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

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Presentation on theme: "Reconstructing Bonds: Forming Attachments in the Aftermath of War Joan K Vanderlaan BSN, MN www.MilitaryChild.org."— Presentation transcript:

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 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.

4  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. Learning objectives 4

5 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

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 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

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 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 The Exploratory System

10 Attachment & Exploratory Balance Secure base from which to explore (Ainsworth 1963) Attachment-exploration balance (Ainsworth, Bell & Stayton 1971) 10

11 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)

12 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)

13 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)

14 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)

15 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)

16 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)

17 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)

18 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)

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

20 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

21 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

22 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

23 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.

24 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

25 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

26 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

27 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

28 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)

29 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

30 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

31 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)

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

33 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

34 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

35 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

36 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

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

38 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.

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

40 40 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 Zero to Three

41 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.)

42 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

43 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:

44 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

45 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:

46 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

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

48 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

49 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

50 50 My Child Psychologist 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

51 51 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.


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