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01/31/1501/31/15 11
Discussion Point #1Discussion Point #1
Some Children are born “bad” orSome Children are born “bad” or
with a personality that iswith a personality that is
difficult.difficult.
01/31/152
Domestic Violence: Affects on the
Neurobiology of the Developing Child
During Their Critical Period
James J. Gross, MC,
LPC, LMHP
November 14, 2007
Omaha, Nebraska
01/31/153
Violence impacts the victims, the witnesses –
and, ultimate us all
-Bruce D. Perry, M.D., Ph.D.
01/31/154
America The Beautiful and the Violent
Violence Overview – Our violent society
– Media: Exposure, desensitization; the norm in our
thinking
– Control agenda – Kids trying to control their environment
for safety, not to control parent
– Locus of Control: Egocentric, Self-Centered-not
Interdependent
– Generational violence – lack of skill base
– SA: Methamphetamine , ATOH, compounds the problem
of violence
– Social factors: Poverty, Low SES
– Emotional factors: fear, stress, anxiety
01/31/155
THE IMPLICATIONS
EXPOSURE TO CHRONIC INTRAFAMILIAL VIOLENCE WILL
DEVELOP A PERSISTING FEAR-RESPONSE
– In boys = AGGRESSION, IMPULSIVE, REACTIVE AND
HYPERACTIVE SYMPTOM PRESENTATION.
– In girls = DISASSOCIATION
A unique event is deemed threatening until determined
otherwise. This stress, creates COGNITIVE DISTORTIONS
leading to MISINTERPRETING EVENTS.
01/31/156
Witnessing Domestic Violence
 Symptoms and Diagnosis – SXs. ODD, ODD, Depression, Anxiety
Disorder, ADHD
 Session Signs – Violent play, defiance, re-experiencing the trauma,
acting out or acting in.
Case Study 1 & 2: Personal experiences working with children
exposed to trauma and violence
 Trauma and its effect on brain development
Stress – How it floods clear thinking esp. for kids
Regulation Model – how to retrain proper behaviors
01/31/157
Pre/Post Birth Brain Development
Brain development after birth
 Amygdule completes @ 18 month
 Hippo 36th
months. Don’t have total ability to calm
own stress. Dependent on caregiver for
development of foundation of regulation
 Orbital Frontal Cortex 25y.
Timeline of Neurobiological development
 4th
week after conception fetus capable of auditory
stimuli
 2nd
trimester, fetus capable of psychological
processing
 Child to self-regulate their own stress.
Establishing their groundwork for regulation.
01/31/1501/31/15 88
Discussion Point #2Discussion Point #2
Genetics determine how theGenetics determine how the
infant will develop; personality,infant will develop; personality,
temperament, mood, etc.temperament, mood, etc.
01/31/159
Witnessing Violence
Experience and Genetics…
 Reciprocal Determinism
01/31/1510
SX’s of Witnessing Violence
1. Withdrawal
2. Depression
3. Abnormal fears
4. Regression
5. Learning problems or a
decline in school
performance
6. Truancy
7. Bullying or a tendency to
become a victim
8. Difficulty in building or
maintaining relationships
9. Impulsiveness
10. Behavioral and emotional
problems
11. Denial or obsessive
retelling of the incident
01/31/1511
Avoidance criteria
For posttraumatic stress disorder in children may
include a
 restricted range of affect,
 detachment, insecure attachment
 inability to recall important aspects of the trauma,
 decreased participation in significant activities,
 a sense of foreshortened future,
 loss of skills,
 or new fears including separation fears.
01/31/1512
Arousal criteria
Generally present in children, including
 Sleep disturbance,
 Irritability,
 Anger outbursts,
 Difficulty with concentration,
 Hyper vigilance
 Exaggerated startle response.
01/31/1513
Experiences can lead to Fear for Survival
01/31/1514
Case study:
Sarah in Arizona – I’m afraid!
 I get scared when I hear my dad’s car
 I don’t sleep good, and I’m afraid all the time
 He said he was coming back to kill us both
Course of Treatment
– Personal Strength, desensitization techniques, CBT
– Resources
01/31/1515
Case Study:
Holly in Nebraska – I hate you!
 I hate you! Go away! I’m going to kill you!
 I don’t have to tell you anything. You can’t make me!
 Oh, did I hurt you? No I didn’t. I didn’t do anything!
Disasso ciatio n
 Course of Treatment
– Resistance from mom – “She has to know my authority!”
01/31/1516
Disclaimer
01/31/1517
Trauma
– The brain and it’s changing chemistry
 Increasing cortical levels
 Thus…fight or flight, or “freeze” response
 thus…increased stress/anxiety due to heightened
cortical level
 Therefore, a more rapidly triggered response.
01/31/1518
Flight, Flight or Freeze
 Upon encountering a novel event (ie. A
request) perceived as a threat
 Freeze misperceived as anger
 Thus, defiance is a “freeze-based” state, not
defiance!
 Reaction patterns: Boys become “hyper-
aroused”; Girls hypo-aroused
01/31/1519
Fight, Flight or Freeze
 Amygdala fear receptor
 Unconscious Thought
 Hippocampus/Orbital Frontal Cortex—
Executive Functioning
 Executive Function-Regulation
 Stress “Overwhelms” the EF; causing
“Confused” and “Distorted” thinking
 Have a working knowledge of the brain
01/31/1520
Tabla Rasa
Resilient
1. Marked by the ability
to recover readily, as
from misfortune.
2. Capable of returning
to an original shape or
position, as after
having been
compressed.
Malleable
1. Capable of being shaped or
formed, as by hammering or
pressure: a malleable metal.
2. Easily controlled or
influenced; tractable.
3. Able to adjust to changing
circumstances; adaptable.
01/31/1521
Neuron Development
Brain at birth Brain at 3 years
01/31/1522
IT IS THE BRAIN
 ‘LOWER’ PARTS OF THE BRAIN (BRAINSTEM &
MIDBRAIN).
 MOST COMPLEX FUNCTIONS (LANGUAGE, ABSTRACT
THINKING), BY ITS MOST COMPLEX CORTICAL
STRUCTURES.
 THE HIERARCHY OF INCREASINGLY COMPLEX
FUNCTIONS IS MEDICATED BY THE HIERARCHY OF
INCREASINGLY COMPLEX BRAIN AREAS.
01/31/1523
01/31/1524
Upper brain modulates the lower, more
primitive portions
AS THE MORE COMPLEX LIMBIC, SUB-CORTICAL AND
CORTICAL AREAS ORGANIZE, THEY BEGIN TO
MODULATE, MODERATE AND ‘CONTROL’ THE MORE
PRIMITIVE AND ‘REACTIVE’ LOWER PORTIONS OF THE BRAIN
01/31/1525
Recognizing this client yet?
BOTH A LACK OF CRITICAL NURTURING EXPERIENCE AND
EXCESS EXPOSURE TO TRAUMATIC VIOLENCE WILL
ALTER THE DEVELOPING CNS, PREDISPOSING TO A
MORE IMPULSIVE, REACTIVE AND VIOLENT INDIVIDUAL.
-Bruce Perry, MD, PhD
01/31/1526
EXPERIENCE-BASED CONFLICT
RESOLUTION MODELS
 Develop Relationship always
 Regulation Model
 Emotive, Physical Exercises
 Non directive
 Play and observation
 Expressive art, play
 Role play
01/31/1527
Some strengths to search for in your
practice
 STRONG SUPPORT FAMILY NETWORK
 STRONG STABLE ADULT
 PREDICTABILTY OF THREAT
01/31/1528
1. EFFECTIVE ASSESSMENT
1. EMOTIONAL, BEHAVIORAL, COGNITIVE, SOCIAL AND
PHYSIOLOGICAL FUNCTIONING.
a. THE USE OF STATE-DEPENDENT APPROACH
a. WHEN THE CHILD IS IN A STATE OF HYPER-AROUSAL- THIS
CHILD WILL NOT EASILY BE TAUGHT COMPLEX COGNITIVE
INFORMATION.
a. NON VERBAL
b. FACIAL EXPRESSIONS,
c. TONE OF VOICE –
Child SEARCHING FOR THREAT
Intervention strategies
01/31/1529
Techniques of Active Listening
 Paraphrasing -- repeating back
in one's own words what the
other person just said.
 Clarifying -- asking for more
information, such as“ What did
you mean when you said that?"
"How long have you been
feeling this way?"
 Reflecting -- listening beyond
the words to try echoing back
the feelings underlying the
speaker's statements.
 Encouraging -- letting the
speaker know you are
interested by phrases such
as "Tell me more."
 Summarizing -- voicing
back the speaker's main
points.
 Validating -- expressing an
understanding of what the
speaker has said and felt.
01/31/1530
IMPORTANT FACTORS IN THE
DIFFERENTIAL IMPACT (OF VIOLENCE)
ON THE DEVELOPING CHILD INCLUDE:
 The type and severity of the violence
 The pattern of the violence
 The presence of a supportive, understanding,
nurturing, willing, caregiver
 The age of the child and their developmental
stage
01/31/1531
01/31/1532
…is there still more??
– Jailed parents
– But he promised
– The foster care system – I can’t handle this child
– We’ve gotta take care of ourselves
– You can’t trust adults…they always lie
– Adoption - They don’t really love us…they just couldn’t
have their own kids
– I was just a part of the packaged deal
01/31/1533
DV INTERVENTIONS FOR CHILDREN
1. Help children recognize their own emotions.
2. Give children words to express their feelings and be able to talk to
others about their emotions.
3. Help children learn how to calm themselves when they are upset.
4. Use moments when children are upset as an opportunity for
intimacy or teaching. This creates a parent-child relationship in
which children feel comfortable coming to parents with their worries
and fears.
5. Guide children in problem solving so children develop their own
answers.
01/31/1534
Is it Obvious by Now??
 Hidden victims?
 Our responsibility
 Do we need a Movement?
 Are we already in a Movement?
 Have you joined the Movement?
01/31/1535
The Bigger Picture…
 The tendency to deal with family violence cases as separate
incidents rather than as symptoms of a broader social
pattern of disorder and dysfunctional behavior has also
contributed to the difficulty of developing a research base to
identify the origins of family violence.
01/31/1536
Movement Ideas
To a great extent, child abuse and battered women's movements
have been successful in asserting that the moral and legal
responsibility for violence rests with the person who commits
the violent act, not the victim, regardless of the circumstances.
01/31/1537
Movement - Police
* Police responding to domestic violence calls should address the
immediate safety, shelter, and medical needs of children in the
household as well as the battered parent.
* Protective orders against abusers should cover both the victim and the
victim's children. These orders might provide for removal of the abuser
from the home, child custody and support arrangements, and
supervised visitation. In some cases, the order might prohibit the abuser
from visiting the children entirely.
* Arrest should be mandatory when an abuser violates child-related
protective orders, including custody or visitation orders.
 The report, "The Impact of Domestic Violence on Children," was released during the (American Bar Association) ABA's annual
meeting in August. It proposed several legal reforms aimed at protecting battered parents and their children from further harm:
01/31/1538
Recommended Procedures for the On-Scene
Responding Law Enforcement Officer
1. If children are present, they should be shielded from witnessing further violence
or the arrest of parents if logistically practical. However, the officer who does so
must take safety into consideration. Shielding the children is usually best
accomplished by back-up officers, if available, who can isolate or remove the
children from the immediate scene.
2. An age-appropriate explanation of the situation should be made to the children
as soon as practical.
3. It is helpful for the officer or the child care or protective services workers to give
the young child something to hold such as a teddy bear or other stuffed animal.
4. Children may need to be relocated to an emergency shelter with relatives or
other responsible adult caretakers or to a location where the child feels safe.
Every effort should be made to keep siblings together in a shelter or in foster
care.
01/31/1539
Movement – Legal
* Convicted batterers and people subject to protective orders should be
barred from possessing firearms.
* Judges hearing child custody and visitation disputes should consider a
history of domestic violence in making their decisions. "Where there is
proof of abuse, batterers should be presumed by law to be unfit
custodians for their children," the report said.
* The report also urged lawyers to make legal services more available and
affordable to domestic violence victims and cited a "profound shortage"
of community legal services for low-income victims. "It is
unconscionable that an indigent parent victimized by domestic violence
is turned away from a legal aid office or placed on a long waiting list
because of program capacity barriers," the report said.
01/31/1501/31/15 4040
Discussion Point #3Discussion Point #3
What is the “shift” in your thinkingWhat is the “shift” in your thinking
now about working with angry,now about working with angry,
defiant children?defiant children?
01/31/1541
Notes on Neuro Sequential Model of
Therapeutics -Bruce Perry
Principle #1
The brain is organized in a hierarchical fashion, such that all
incoming sensory input enters the lower parts of the brain.
Clinical Implications
 Transference and counter Transference are also related to the
neurobiological principle of “association.” In order to break these
inaccurate and false associations, the client must have the
opportunity for new, healthy associations, to allow the brain to break
false associations, or to decrease the over-generalization of trauma-
related associations. I.e. Child sexual abuse by a male. If over
generalization to the entire male population, child will need time to
generate new healthy experiences with males.
01/31/1542
Notes on Neuro Sequential Model of
Therapeutics -Bruce Perry
Principle #2
Neurons and Neural systems are designed to change in a
“use-dependant” fashion.
Clinical Implications
 Use of repetition to help change use-dependent dysfunctional systems.
I.e. If attachment is insecure, use of animals to reconnect may work.
Animal is unconditional. Have the child hold or carry a stuffed animal
around to love, and watch over, care for.
 For these mal-treated children, Consistent, Predictable, Patterned and
Frequent!
01/31/1543
Notes on Neuro Sequential Model of
Therapeutics -Bruce Perry
Principle #3 The Brain Develops in a Sequential Fashion
The brain at birth is underdeveloped. Starting from the lowest, most
regulatory regions of the brain, and proceeding upward toward the
more complex parts of the brain responsible for more complex
functioning.
 sequential development and sensitivity
 use-dependent organization
The stress response systems originate in the lower parts of the brain and
help regulate and organize higher parts of the brain; if they are poorly
organized and regulated themselves, they disregulate and
disorganize higher parts of the brain.
Clinical Implications
 The key to therapeutic intervention is to remember that the stress-
response systems originate in the brainstem and dienchephalon.
01/31/1544
Notes on Neuro Sequential Model of
Therapeutics -Bruce Perry
Principle #4 The Brain Develops most rapidly early in life.
 0-5 Discussion Critical Period!
 Malleability versus Resilient
Clinical Implications
 The Implication is that early childhood traumatic or maltreatment
experiences have a disappropriate capacity to cause significant
dysfunction, in comparison to similar experiences or forms of
maltreatment later in life.
 This principle informs policy, programming and practice.
 Early intervention works! This is why we work with children!
 Unfortunately, the medical model waits until aberrant behaviors/
symptoms become “out of hand,” or “control.”
01/31/1545
Notes on Neuro Sequential Model of
Therapeutics -Bruce Perry
Principle #5
Neural systems can be changed, but some systems are easier
to change than others.
 The general belief of therapy is that it can “change” the present state.
With this in mind, the brain is seen as continuing to be “malleable,”
that is, ability to change and re-conform to change. Thus, the brain
is able to be “influenced, modified and changed.”
This degree of “plasticity” is dependent on two factors –
 the stage of development
 The area or system of the brain.
01/31/1546
Notes on Neuro Sequential Model of
Therapeutics -Bruce Perry
Principle #5 cont.
Clinical Implications:
 Trauma-related systems are related to dysfunction of neuro systems in
the lower, less plastic parts of the brain. The number of repetitions
required to change brainstem neuro development changes is greater
than the number required to change the cortical neural organization.
In other words, it is easier to change beliefs than feelings.
01/31/1547
Youth Violence
A Public Health Issue
We overwhelmingly conclude, on the basis of the body of
psychological research on violence, that violence is not a
random, uncontrollable, or inevitable occurrence. Although we
acknowledge that the problem of violence involving youth is
staggering, there is overwhelming evidence that we can
intervene effectively in the lives of young people to reduce and
prevent their involvement in violence
The American Psychological Association's Commission on Violence and Youth (quoted in
Lantieri and Patti, 1996)
01/31/1548
Weighing In…
Widespread ignorance of the intimate relationships between
cultural belief systems, childrearing practices and the
development of vigilant behaviors will doom any attempts to
truly understand and prevent violence.
Dodge, et al, 1991
01/31/1549
Our Challenge as Society
Change our childrearing practices
Change the malignant and destructive view that children are the
property of their biological parents
Children belong to the community, they are entrusted to parents.
Incubated in Terror: Neurodevelopmental Factors in the Cycle of
Violence-
Bruce D. Perry, M.D., Ph.D.
01/31/1550
Interdependence
 There is no more specific ‘biological’ determinant than a
relationship.
 Social animals belonging to a greater “whole,” a family, a clan.”
Incubated in Terror: Neurodevelopmental Factors in the Cycle of Violence-
Bruce D. Perry, M.D., Ph.D.
01/31/1501/31/15 5151
Relationship!!!Relationship!!!
Speak to your children…Speak to your children…
not at them…not at them…

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DV affects on Kids 0-5

  • 1. 01/31/1501/31/15 11 Discussion Point #1Discussion Point #1 Some Children are born “bad” orSome Children are born “bad” or with a personality that iswith a personality that is difficult.difficult.
  • 2. 01/31/152 Domestic Violence: Affects on the Neurobiology of the Developing Child During Their Critical Period James J. Gross, MC, LPC, LMHP November 14, 2007 Omaha, Nebraska
  • 3. 01/31/153 Violence impacts the victims, the witnesses – and, ultimate us all -Bruce D. Perry, M.D., Ph.D.
  • 4. 01/31/154 America The Beautiful and the Violent Violence Overview – Our violent society – Media: Exposure, desensitization; the norm in our thinking – Control agenda – Kids trying to control their environment for safety, not to control parent – Locus of Control: Egocentric, Self-Centered-not Interdependent – Generational violence – lack of skill base – SA: Methamphetamine , ATOH, compounds the problem of violence – Social factors: Poverty, Low SES – Emotional factors: fear, stress, anxiety
  • 5. 01/31/155 THE IMPLICATIONS EXPOSURE TO CHRONIC INTRAFAMILIAL VIOLENCE WILL DEVELOP A PERSISTING FEAR-RESPONSE – In boys = AGGRESSION, IMPULSIVE, REACTIVE AND HYPERACTIVE SYMPTOM PRESENTATION. – In girls = DISASSOCIATION A unique event is deemed threatening until determined otherwise. This stress, creates COGNITIVE DISTORTIONS leading to MISINTERPRETING EVENTS.
  • 6. 01/31/156 Witnessing Domestic Violence  Symptoms and Diagnosis – SXs. ODD, ODD, Depression, Anxiety Disorder, ADHD  Session Signs – Violent play, defiance, re-experiencing the trauma, acting out or acting in. Case Study 1 & 2: Personal experiences working with children exposed to trauma and violence  Trauma and its effect on brain development Stress – How it floods clear thinking esp. for kids Regulation Model – how to retrain proper behaviors
  • 7. 01/31/157 Pre/Post Birth Brain Development Brain development after birth  Amygdule completes @ 18 month  Hippo 36th months. Don’t have total ability to calm own stress. Dependent on caregiver for development of foundation of regulation  Orbital Frontal Cortex 25y. Timeline of Neurobiological development  4th week after conception fetus capable of auditory stimuli  2nd trimester, fetus capable of psychological processing  Child to self-regulate their own stress. Establishing their groundwork for regulation.
  • 8. 01/31/1501/31/15 88 Discussion Point #2Discussion Point #2 Genetics determine how theGenetics determine how the infant will develop; personality,infant will develop; personality, temperament, mood, etc.temperament, mood, etc.
  • 9. 01/31/159 Witnessing Violence Experience and Genetics…  Reciprocal Determinism
  • 10. 01/31/1510 SX’s of Witnessing Violence 1. Withdrawal 2. Depression 3. Abnormal fears 4. Regression 5. Learning problems or a decline in school performance 6. Truancy 7. Bullying or a tendency to become a victim 8. Difficulty in building or maintaining relationships 9. Impulsiveness 10. Behavioral and emotional problems 11. Denial or obsessive retelling of the incident
  • 11. 01/31/1511 Avoidance criteria For posttraumatic stress disorder in children may include a  restricted range of affect,  detachment, insecure attachment  inability to recall important aspects of the trauma,  decreased participation in significant activities,  a sense of foreshortened future,  loss of skills,  or new fears including separation fears.
  • 12. 01/31/1512 Arousal criteria Generally present in children, including  Sleep disturbance,  Irritability,  Anger outbursts,  Difficulty with concentration,  Hyper vigilance  Exaggerated startle response.
  • 13. 01/31/1513 Experiences can lead to Fear for Survival
  • 14. 01/31/1514 Case study: Sarah in Arizona – I’m afraid!  I get scared when I hear my dad’s car  I don’t sleep good, and I’m afraid all the time  He said he was coming back to kill us both Course of Treatment – Personal Strength, desensitization techniques, CBT – Resources
  • 15. 01/31/1515 Case Study: Holly in Nebraska – I hate you!  I hate you! Go away! I’m going to kill you!  I don’t have to tell you anything. You can’t make me!  Oh, did I hurt you? No I didn’t. I didn’t do anything! Disasso ciatio n  Course of Treatment – Resistance from mom – “She has to know my authority!”
  • 17. 01/31/1517 Trauma – The brain and it’s changing chemistry  Increasing cortical levels  Thus…fight or flight, or “freeze” response  thus…increased stress/anxiety due to heightened cortical level  Therefore, a more rapidly triggered response.
  • 18. 01/31/1518 Flight, Flight or Freeze  Upon encountering a novel event (ie. A request) perceived as a threat  Freeze misperceived as anger  Thus, defiance is a “freeze-based” state, not defiance!  Reaction patterns: Boys become “hyper- aroused”; Girls hypo-aroused
  • 19. 01/31/1519 Fight, Flight or Freeze  Amygdala fear receptor  Unconscious Thought  Hippocampus/Orbital Frontal Cortex— Executive Functioning  Executive Function-Regulation  Stress “Overwhelms” the EF; causing “Confused” and “Distorted” thinking  Have a working knowledge of the brain
  • 20. 01/31/1520 Tabla Rasa Resilient 1. Marked by the ability to recover readily, as from misfortune. 2. Capable of returning to an original shape or position, as after having been compressed. Malleable 1. Capable of being shaped or formed, as by hammering or pressure: a malleable metal. 2. Easily controlled or influenced; tractable. 3. Able to adjust to changing circumstances; adaptable.
  • 21. 01/31/1521 Neuron Development Brain at birth Brain at 3 years
  • 22. 01/31/1522 IT IS THE BRAIN  ‘LOWER’ PARTS OF THE BRAIN (BRAINSTEM & MIDBRAIN).  MOST COMPLEX FUNCTIONS (LANGUAGE, ABSTRACT THINKING), BY ITS MOST COMPLEX CORTICAL STRUCTURES.  THE HIERARCHY OF INCREASINGLY COMPLEX FUNCTIONS IS MEDICATED BY THE HIERARCHY OF INCREASINGLY COMPLEX BRAIN AREAS.
  • 24. 01/31/1524 Upper brain modulates the lower, more primitive portions AS THE MORE COMPLEX LIMBIC, SUB-CORTICAL AND CORTICAL AREAS ORGANIZE, THEY BEGIN TO MODULATE, MODERATE AND ‘CONTROL’ THE MORE PRIMITIVE AND ‘REACTIVE’ LOWER PORTIONS OF THE BRAIN
  • 25. 01/31/1525 Recognizing this client yet? BOTH A LACK OF CRITICAL NURTURING EXPERIENCE AND EXCESS EXPOSURE TO TRAUMATIC VIOLENCE WILL ALTER THE DEVELOPING CNS, PREDISPOSING TO A MORE IMPULSIVE, REACTIVE AND VIOLENT INDIVIDUAL. -Bruce Perry, MD, PhD
  • 26. 01/31/1526 EXPERIENCE-BASED CONFLICT RESOLUTION MODELS  Develop Relationship always  Regulation Model  Emotive, Physical Exercises  Non directive  Play and observation  Expressive art, play  Role play
  • 27. 01/31/1527 Some strengths to search for in your practice  STRONG SUPPORT FAMILY NETWORK  STRONG STABLE ADULT  PREDICTABILTY OF THREAT
  • 28. 01/31/1528 1. EFFECTIVE ASSESSMENT 1. EMOTIONAL, BEHAVIORAL, COGNITIVE, SOCIAL AND PHYSIOLOGICAL FUNCTIONING. a. THE USE OF STATE-DEPENDENT APPROACH a. WHEN THE CHILD IS IN A STATE OF HYPER-AROUSAL- THIS CHILD WILL NOT EASILY BE TAUGHT COMPLEX COGNITIVE INFORMATION. a. NON VERBAL b. FACIAL EXPRESSIONS, c. TONE OF VOICE – Child SEARCHING FOR THREAT Intervention strategies
  • 29. 01/31/1529 Techniques of Active Listening  Paraphrasing -- repeating back in one's own words what the other person just said.  Clarifying -- asking for more information, such as“ What did you mean when you said that?" "How long have you been feeling this way?"  Reflecting -- listening beyond the words to try echoing back the feelings underlying the speaker's statements.  Encouraging -- letting the speaker know you are interested by phrases such as "Tell me more."  Summarizing -- voicing back the speaker's main points.  Validating -- expressing an understanding of what the speaker has said and felt.
  • 30. 01/31/1530 IMPORTANT FACTORS IN THE DIFFERENTIAL IMPACT (OF VIOLENCE) ON THE DEVELOPING CHILD INCLUDE:  The type and severity of the violence  The pattern of the violence  The presence of a supportive, understanding, nurturing, willing, caregiver  The age of the child and their developmental stage
  • 32. 01/31/1532 …is there still more?? – Jailed parents – But he promised – The foster care system – I can’t handle this child – We’ve gotta take care of ourselves – You can’t trust adults…they always lie – Adoption - They don’t really love us…they just couldn’t have their own kids – I was just a part of the packaged deal
  • 33. 01/31/1533 DV INTERVENTIONS FOR CHILDREN 1. Help children recognize their own emotions. 2. Give children words to express their feelings and be able to talk to others about their emotions. 3. Help children learn how to calm themselves when they are upset. 4. Use moments when children are upset as an opportunity for intimacy or teaching. This creates a parent-child relationship in which children feel comfortable coming to parents with their worries and fears. 5. Guide children in problem solving so children develop their own answers.
  • 34. 01/31/1534 Is it Obvious by Now??  Hidden victims?  Our responsibility  Do we need a Movement?  Are we already in a Movement?  Have you joined the Movement?
  • 35. 01/31/1535 The Bigger Picture…  The tendency to deal with family violence cases as separate incidents rather than as symptoms of a broader social pattern of disorder and dysfunctional behavior has also contributed to the difficulty of developing a research base to identify the origins of family violence.
  • 36. 01/31/1536 Movement Ideas To a great extent, child abuse and battered women's movements have been successful in asserting that the moral and legal responsibility for violence rests with the person who commits the violent act, not the victim, regardless of the circumstances.
  • 37. 01/31/1537 Movement - Police * Police responding to domestic violence calls should address the immediate safety, shelter, and medical needs of children in the household as well as the battered parent. * Protective orders against abusers should cover both the victim and the victim's children. These orders might provide for removal of the abuser from the home, child custody and support arrangements, and supervised visitation. In some cases, the order might prohibit the abuser from visiting the children entirely. * Arrest should be mandatory when an abuser violates child-related protective orders, including custody or visitation orders.  The report, "The Impact of Domestic Violence on Children," was released during the (American Bar Association) ABA's annual meeting in August. It proposed several legal reforms aimed at protecting battered parents and their children from further harm:
  • 38. 01/31/1538 Recommended Procedures for the On-Scene Responding Law Enforcement Officer 1. If children are present, they should be shielded from witnessing further violence or the arrest of parents if logistically practical. However, the officer who does so must take safety into consideration. Shielding the children is usually best accomplished by back-up officers, if available, who can isolate or remove the children from the immediate scene. 2. An age-appropriate explanation of the situation should be made to the children as soon as practical. 3. It is helpful for the officer or the child care or protective services workers to give the young child something to hold such as a teddy bear or other stuffed animal. 4. Children may need to be relocated to an emergency shelter with relatives or other responsible adult caretakers or to a location where the child feels safe. Every effort should be made to keep siblings together in a shelter or in foster care.
  • 39. 01/31/1539 Movement – Legal * Convicted batterers and people subject to protective orders should be barred from possessing firearms. * Judges hearing child custody and visitation disputes should consider a history of domestic violence in making their decisions. "Where there is proof of abuse, batterers should be presumed by law to be unfit custodians for their children," the report said. * The report also urged lawyers to make legal services more available and affordable to domestic violence victims and cited a "profound shortage" of community legal services for low-income victims. "It is unconscionable that an indigent parent victimized by domestic violence is turned away from a legal aid office or placed on a long waiting list because of program capacity barriers," the report said.
  • 40. 01/31/1501/31/15 4040 Discussion Point #3Discussion Point #3 What is the “shift” in your thinkingWhat is the “shift” in your thinking now about working with angry,now about working with angry, defiant children?defiant children?
  • 41. 01/31/1541 Notes on Neuro Sequential Model of Therapeutics -Bruce Perry Principle #1 The brain is organized in a hierarchical fashion, such that all incoming sensory input enters the lower parts of the brain. Clinical Implications  Transference and counter Transference are also related to the neurobiological principle of “association.” In order to break these inaccurate and false associations, the client must have the opportunity for new, healthy associations, to allow the brain to break false associations, or to decrease the over-generalization of trauma- related associations. I.e. Child sexual abuse by a male. If over generalization to the entire male population, child will need time to generate new healthy experiences with males.
  • 42. 01/31/1542 Notes on Neuro Sequential Model of Therapeutics -Bruce Perry Principle #2 Neurons and Neural systems are designed to change in a “use-dependant” fashion. Clinical Implications  Use of repetition to help change use-dependent dysfunctional systems. I.e. If attachment is insecure, use of animals to reconnect may work. Animal is unconditional. Have the child hold or carry a stuffed animal around to love, and watch over, care for.  For these mal-treated children, Consistent, Predictable, Patterned and Frequent!
  • 43. 01/31/1543 Notes on Neuro Sequential Model of Therapeutics -Bruce Perry Principle #3 The Brain Develops in a Sequential Fashion The brain at birth is underdeveloped. Starting from the lowest, most regulatory regions of the brain, and proceeding upward toward the more complex parts of the brain responsible for more complex functioning.  sequential development and sensitivity  use-dependent organization The stress response systems originate in the lower parts of the brain and help regulate and organize higher parts of the brain; if they are poorly organized and regulated themselves, they disregulate and disorganize higher parts of the brain. Clinical Implications  The key to therapeutic intervention is to remember that the stress- response systems originate in the brainstem and dienchephalon.
  • 44. 01/31/1544 Notes on Neuro Sequential Model of Therapeutics -Bruce Perry Principle #4 The Brain Develops most rapidly early in life.  0-5 Discussion Critical Period!  Malleability versus Resilient Clinical Implications  The Implication is that early childhood traumatic or maltreatment experiences have a disappropriate capacity to cause significant dysfunction, in comparison to similar experiences or forms of maltreatment later in life.  This principle informs policy, programming and practice.  Early intervention works! This is why we work with children!  Unfortunately, the medical model waits until aberrant behaviors/ symptoms become “out of hand,” or “control.”
  • 45. 01/31/1545 Notes on Neuro Sequential Model of Therapeutics -Bruce Perry Principle #5 Neural systems can be changed, but some systems are easier to change than others.  The general belief of therapy is that it can “change” the present state. With this in mind, the brain is seen as continuing to be “malleable,” that is, ability to change and re-conform to change. Thus, the brain is able to be “influenced, modified and changed.” This degree of “plasticity” is dependent on two factors –  the stage of development  The area or system of the brain.
  • 46. 01/31/1546 Notes on Neuro Sequential Model of Therapeutics -Bruce Perry Principle #5 cont. Clinical Implications:  Trauma-related systems are related to dysfunction of neuro systems in the lower, less plastic parts of the brain. The number of repetitions required to change brainstem neuro development changes is greater than the number required to change the cortical neural organization. In other words, it is easier to change beliefs than feelings.
  • 47. 01/31/1547 Youth Violence A Public Health Issue We overwhelmingly conclude, on the basis of the body of psychological research on violence, that violence is not a random, uncontrollable, or inevitable occurrence. Although we acknowledge that the problem of violence involving youth is staggering, there is overwhelming evidence that we can intervene effectively in the lives of young people to reduce and prevent their involvement in violence The American Psychological Association's Commission on Violence and Youth (quoted in Lantieri and Patti, 1996)
  • 48. 01/31/1548 Weighing In… Widespread ignorance of the intimate relationships between cultural belief systems, childrearing practices and the development of vigilant behaviors will doom any attempts to truly understand and prevent violence. Dodge, et al, 1991
  • 49. 01/31/1549 Our Challenge as Society Change our childrearing practices Change the malignant and destructive view that children are the property of their biological parents Children belong to the community, they are entrusted to parents. Incubated in Terror: Neurodevelopmental Factors in the Cycle of Violence- Bruce D. Perry, M.D., Ph.D.
  • 50. 01/31/1550 Interdependence  There is no more specific ‘biological’ determinant than a relationship.  Social animals belonging to a greater “whole,” a family, a clan.” Incubated in Terror: Neurodevelopmental Factors in the Cycle of Violence- Bruce D. Perry, M.D., Ph.D.
  • 51. 01/31/1501/31/15 5151 Relationship!!!Relationship!!! Speak to your children…Speak to your children… not at them…not at them…

Editor's Notes

  1. Violence affects all areas of our lives The fall out are our children. Will trauma, comes altered brain development Come memories Come belief systems, or experience, that shape the next generation
  2. why so much violence? Show statistics page Read over some of the stats Discuss if needed. Social services system. The need for. Other countries, more prevention, less need for services.
  3. Exposure via media, Zeitgeist of the day Violence accepted because, “It’s entertaining.” We have become desensitized to violence- so much in some cases, need more violence to feel something…violent movies that “scare” us. Egocentric, self-centeredness works best by controlling others… control defines domestic violence. Interdependence not taught, discussed, nor clearly seen in larger communities. A good model might be Treatment Team approach! Generational Violence – determined this job is difficult due to generational mishandling of child rearing! SA enhances, accentuates and complicates the picture Poverty – current research going this way, to define precursors to mental illness, lack of resources, skills…this now tying into interdependence…ie, more need for Social Services and the where are the dollars coming from??
  4. fix
  5. 7yo female Presenting issue was “anxiety” Normally, brought on my Irrational fears. Rational, (real) threat of violence. Validation of fears, and put authority for safety back on mother Give client skills for coping. Discussed first how often actual violence had taken place recently. Next, developed strategies to help her prepare for the worst. Met with father in family session – set up rules which he quickly broke Wanted to meet him to send a strong message to him, not to harm! Attempted to maintain a safe environment for client. Mom had economic limitations – couldn’t move
  6. 7yo female Witnessed her mother being hit for years, (majority of her life). never talks about being afraid, rather, mad, angry Demonstrated this in first session, and continues to take dolls that hit each other. Trauma was trigger with mom hitting step father – client attempted to intervene. next day client began acting out, hurting herself, hitting head against the wall. Client became enraged and began to dissociate. Took 3 adults 1 hour to restrain her. Biting, hitting, punching Client covers up well. Client uses acting out as her expression of feelings, not words. Mother still suffers traumatic past, difficulty parenting Feels strength and intimidation is the way to parent.
  7. fix
  8. fix
  9. fix
  10. 10 days ago. Sometimes mommies have black eyes
  11. More affects as a result of violence. If perpetrator incarcerated, child experiences loss – grief issues. Whose going to teach me about life? Harm through broken promises – lack responsibility Foster Care – hearing more and more about children too difficult to handle, as before. (Ask audience). Children parenting selves, and siblings. Growing up too fast, and not trusting that adults can take care of them. Recent Case – difficulty for child to believe she was loved and adopted for herself. Believed it was a “package deal.” Insecurity, lack of trust, self survivor, reactionary and wanting to recreate the violence, the trauma.
  12. Fix elaborate
  13. Simple concept, but it’s power overlooked! In relationship, children know what parents expect, and if solid, will seek to please that parent. Children are people too…and have minds to prove it!