1. Reconstructing Bonds: Forming Attachments in the Aftermath of War Joan K Vanderlaan BSN, MN

2. Sesame Street Video Clip Talk, listen, connect Changes, adult section

3. Sesame Street Video – Changed Parent
I remember he really couldn’t really remember me, which was hard for me. Because it was like you’ve known him and he’s been there for you, he was the guy that named you. And him not being able to remember your name was very hard to take and frustrating. All you could really do was … you really couldn’t do anything at all, just watch and pray.
Dad 3

4. Learning objectives
Explore how the alternations in a service member with PTSD or TBI can disrupt development attachments with very young children and change attachments with older children.
Be aware of symptoms related to TBI and PTSD
Discuss the concept of ambiguous loss and how that relates to child/parent attachment in the aftermath of war
Develop parenting styles and strategies that can assist the Changed Parent in forming a close relationship with his/her children after return from war.
Identify resources that can be used to enhance parenting skills and ultimately strengthen attachment bonds at all stages of the child’s development. 4

5. The Bowlby–Ainsworth Perspective: Some Relevant Issues
Attachment theory is concerned with the development of infant/child–caregiver relationships, the maintenance of such relationships through the lifespan, and the role those relationships play in future close relationships and individual development.
Chapter 7 Attachment Ties in Military Families: Mothers’ Perception of Interactions with Their Children, Stress, and Social Competence: Germán Posada, Nancy Longoria, Casey Cocker, and Ting Lu) S. MacDermid Wadsworth and D. Riggs (eds.), Risk and Resilience in U.S. Military Families, DOI / _7, © Springer Science+Business Media, LLC 2011
Dad 5

6. Biological Bases of Attachment Behavior
“Attachment behavior has the predictable outcome of increasing the proximity of the child to the attachment figure (usually the mother). Some attachment behaviors (smiling, vocalizing) are signaling behaviors that alert the mother to the child’s interest in interaction and thus serve to bring her to the child. Other behaviors (crying) are aversive, and bring the mother to the child to terminate them. Some (approaching and following) are active behaviors that move the child to the mother. “
(Handbook of Attachment, pg 4, emphasis mine) 6

7. Ainsworth Maternal Care Variables
sensitivity to the infant’s signals and communications
cooperation with baby’s ongoing behavior
acceptance of the baby’s needs
physical and psychological accessibility
Chapter 7, pg 138 Attachment Ties in Military Families: Mothers’ Perception of Interactions with Their Children, Stress, and Social Competence: Germán Posada, Nancy Longoria, Casey Cocker, and Ting Lu) S. MacDermid Wadsworth and D. Riggs (eds.), Risk and Resilience in U.S. Military Families, DOI / _7, © Springer Science+Business Media, LLC 2011 7

8. Outcomes beneficial to the child
Feeding
Learning about the environment
Social interaction
Less likely to be killed by predators
“Attachment is considered a normal and healthy characteristic of humans throughout the lifespan, rather than a sign of immaturity that needs to be outgrown.”
(Handbook of Attachment, pg 5) 8

9. The Exploratory System
Links exist between exploratory & attachment systems
Exploratory system gives survival advantages to the child - provides information about the workings of the environment
use tools
build structures
obtain food
negotiate physical obstacles
(Handbook of Attachment, pg 8) 9

10. Attachment & Exploratory Balance
Secure base from which to explore (Ainsworth 1963)
Attachment-exploration balance (Ainsworth, Bell & Stayton 1971)
a concept first described by Ainsworth (1963) and central to attachment theory 10

11. Dynamic Equilibrium
Mother provides “a secure base from which to explore.” The mother’s monitoring of infant-mother proximity frees the infant from such monitoring and permits greater attention to exploring.
(Handbook of Attachment, pg 10) 11

12. Infant-Father Attachment
“Individual differences in quality of infant-father attachment are related to paternal behavior: Infants are more likely to be securely attached to fathers who have been sensitively responsive to them.”
(Handbook of Attachment, pg 14) 12

13. Sense of Safety & Security - Young
Derived from maintaining a bond with an accessible and responsive caregiver.
Perceived threats to caregiver’s availability causes feelings of anxiety and anger
Persistent disruption of attachment bond results in feelings of sadness and despair
(Handbook of Attachment, pg 24, emphasis author’s) 13

14. Sense of Safety & Security - Older
Perceive threats to caregiver’s availability when lines of communication are disrupted by
prolonged absence
emotional disengagement
signals of rejection or abandonment
Can produce feelings of anxiety, anger, and sadness similar to younger children after physical separation
(Handbook of Attachment, pg 24) 14

15. Chad, 17 yrs old
“Dad was in Kandahar for six months.
I ed him there. We talked about how we were going to go fishing when he got back, maybe get a car and fix it up for the drag races. We were talking about how he was going to retire, but that’s not happening now. He’s staying in for a few more years. He wants to get his chief ranking.
Before Kandahar, he was quiet, but he always wanted to do stuff with us. Now he’s always running around all over the place, trying to keep himself busy.
He lives on the base with me… My dad and I live here on the base so I can finish high school here. We share a house, and we hang out, but we don’t talk.”
Off to War – Deborah Ellis, pg 56) 15

16. Threats to Availability – Child/Parent
Threats of suicide by parent can lead to..
Child experiencing anxiety about
physical accessibility
fear of violence
prospect of loss
Child interpreting an implied message that he or she is responsible for the parent’s desperation and despair
(Handbook of Attachment, pg 33) 16

17. Witnessing Violence – Parent/Parent
Seeing parents argue violently may
threaten child’s confidence in parent’s availability
create fear in the child about harm to one or both parents
“Parents who are living with constant conflict and fear are likely to have reduced capacities to attend to the child.”
(Handbook of Attachment, pg 33) 17

18. Symptomatic Expressions of Aggression
“Parents are likely to be most frightening to their children when their unusual behavior occurs in unpredictable ways.”
Threats to availability
Threats to safety
(Handbook of Attachment, pg 36) 18

19. Traumatic Brain Injury
Neurologic injury
Possible physical, cognitive, behavioral, and emotional symptoms
Range
Mild
Moderate
Severe
Penetrating
Battlemind Training System Office 19

20. Mild Traumatic Brain Injury (mTBI)
Type of concussion
Results from a “blow to the head”
Does NOT result in obvious physical injury
Don’t have to be knocked out to have a mTBI
May be dazed, confused, had your “bell rung”
If knocked out, for less than 30 min
Battlemind Training System Office 20

21. Symptoms of mTBI Headache Confusion Dizziness
Blurred vision or tired eyes
Ringing in the ears
Change in ability to smell or taste
Sensitivity to sound or light
Nausea/vomiting
Irritability (possibly anger or aggression)
Fatigue
Change in sleep patterns
Mood changes
Trouble with memory, concentration, attention, or thinking
Battlemind Training System Office 21

22. Invisible Injuries Hardest for children to understand
Why does a parent seem angry or sad? Why does he forget things or just seem “out of it”?
Help the child understand an injury may change the way a parent feels, talks, and acts.
Validate the child’s confusion, and make sure that he knows he is not to blame.
Sesameworkshop.org/tlc 22

23. Sesame Street Video – Changed Parent
Too many people talking. Too many decisions about dinner. Do you want a coke. And that will never end. That will always be my biggest mental weakness, I can’t intake a lot.
Dad 23

24. Post Combat Stress Also referred to as Post Traumatic Stress
Can result in a diagnosis of
Post Traumatic Stress Disorder
Preferred terminology
Post Traumatic Stress Illness 24

25. Physical Symptoms of PCS
Fatigue and/or weakness
Chest pain
Pounding heart
Breathing difficulty
Sleep problems (insomnia or nightmares)
Muscle tremors or twitches
Grinding of teeth
Profuse sweating
Headaches
Diarrhea/Intestinal upsets
Battlemind Training System Office – List not all inclusive 25

26. Behavioral Symptoms of PCS
Withdrawal
Pacing & Restlessness
Emotional outbursts
Anti-social acts
Suspicion & Paranoia
Inability to rest
Loss of interest in hobbies
Alcohol consumption
Substance abuse
Battlemind Training System Office – List not all inclusive 26

27. Emotional Symptoms of PCS
Anxiety or panic
Guilt
Fear
Denial
Irritability
Depression
Intense anger
Agitation
Apprehension
Isolating & withdrawing from others
Battlemind Training System Office – List not all inclusive 27

28. Kaela, 13 yrs old
“Dad had a lot of combat stress when he came home. He tried to hide it from us kids, but I could see that he was a lot quicker to get angry. Before he went, he was so patient with my brothers, more patient even than Mother Teresa would be, my mom says. When he came back he lost it. His patience was gone – not just with my brothers, but with me, too. He’d start in on me for making just the smallest sort of thirteen-year-old comment. He’d get so upset about the smallest, dumbest things.” Off to War – Deborah Ellis, pg 44-45) 28

29. What about the children?
Common symptoms of mTBI or PCS are diametrically opposed to the behaviors young or older children need to form/maintain attachments
Young children need a consistent response to their behaviors
Parent may be unable to respond consistently depending on degree or severity of his or her symptoms 29

30. What about the children? (cont)
Older children seek consistent communication pathways
Parents may be unable to re-establish previous patterns of communication or shared activities 30

31. Kaela, 13 yrs old (cont)
“The whole deployment has improved my relationship with my mom, but it didn’t start out that way. At first she would keep stuff from me. She didn’t want to worry me. She’d hear things from Afghanistan and keep them to herself. I knew she was bothered by something but didn’t know what it was. I thought she was angry with me. I was hurting and angry and lonely, and we weren’t talking to each other. This big space opened up between us until one day we had this huge fight. I told her, “Mom, you’re not helping me, you’re hurting me.” Since then, things have gotten a lot better. We’re communicating again.”
Off to War – Deborah Ellis, pg 45) 31

32. Ambiguous Loss Physical Absence and Psychological Presence
Loss, Trauma, and Resilience by Pauline Boss, pg 9
Physical Presence
and
Psychological Absence 32

33. Ambiguous Loss
“Ambiguous loss is a problem structurally when parenting roles are ignored, decisions are put on hold, daily tasks are not done, and family members are ignored or cut off. “
Loss, Trauma, and Resilience by Pauline Boss, pg 15
Dad 33

34. Ambiguous Loss
“In United States culture, the valued and expected goals are to fix, cure, win, and solve. Living with loss is discouraged. Rather, one is supposed to get over it and do so quickly.”
Loss, Trauma, and Resilience by Pauline Boss, pg 19
Dad 34

35. Absolute Reactions to Ambiguous Loss
Prematurely closing out the changed parent by acting as if they were dead
Denying the parent’s psychological absence and acting as if nothing changed
Loss, Trauma, and Resilience by Pauline Boss, pg 165
Dad 35

36. Double Whammy
“Lose one parent {to TBI or PCS} and the remaining parent becomes depressed and preoccupied with the missing mate.
Child ends up losing both parents, but no one notices because they are still there in the home.”
Loss, Trauma, and Resilience by Pauline Boss, pg 8
Dad 36

37. Safety of the Child must be paramount Regardless of age
Tips for Parenting to Enhance Attachment
Safety of the Child must be paramount
Regardless of age 37

38. Tips for Parenting to Enhance Attachment
Encourage all parents to participate in Child Growth & Development Classes and Parenting Classes, or to read books on positive patenting techniques.
Knowledge of normal infant and toddler behaviors is not intuitive in today’s society. 38

39. Resources Zero to Three Behavior & Development Care & Education
Offers podcasts, printable handouts, videos to watch on-line, free Parent Brochures and Guides 39

40. Zero to Three
ZERO TO THREE is a national nonprofit that informs, trains and supports professionals, policymakers and parents in their efforts to improve the lives of infants and toddlers.
All of our work is:
Grounded in research and experience
Multidisciplinary
Collaborative
Culturally responsive
Clinically informed
Accessible 40

41. Illinois Early Learning Project
The Curious Child
"Where did Navy Pier come from?" "Why do we have to wear seat belts?"
Do you know a child who is full of questions? Young children are naturally curious. They believe parents, caregivers, and teachers know a lot about the world. Asking questions and listening to answers are vital to their learning. The way you respond can affect what and how a child learns.
Do you...
...reject questions?
"Stop asking. Be quiet. Don't bother me." Responses like these may tell a child that curiosity is unimportant or annoying. If you are too busy, or uncomfortable about a question, you might say, "Let's talk about it later. Right now my mind is on something else."
..deflect questions?
Answers like "Because I said so" give the child no information. It may be true that he must sometimes do something "because Daddy said." But too many responses like this can squelch his curiosity and creativity.
...give answers?
A short explanation accepts her question and acknowledges your ability to answer. "We wear seat belts because it's safer and the law says to." It's also all right to tell her, "I don't know!"
...invite the child to find answers?
Your response can encourage higher-order thinking. Depending on the question and the child's age, you might:
Suggest ways to look for answers (reference books, the Internet, an expert, an experiment). "I wonder about Navy Pier, too. Let's look it up in ___."
Invite her to brainstorm with you. "I don't know the answer. Let's write down some possibilities." When you brainstorm, don't throw away any ideas. (That's the next step.) 41

42. Tips for Parenting to Enhance Attachment
Structure interactions with child based on “best” potential
Best time of day
for the parent
for the child
morning
after nap
bedtime routine
Best activity - accommodates
parent’s symptoms
child’s likes/developmental stage 42

43. Strategies
Situation: Child wants parent to attend their (name sport here) game.
Parent is unable to tolerate crowds, loud noises, or closed in spaces.
Possible solutions: 43

44. Strategies
Situation: Child wants parent to attend their (name sport here) game.
Parent is unable to tolerate crowds, loud noises, or closed in spaces.
Possible solutions:
attend practice
watch game day video with child
ask about access to a press box or private box that minimizes the effects of crowd or noise 44

45. Strategies
Situation: Child wants to go to Chuck E Cheese with parent like before.
Parent is unable to tolerate crowds or loud noises.
Possible solutions: 45

46. Strategies
Situation: Child wants to go to Chuck E Cheese with parent like before.
Parent is unable to tolerate crowds or loud noises.
Possible solutions:
call the manager and ask when is the least crowded time to come
pick a new restaurant that is quieter but still a special treat for parent & child 46

47. Strategies
Situation: Child wants to “rough house” with parent like before the deployment
Parent is agitated by physical contact.
Possible solutions: 47

48. Strategies
Situation: Child wants to “rough house” with parent like before the deployment
Parent is agitated by physical contact.
Possible solutions:
identify new physical activities where contact is controlled or predictable and parent is able to tolerate
find physical activities that minimize physical contact but provide time together 48

49. Strategies Re-assign parent and child activities
Service member parent could:
Take child to library – routine, enjoyable event, quiet environment
Walk child to school in the mornings (even park car a block away and walk the last bit to avoid car congestion)
Adjust nap time so toddler is waking up when parent available to play quietly or share snack time 49

50. My Child Psychologist http://mychildpsychologist.com/articles/
Welcome to MyChildPsychologist.com’s original articles. Dr. Dawn Koontz and Dr. Catherine Judkins write commentaries and summaries on anything child-related, most often issues related to child psychology. Please browse our entries! Dr. Dawn Koontz and Dr. Catherine Judkins are licensed clinical psychologists who received their graduate and clinical training in child and adolescent psychology
19 Really Cheap Activities for Summer Fun with the Kids
Bedtime and Sleep Problems
Managing Increased Independence in Toddlers 50

51. 20 reasons why your child needs you to be an active father
Kids Growth
20 reasons why your child needs you to be an active father
Fathers play a critical role in the development of their children; however, many fathers are uncertain about the responsibilities and privileges associated with this role. Children need fathers who love and care for them on a consistent basis. The latest research indicates that fathers who are actively involved in raising their children can make a positive and lasting difference in their lives. In contrast, this same research reveals a number of potentially negative outcomes for children whose fathers are not involved. Listed below are 20 reasons why your child needs you to be an active father. 51