1. A Glance at Attachment with Foster & Adoptive Parents  Scottish Attachment in Action  St. Andrew’s Children’s Society  and  Dan Hughes  ----------  25 September 2015

3. Developmental Trauma Disorder  Attachment  Biology  Affect Dysregulation  Cognitive Functioning  Dissociation  Behavioral Controls  Self-Concept

4. Developmental Trauma Disorder Treatment  Safety  Regulation  Reflection  Relational Engagment  Trauma Experience Integration  Positive Affect Enhancement

5. TYPICAL DEVELOPMENTAL SEQUENCE: TRUST, THEN SOCIALIZATION FIRST YEAR OF LIFE: CHILD AND PARENT ARE BUILDING THE BONDS OF SECURE ATTACHMENT AND TRUST SECOND YEAR OF LIFE: PARENT AND CHILD ARE LEARNING TO MANAGE NATURAL TENSIONS ARISING FROM THE CHILD’S NORMAL ASSERTION OF INDEPENDENCE AND PARENT’S ROLE AS RULE MAKER, LIMIT SETTER, “AGENT OF SOCIALIZATION” REINFORCES TRUST

6. ATYPICAL SEQUENCE WITH MALTREATED CHILDREN CHILD LEARNS TO MISTRUST CAREGIVERS IN THE FIRST YEAR OF LIFE CHILD COMES INTO CARE AND FACES THE CHALLENGE OF NEEDING TO ACCEPT LIMITS WITHOUT HAVING THE FOUNDATION OF BASIC TRUST OF THE “LIMIT SETTER” REINFORCES MISTRUST

7. Enhance Relationship Security  Available, Sensitive, Responsive  Relationship Repair  Adult’s Attachment Security

8. 8 THE TRUSTING BRAIN: HOW YOU RESPOND TO AMBIGUITY…… THE BENEFIT OF THE DOUBT IN A TRUSTING RELATIONSHIP, AN AMBIGUOUS FACIAL EXPRESSION OR TONE OF VOICE IS NOT “READ” IMMEDIATELY AS NEGATIVE. THE TRUSTING BRAIN GIVES THE TRUSTED OTHER THE “BENEFIT OF THE DOUBT” AND AUTOMATICALLY ASSUMES MORE POSITIVE THAN NEGATIVE INTENT VENTRO- MEDIAL PFC SHOWS GREATER ACTIVATION THAN THE AMYGDALA MISTRUSTING BRAIN: AMYGDALA RESPONDS MORE STRONGLY THAN THE VMPFC TO AMBIGUOUS FACES AND VOICES mistrusttrust

9. 9 HIPPOCAMPUS AMYGDALA CINGULATE REFLECT REVISE TRUST REGULATE FIGHT/FLIGHT/ FREEZE PFC ACCACC 9 SAFETY MESSAGES TO THE AMYGDALA: FACE, VOICE, TOUCH OXYTOCIN: SAFE ENOUGH

10. “CINGULATION”: Experiencing and Expressing Different Feelings sgACC rACC A = SAD = HAPPY = AFRAID: UH-OH! = IRRITATED/ ANGRY dACC MCC sgACC = subgenual ant. cing. rACC = rostral ant. Cing. dACC = dorsal ant. Cing. MCC = middle cing. cortex

11. The Brain’s Sad Memory System sACC In attachment-focused interventions, It would then be important that The caregiver be available when the SAD MEMORY SYSTEM is activated to associate caregiving the sadness. This then gives the child and Adult a chance to experience The mutually rewarding Process of seeking and giving Comfort. This interaction Would then modify the SAD MEMORY system to include The memory of being comforted By the new caregiver when The SAD MEMORIES get Triggered.

12. SECURE ATTACHMENT AND THE “FRONTO-LIMBIC” BRAIN SYSTEM: HELPING THE CHILD DEVELOP A “GOOD LID” GOOD PARENTING PROMOTES GOOD CONNECTIONS BETWEEN THE CHILD’S PREFRONTAL CORTEX AND LIMBIC SYSTEM: THE NEWLY FAMOUS UNCINATE FASCICULUS (UF)

13. 13 STAGES IN RECOVERING THE CAPACITY FOR SOCIAL ENGAGEMENT SAFE TO BE SAD AND NEED COMFORT AND TO CRY IN YOUR PRESENCE SAFE TO SHINE IN YOUR DELIGHT AND MIRROR YOUR JOY IN BEING WITH ME SAFE TO BE CURIOUS AND SHARE A STATE OF WONDER AND ASK YOU “WHY……?” Comfort OPEN & ENGAGED Joy

14. 14 PACING THE CHILD’S BRAIN: ENGAGING THE BRAIN’S “MISTRUST OVERRIDE SYSTEM” FEAR CONDITIONING: REFLEXIVE MISTRUST SYSTEM MISTRUST OVERRIDE SYSTEM: MAYBE THIS TEACHER IS TRUSTABLE Subgenual ACC Amygdala- Brainstem Fight/flight/freeze system PACE IS A FORMULA FOR ENGAGING THE PART OF THE CHILD’S BRAIN THAT CAN OVERRIDE THE AUTOMATIC FEAR-DRIVEN REACTIONS LEARNED EARLIER IN LIFE P LAYFULNESS, A CCEPTANCE, C URIOSITY, E MPATHY: PACE

15. PACE Playfulness: A light, hopeful, open and spontaneous Playfulness: A light, hopeful, open and spontaneous Acceptance: Unconditionally directed at all of the experience of the other Acceptance: Unconditionally directed at all of the experience of the other Curiosity: Nonjudgmental, not- knowing, active interest in the other’s experience Curiosity: Nonjudgmental, not- knowing, active interest in the other’s experience Empathy: Felt sense of the other; actively experienced and communicated. Empathy: Felt sense of the other; actively experienced and communicated.

16. INTERSUBJECTIVE Behavior is Reciprocal ATTACHMENT Behavior is One Direction

17. When infants feel safe much of their energy is spent in “joyful dialogic companionship” with their parents.

21. INTERSUBJECTIVE DISCOVERY of Self nLOVABLE nCOMPETENT nRESILIENT nENJOYABLE nDELIGHTFUL nPERSISTENT WORTHWHILE HONEST SMART COURAGEOUS HOPEFUL DEVELOPING

22. 22 Shifting From Mistrust to Trust: THE ELEMENT OF SURPRISE Child’s Brain On Mistrust And Defense-based Living Child’s Brain On Trust And Connection  PLAYFULNESS  ACCEPTANCE  CURIOSITY  EMPATHY PACE SURPRISING THE MISTRUSTING BRAIN BY VIOLATING EXPECTATIONS ABOUT CAREGIVER’S REACTIONS PACE AS A FORMULA FOR THERAPEUTIC CONFUSION: DISCOMBOBULATING THE CHILD’S NEGATIVE EXPECTATIONS AND ACTIVATING THE CHILD’S CURIOSITY…… “YOUR WEIRD”

23. PACING THE KID AND CREATING THE ESSENTIAL EXPERIENCE OF SURPRISE: “YOU’RE WEIRD” PARENT RESPONDS WITH PACE PARENT RESPONDS WITH PACE BRAIN-BASED MODEL: PACE “JIGGLES” THE KID’S ANTERIOR CINGULATE CORTEX (ACC) INTO ACTION AS SHE EXPERIENCES A CONFLICT BETWEEN HOW SHE EXPECTED YOU TO REACT AND HOW YOU ACTUALLY REACTED, RAMPING UP ATTENTION, ENGENDERING A BRAIN STATE OF “THERAPEUTIC CONFUSION,” AND TRIGGERING PROCESSES OF REVERSAL LEARNING, EXTINCTION, AND “SET SHIFTING” PARENT RESPONDS WITH PACE

24. Have compassion for everyone you meet even if they don’t want it. What seems conceit, bad manners or cynicism is always a sign of things

25. no ears have heard, nor eyes have seen. You do not know what wars are going on down there where the spirit meets the bone. ----------Miller Williams