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Reactive Attachment Disorder & Trauma, A Powerpoint Presentation

This powerpoint presentation defines trauma and reactive attachment disorder (RAD) and points out that children require the safety of secure relationships in order to cope with adapt to, and overcome trauma and also to work through their symptoms of RAD. Children with reactive attachment disorder have also experienced complex trauma. A wise course of action is to help children cope with their trauma and then observe whether they have symptoms of reactive attachment disorder.

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Jane Gilgun
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1K views

Reactive Attachment Disorder & Trauma, A Powerpoint Presentation

This powerpoint presentation defines trauma and reactive attachment disorder (RAD) and points out that children require the safety of secure relationships in order to cope with adapt to, and overcome trauma and also to work through their symptoms of RAD. Children with reactive attachment disorder have also experienced complex trauma. A wise course of action is to help children cope with their trauma and then observe whether they have symptoms of reactive attachment disorder.

Uploaded by

Jane Gilgun
Copyright
© Attribution Non-Commercial (BY-NC)
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PPT, PDF, TXT or read online on Scribd
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Reactive Attachment Disorder & Trauma

Jane F. Gilgun, Ph.D., LICSW School of Social Work University of Minnesota, Twin Cities [email protected] September 2011

NEATS
Neurobiology Executive Function Attachment Trauma Self-Regulation

Childrens Development Linked to Availability & Responsiveness of Parents


Children mirror parents Parents Issues Neurobiological Executive Function Attachment Trauma Self-Regulation

Adult Styles of Attachment

Linked to Childrens with Parents


Resolved/Secure===Secure Dismissive===Avoidant Preoccupied===Ambivalent Disorganized===Disorganized

Children Respond to Safety, Structure, Predictability, and Care


Parents do whatever it takes Parents situations improve

Children show improvement Role of CPS is central when children are in care

Children in new placements

Key Concepts of Attachment

Inner Working Models


Based on relationships Key word: Expectations


of what I deserve How other people will respond to me how the world works

My self-worth How I am entitled to behave

Key Concepts

Secure Attachments

Modulation of behavior and emotions Children develop these capacities

Attachment Figure as Source of Trauma


Hideous Result in disorganized attachment

Trauma

Definition from DSM events that are life-threatening or psychologically devastating to the point where
persons

capacities to cope are overwhelmed and that result in changes in brain circuitry and structures

Developmental Trauma Disorder


A. Exposure to trauma B. Triggered pattern of repeated dysregulation in response to trauma cues

C. Persistently Altered Attributions & Expectancies D. Functional Impairment

Developmental Trauma Disorder: Exposure


Multiple or chronic exposure to one or more forms of developmentally adverse interpersonal trauma Subjective experience (eg, rage, betrayal, fear, resignation, defeat, shame).

Developmental Trauma Disorder: Patterns of Dysregulation

Repeated dysregulation in response to trauma cues Dysregulation (high or low) in presence of cues. Changes persist and do not return to baseline; not reduced in intensity by conscious awareness.

Developmental Trauma Disorder: Types of Dysregulation


Affective Somatic (eg, physiological, motoric, medical) Behavioral (eg, re-enactment, cutting) Cognitive (eg, thinking that it is happening again, confusion, dissociation, depersonalization). Relational (eg, clinging, oppositional, distrustful, compliant). Self-attribution (eg, self-hate, blame).

Developmental Trauma Disorder: Attributions & Expectancies


Negative self-attribution Distrust of protective caretaker Loss of expectancy of protection by others Loss of trust in social agencies to protect Lack of recourse to social justice/retribution

Developmental Trauma Disorder: Functional Impairment


Educational Familial Peer Lega. Vocational IF THERE IS ABSENCE OF THE SAFETY OF SECURE RELATIONSHIPS WHERE CHILDREN CAN PROCESS EVENTS

Reactive Attachment Disorder of Infancy or Early Childhood


Essential Features Criterion A

markedly disturbed & developmentally inappropriate social relatedness in most context that begins before age 5 years & is associated

Two Types

Inhibited Disinhibited/indicriminant sociability

Associated with grossly pathological care

Reactive Attachment Disorder of Infancy or Early Childhood


Essential Features Criterion B

Does not meet criterion for pervasive developmental disorder

Reactive Attachment Disorder of Infancy or Early Childhood


Essential Features Criterion C

Persistent disregard for childs basic physical needs Repeated change of caregiver than interfere with development of secure attachments Pathological care is assumed to be the cause of the behaviors

Case Examples: Children Who Have Experienced Trauma

Joey, 3, screams whenever he sees a woman with red hair Sally, 4, runs away whenever her mother approaches her Mark, 9, crawls on his hands and knees and barks like a dog Marietta, 7, wets the bed nightly for the first time in four years

Case Examples

RAD

Runs to strangers with open arms and may ignore foster/adoptive parents Superficial charm Withdrawal Frozen watchfulness Sense of consistent detachment At risk for self-harm or antisocial behaviors REQUIRE: Safety of secure relationships over time

RAD & PTSD


Whats the difference? Is there overlap? Is RAD possible without complex trauma/?

GUIDELINE: assess for trauma; treat trauma, then see what the behaviors are

Implications for Practice

Do not isolate children/adolescents/adults who are re-experiencing trauma Show up Provide a safe environment Work directly with the effects of the traumatic event Involve children with enjoyable, safe, structured environments

The Effects of Protective Factors on Human Functioning After Trauma


Jane Gilgun, Ph.D., LICSW

emotion cognition memory sympathetic nervous system

Time

References

Gilgun, Jane F. (2011). The NEATS: A child & family assessment. Amazon Kindle or scribd.com Lieberman, Alicia F. (2004). Traumatic stress and quality of attachment: Reality and internalization in disorders of infant mental health. Infant Mental Health Journal, 25(4), 336-351. Schechter, Daniel set al (2006). Traumatized mothers can change their minds about their toddlers: Understanding how a novel use of videofeedback supports positive change of maternal attributions. Infant Mental Health Journal, 27(5), 429447. Shonkoff, Jack P., & Deborah A. Phillips (Eds.). (2000). Acquiring selfregulation. From neurons to neighborhoods: The science of early childhood development (pp. 93-123). Washington, D.C.: National Academy Press. Smyke, Anna T., & Briedenstein, Angela S. (2009). Foster care in early childhood. In Charles H. Zeanah, Jr. (Ed.). Handbook of infant mental health (3rd ed.) (pp. 500-515). New York: Guilford. Available from e-reserves. Van der Kolk, Bessel A. (2005). Developmental Trauma Disorder: A new, rational diagnosis for children with complex trauma histories. Psychiatric Annals 35(5), 390-398.

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