Adrenalin) are released

Rising levels of glucose in blood, heart & breathing rates increase

What happens next?

Distress not relieved •Stress hormones reach

toxic levels •Prolonged exposure = brain

cell damage & cell death •Impairment of heart,

digestive, respiratory and immune systems

Distress relieved •Levels of stress hormones

fall •Opioids and Oxytocin

released •Vagus nerve restores function of heart rate, breathing, digestion,

immune system

The Cornfield Model

The Staircase Model

‘Think Toddler’

First, Calm the Body

Behaviour ‘Management’ Cycles

New

neural

pathways

=

changes

in

behaviour

Emotional Age Versus Chronological Age:

Brain Responses

Adapted from Perry, 2002

‘Think Toddler’

(Based on Archer: 2002)

First, calm the body

Traditional Behaviour Management Cycle

Classroom Nurturing Cycle

Classroom Nurturing Cycle

Held in Mind

Routines and Relaxation

Permission to Fail

Rewards & Sanctions

Behaviour ‘Management’ Cycles

Observing: ABC & the three strand

approach

Held in Mind

‘The child exists for the teacher when

he is not immediately with her. The

teacher conveys this sense... by

perceiving a need and offering

something to him before he had

directly indicated that he wanted it.’

(Pawl, 2006)

Change and uncertainty cause

anxiety.

‘Uncertainty can be felt as

overwhelming anxiety, and

tolerating the uncertainty of not

knowing becomes an unbearable

threat.’

(Geddes, 2007)

Routines and Relaxation

Permission to Fail

‘The emotion of shame plays an important

role in healthy identity formation. In its

healthiest form, shame teaches the child

that he is human, with limitations and

fallibility. Taken to an extreme, however,

shame can lead a child to feel flawed as a

human being, even to the point of being

somehow less than human.’

(Van Gulden & Bartels-Rabb, 1993)

‘Empathy will support the child to

experience discipline for its intended

purpose rather than as abuse or

rejection.’ (Bombèr, 2007)

‘We may feel that praising a child will help

to make him feel more positive about

himself, while the child may view praise

as a threat to his sense of self.’

(Family Futures, 2008)

Rewards & Sanctions

Stress, burnout, depression, anxiety, compassion fatigue, secondary PTSD...

It is important to safeguard the health of those facing aggressive

outbursts on a daily basis.