1. Attachment and the Secure Base System

2. Secure Base Self-Confidence/Exploration Perceived Threat Felt security Attachment System Signaling Proximity Seeking Safe Haven Caregiver’s Signal detection

3. The Effects of Secure Base Repeated Secure-base interactions create internalized models of relationships that are carried forward to new relationship experience experiences What to expect How to behave

4. Secure Base Effects Powerful influence on Neurobiology Emotion-Regulation and Sensory Integration Language Development Executive skills— Shifting Monitoring Labeling Problem-solving

5. Healthy Neurobiology Three interrelated systems Thinking Feeling Relating/communicating Working together in an integrated, goal-directed, collaborative fashion

6. Attachment Problems Attachment Problems—failures in the secure base system result: Defensive, maladaptive relationship models Neurobiological failure Neurocognitive deficits—lagging skills in: Thinking Feeling Relating/communicating

7. Copy Right: /Sibcy, 2005 gsibcy@Liberty.edu Most commonly referral to community mental health centers Includes: Attention Deficit Hyperactivity Disorder Oppositional Defiant Disorder Conduct Disorder

8. Oppositional Defiant Disorder Symptoms Temper tantrums Arguing with adults Questioning rules Active defiance and refusal to comply with rule Deliberate attempts to annoy Touch and easily annoyed Anger and resentment Mean and hateful when upset Spiteful attitude and revenge seeking

9. Complex Oppositional Defiant Disorder Define the problem: Meets criteria for ODD, Plus Executive skill dysfunction Emotion dysregulation—anger plus other emotions Relationship disturbances, which includes attachment system Highly resistant to traditional parenting practices

10. Severe Mood Dysregulation (SMD) Distinguished from Classic Bipolar Disorder in Children (episodic irritability) Abnormal baseline mood: irritable, anger, and/or sadness, noticeable to others & present most of time Hyperarousal: insomnia, physical restlessness, distractibility, racing thoughts or flight of ideas, pressured speech, intrusiveness Increased reactivity to emotional stimuli (temper outburst) at least 3x/week

11. Differences in anger expression Hand-grenade –ADHD/ODD combo only Hurricane—SMD or BPD

12. Sameroff’s three R’s of intervention Re-education Redefine Remediate

13. Re-education The Pyramid Self-Control Self Control Problem Solving Cognitive Flexibility Language Processing/Mindsight Social Skills Emotion Regulation

14. Redefine Motivation vs Skills MotivationSkills

15. Adaptive Maladaptive (Family System) Maladaptive SMD/BPD Maladaptive Family + CODD with SMD Skills Motivation Yes No Yes No

16. Preventing explosions while enhancing secure-base and neuro-cognitive skill development

17. Goals: 1. Take parent concerns seriously 2. Take child concerns seriously 3. Reduce Challenging Behaviors, especially Reduce Melt- Downs Destructive child’s nervous system Conditioned Emotional Responses (CERs) Reinforces insecure relationship models (attachment) 4. Work on Neuro-Cognitive Skills—Whole Brain Child 5. Improve Secure Base

18. Using the Whole Brain Left-Right Hemisphere Brain Stem Limbic System Avoid Amygdala Hijacking Septal Rages Prefrontal Cortex

19. Secure Base Effects Powerful influence on Neurobiology Emotion-Regulation and Sensory Integration Language Development Executive skills— Frustration tolerance Shifting Monitoring Labeling Problem-solving

20. Three Pathways Compliance Interaction Pathway A—forcing concern Pathway C—temporarily dropping concern Pathway B—Working on Pyramid

21. Three Pathways Compliance Interactions Pathway A—Force Adult Concern Advantages Disadvantages Pathway B—Collaborative Problem Solving Advantages Disadvantages Pathway C—Temporarily Dropping Concern Advantages Disadvantages

22. Collaborative Problem Solving: E—empathy— A—Assert— R—Respect— ----------------------------- I—Invite-- C—Collaboration—

23. Empathy & Validation Listening and understanding child concerns Helping child articulate concerns what the concern Taking concerns seriously Empathy is a reciprocal process, so you may try to empathize but if the child does not believe you understand then you have not empathized

24. Assert—with limits Define Problem, expressing concern or expectation Don’t mistake your solutions for concerns or expectation Appeal to rules as important principles to follow “You can be angry but you can’t do…”

25. Regulation—keeping it safe Work at monitoring and managing your own emotion regulation—if too upset, go to pathway C Non-contingent respect Never use disrespect as a form of punishment Avoid global, negative attributions Remain warm—avoid triggering CER’s

26. Invite asking child to generate possible solutions Avoid forcing solutions Think out loud

27. Collaboration Working with child to come up with workable solutions Help child use foresight and hindsight Model flexibility Model regulation Model respect Maintain warmth

28. Qualities of Good Solutions Mutually satisfactory Do-able Durable

29. Back to the pathways When to use A When to use C Different kinds of C’s, some are better than others Two kinds of B’s Emergence Proactive—timing is everything

30. Parenting and Mentalization The use parent-child interaction questionnaire Describe situation: beginning, middle, end Describe behavior Interpretations Actual outcome Desired outcome Question: did you get DO? Why? Remediation Phase

31. Engaging the Repair Cycle Turning conflict into learning