1. Healing the Wounded Child: (re)-integrating the child into the family
Lark Eshleman, PhD
Institute for Children and Families

2. Founder and Director, Institute for Children and Families
Who Am I?
Author, Becoming a Family: Promoting Healthy Attachments with Your Adopted Child
Founder and Director, Institute for Children and Families

3. Who Am I?
Creator of
Healing Emotional Trauma: Treating the Wounded Child, a community response program for healing child trauma after community disasters: community violence, natural disasters, and war.

4. Croatian Hand Kiss

5. Most Important and Helpful … Parent.
Who Am I?
Former School Principal, former Child Librarian, International Lecturer, and
Most Important and Helpful … Parent.

6. Who Am I?

7. Who Am I?
Credentials include PhD in Clinical Psychology, specialty in child development, attachment, and emotional trauma;
Theraplay™ Institute, Chicago, IL, Intermediate Level, APA approved;
Pennsylvania Certified School Psych.

8. Healing the Wounded Child: (re)-integrating the child into the family
This presentation will overview
Normal, healthy attachment development,
What happens if attachment development goes off track,
What families can do about it.

9. 1. Healthy Attachment
Healthy attachments are formed between infant and parent when the child learns that his or her needs will be met in a predictable way, by a loving, trusted adult.

10. 1. Healthy Attachment
This LEARNED behavior begins at about 8 months of age, although the stage has been set through healthy bonding.

12. 1. Healthy Attachment First Year Attachment Cycle
Need – Rage (helpless, hopeless, anger, fear of dying)
Gratification (touch, eye contact, movement, smiles, lactose)

13. Development of Trust and Secure Attachment
1. Healthy Attachment
First-Year Attachment Cycle
Needs
Relief
Relaxation
Development of Trust and Secure Attachment
Arousal
Displeasure
Gratification
eye contact
touch
smile
movement
feeding
heart connection
in arms

14. (from hunger, wetness, thirst, fear, exhaustion…)
1. Healthy Attachment
What are the Needs?
To experience relief
(from hunger, wetness, thirst, fear, exhaustion…)
Let’s make this basic & practical for a minute…

16. 1. Healthy Attachment How does that Feel? Baby experiences Arousal or
Displeasure
Imagine if you are on the phone now, and needing to go to the bathroom of you’re thirsty. How easy is it for you to experience “calm alert” state of being able to focus on what we’re saying? What do you then feel? Irritation? … Distraction?

18. How does baby experience the reduction of the arousal/displeasure?
1. Healthy Attachment
How does baby experience the reduction of the arousal/displeasure?
Baby is gratified through eye contact, touch, smile, movement, food/drink, change of diaper, being held…
What reduces your irritation, distraction, etc? You can say, “I’ll be back in a moment” and go to the bathroom, get a drink, etc….

20. This means State Regulation.
1. Healthy Attachment
This means State Regulation.
Let’s try it ……

21. 1. Healthy Attachment
What comes of countless experiences of gratification by Primary Caregiver?
Development of trust and secure attachment. “I know my needs will be met. Arousal/Displeasure are only temporary. I can feel calm and secure in my world.”
With secure attachments, babies/children can go about their primary job in life ~~ allowing their busy little brains to develop according to the way nature meant for them to develop.

22. Healthy Attachment
What comes of countless experiences of gratification by Primary Caregiver?
We learn to self-regulate – to regulate our own state of being. We learn to return to a “normal” state after having experienced a signficant state change.

23. 1. Healthy Attachment
Over time and with lots of help, this leads to a child’s confidence that he or she can be successful in “negotiating” or “manipulating” to have his or her own needs met.

24. What does healthy attachment look like?
Parents want Baby and are in a position to keep Baby healthy, happy & safe.
Baby is born after a healthy, happy, nurturing pregnancy.
Think about the experience of your child. New research about Mom’s emotional state during pregnancy and how that sets the baby up for possible problems in the future.

25. 1. Healthy Attachment
3. Mom/parents and Baby fall in love, and Baby’s every need is anticipated and met.

26. 1. Healthy Attachment
Baby develops healthy, positive Internal Working Model:
I am a good person
I can depend on & trust others
The world is safe; I am safe in it
…Good brain development “happens,” according to nature’s plan.

27. 1. Healthy Attachment Secure Attachment:
Good, active template for Emotional Regulation (gets upset, asks for help, receives help, calms down,
Relationships are Stable, Flexible, and Adaptive
Examples: Good friend or partner cannot be available at the moment your teenager needs him or her; teen can understand that there is a need on the other’s part for a temporary separation and has trust that the relationship will pick up again when the other person can do be available.

28. 1. Healthy Attachment
“…secure attachment is the psychoneurobiological mechanism that underlies infant mental health and sets the neurological & developmental groundwork, or template, on which the psychophysiology of stress patterns become our young adult and adult behaviors.” (Schore, 2001)

29. 2. Attachment Off Track Secure ** Insecure – Avoidant
Insecure – anxious ambivalent
Insecure -- disorganized
According to Mary Ainsworth, different types lead to different behaviors on the part of the child. The first three exemplify PREDICTABLE or “organized” attachment. First: I need something, you can give it to me, and I will accept it. Now put your hands up to (1) call someone towards you, and (2) push that same person away. This exemplifies, in some way, the second and third types of attachment – organized, but insecure. “I know I need something, and I’m asking you for it, but I’m keeping you at a distance because I don’t know that I can trust you totally.” The fourth is disorganized – the child hardly knows what he or she is asking, and CERTAINLY doesn’t expect to receive it, and CERTAINLY cannot trust the person offering it.

30. 2. Attachment Off Track
Physical separation between child and Primary Caregiver
Emotional separation between Child and Primary Caregiver
Abandonment
Illness or inconsolable pain*
What creates these less effective, more painful types of attachment? *Very important to get as much physical history as possible

31. 2. Attachment Off Track
Neglect (including ineffective, inept caregiving)
Frequent moves
Physical, emotional, or sexual abuse
Witnessing abuse of a significant caregiver

32. 2. Attachment Off Track
What happens if attachment does not develop in a positive way? What if adults are faced with parenting a child who has needs they cannot meet?

33. 2. Attachment Off Track
Many children on the autism spectrum are isolated not just by the nature of the disorder, but also by the fact that loving parents may lack the knowledge, tools and support to regularly meet the child’s needs, much less make progress over time.

34. 2. Attachment Off Track
Families often feel shame, fear, and frustration in not knowing how to parent an autistic child or keep others in the family safe.

35. 3. What we CAN do!
Here are practical suggestions and insights that can help on a day-to-day basis.

36. Go Back to the Beginning
3. What we CAN do!
Go Back to the Beginning
Find any way you can meet your child’s needs, and do it, over and over and over again.
An example might be that your child has or had a favorite toy, animal, story, game. Make sure that you are the one to offer it to him every time he becomes upset. Which leads to the second suggestion:

37. 3. What we CAN do!

38. 3. What we CAN do!
Determine your child’s EMOTIONAL age and meet her needs at that level.
Helps to secure good attachment
Allows a more secure base from which to grow.

39. 3. What we CAN do!

40. 3. What we CAN do!
Make sure that YOU (the small circle of trusted caregivers) are the one offering all of the good things in your child’s life.
All good things come from Mom. Mention study about giving shots …

42. Limit number of primary caregivers.
3. What we CAN do!
Limit number of primary caregivers.
Although this is difficult to do, there is at least one way to help make this happen ….

43. 3. What we CAN do!
Teach therapists, technicians, medical and other caregivers to support YOU in being the one to offer the intervention and reward each successful try.

44. 3. What we CAN do!
This goes for family members, too … allow younger children to support YOU in nurturing/structuring your child in your home and elsewhere.

45. Make best use of transitional objects.
3. What we CAN do!
Make best use of transitional objects.

46. 3. What we CAN do!

47. 3. What we CAN do!

48. 3. What we CAN do!

49. 3. What we CAN do!

50. 3. What we CAN do!

51. 3. What we CAN do!
Have your child bring a picture (photo or drawing) of you to everywhere. Use it to help the child remember that you may not be present at that moment, but you are still “there” and still love her very much.

52. Transition slowly and with great forethought.
3. What we CAN do!
Transition slowly and with great forethought.

54. Everyone in the Family has a role.
3. What we CAN do!
Everyone in the Family has a role.

56. 3. What we CAN do!
Insist on regular (daily?) communication with school personnel whom you trust.

57. American Academy of Pediatrics says:
3. What we CAN do!
American Academy of Pediatrics says:
3 R’s toward healing:
Reassurance
Routine
Ritual

58. 3. What we CAN do!
(As crazy as it sounds), make arrangements for private time with your partner and each child in the family on a regular and predictable schedule.

59. 3. What we CAN do!
Use infant and toddler play as much as possible to secure attachment and to restore calm, alert state

60. Keep things as simple, predictable, routine, and quiet as possible.
3. What we CAN do!
Keep things as simple, predictable, routine, and quiet as possible.

61. 3. What we CAN do! Find ways to laugh and keep a sense of humor.
Use a “laugh channel” on the radio or television if helpful.
Tell friends and family to help you laugh – maybe sending computer jokes each day

62. 3. What we CAN do!
Quietly celebrate and treasure each positive interaction, each sign of progress, and each intimate moment you and your child have together.

63. Consider EEG Biofeedback as a possible intervention for your child.
3. What we CAN do!
Consider EEG Biofeedback as a possible intervention for your child.
(I receive NO compensation from this group!)

64. Review: This presentation has overviewed
Normal, healthy attachment development,
What happens if attachment development goes off track,
What families can do about it.