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Parenting and Therapeutic Interventions 921: Reactive Attachment Disorder (RAD):

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Presentation on theme: "Parenting and Therapeutic Interventions 921: Reactive Attachment Disorder (RAD):"— Presentation transcript:

1 Parenting and Therapeutic Interventions 921: Reactive Attachment Disorder (RAD):

2 921: Reactive Attachment Disorder: Parenting and Therapeutic Interventions The Pennsylvania Child Welfare Resource Center WELCOME!  Name Tents  Name  County  Number of Children  Number of Years as a Resource/Adoptive Parent  One thing you want to know about the topic 2

3 921: Reactive Attachment Disorder: Parenting and Therapeutic Interventions The Pennsylvania Child Welfare Resource Center What’s In It For Me? Training Needs? What’s do you want to know by the end of this training? 3

4 921: Reactive Attachment Disorder: Parenting and Therapeutic Interventions The Pennsylvania Child Welfare Resource Center Learning Objectives Define Reactive Attachment Disorder (RAD) Describe common behaviors exhibited by children diagnosed with RAD and related disorders Utilize parenting approaches that facilitate attachment Identify parenting strategies to prevent and manage the behaviors exhibited by children diagnosed with RAD and related disorders Describe the extensive collaboration needed among resource/adoptive families, caseworkers, therapists and educators to support children diagnosed with RAD and related disorders The Pennsylvania Child Welfare Resource Center 4

5 921: Reactive Attachment Disorder: Parenting and Therapeutic Interventions The Pennsylvania Child Welfare Resource Center Agenda I.Introduction II.Definitions and Characteristics of RAD and Related Disorders III.Parenting approaches to facilitate attachment IV.Prevention and intervention parenting strategies V.Collaboration techniques to create a team approach among families, caseworkers, mental health professionals and educators VI.Closing 5

6 921: Reactive Attachment Disorder: Parenting and Therapeutic Interventions The Pennsylvania Child Welfare Resource Center Definition and Characteristics of RAD and Related Disorders 6

7 921: Reactive Attachment Disorder: Parenting and Therapeutic Interventions The Pennsylvania Child Welfare Resource Center Definition of RAD and Related Disorders RAD A pattern of attachment behaviors before age 5 –Rarely or minimally seeks comfort when distressed –Rarely or minimally responds to comfort offered when distressed At least 2 of following: –Relative lack of social and emotional responsiveness –Limited positive affect –Episodes of irritability, sadness, or fearfulness during nonthreatening interactions with adult caregivers DSED Attachment present/not Reduced or absent reticence to approach and interact with unfamiliar adults Overly familiar behavior (verbal or physical violation of culturally sanctioned social boundaries) Diminished or absent checking back with adult caregiver after venturing away Willingness to go off with an unfamiliar adult with minimal or no hesitation 7

8 921: Reactive Attachment Disorder: Parenting and Therapeutic Interventions The Pennsylvania Child Welfare Resource Center Definition of RAD and Related Disorders PTSD Symptoms of avoidance and emotional numbing Symptoms of intrusive memories –Flashbacks –Nightmares Symptoms of altered cognitions and mood SPD Difficulty processing sensory input –Sight, sound, taste, smell, touch, body positioning, balance Hyper (over) or hypo (under) in one or more senses 8

9 921: Reactive Attachment Disorder: Parenting and Therapeutic Interventions The Pennsylvania Child Welfare Resource Center CHARACTERISTICS OF CHILDREN WITH RAD AND RELATED DISORDERS Superficially engaging and charming Indiscriminate affection Lack of affection Little eye contact Persistent nonsense questions Incessant chatter 9

10 921: Reactive Attachment Disorder: Parenting and Therapeutic Interventions The Pennsylvania Child Welfare Resource Center CHARACTERISTICS OF CHILDREN WITH RAD AND RELATED DISORDERS Lying about the obvious Stealing Destructive behavior (accident-prone) Abnormal eating patterns No impulse control Lags in learning 10

11 921: Reactive Attachment Disorder: Parenting and Therapeutic Interventions The Pennsylvania Child Welfare Resource Center CHARACTERISTICS OF CHILDREN WITH RAD AND RELATED DISORDERS Abnormal speech patterns Poor peer relationships Lack of cause and effect thinking Lack of conscience Cruelty to animals Preoccupation with fire, blood, gore 11

12 921: Reactive Attachment Disorder: Parenting and Therapeutic Interventions The Pennsylvania Child Welfare Resource Center Risk Factors (Pathogenic Care Due To:) Abuse Neglect Maternal postpartum depression Parental mental illness Substance abuse of parent Inexperienced parent Inconsistent care giving/many different caregivers (Source: Mayo Clinic, 2013) 12

13 921: Reactive Attachment Disorder: Parenting and Therapeutic Interventions The Pennsylvania Child Welfare Resource Center Parenting Approaches to Facilitate Attachment 13

14 921: Reactive Attachment Disorder: Parenting and Therapeutic Interventions The Pennsylvania Child Welfare Resource Center Attachment Parenting Approaches Take care of self first Engender respect Create structure and consistency Establish consequences and restitution Provide nurture Process feelings Provide child with success 14

15 921: Reactive Attachment Disorder: Parenting and Therapeutic Interventions The Pennsylvania Child Welfare Resource Center Attachment Parenting Approaches: Questions for Reflection Please move into pairs and refer to HO#5 Attachment Parenting Approaches 1. Star the parenting approaches that you already use. 2. Place a check mark next to at least one parenting approach that you would like to start using. 3. Share with your partner the biggest challenge(s) you might face when trying out the new approach(es) and why it might be difficult for you. 15

16 921: Reactive Attachment Disorder: Parenting and Therapeutic Interventions The Pennsylvania Child Welfare Resource Center Prevention and Intervention Parenting Strategies 16

17 921: Reactive Attachment Disorder: Parenting and Therapeutic Interventions The Pennsylvania Child Welfare Resource Center Parenting Strategies  Lego Level  Steel Box/Velvet Lining  Lying and Stealing 17

18 921: Reactive Attachment Disorder: Parenting and Therapeutic Interventions The Pennsylvania Child Welfare Resource Center Parenting Strategies Practice: Case Vignette It’s 7:00 pm and fifteen year old Terrance states that he made plans to do homework with his friend, James, who lives down the street. You give permission and state that he must return by 8:30 pm. Forty-five minutes later James calls, shares that he is at a sports game, and asks if Terrance can call him when he returns in an hour. James seems surprised when you mention the plan to do homework. Terrance arrives home promptly at 8:30, noting that he is exactly on time. How will you use the “short and sweet” strategy to deal with his lying? Refer to HO#6 Parenting Strategies to review the strategy steps. 18

19 921: Reactive Attachment Disorder: Parenting and Therapeutic Interventions The Pennsylvania Child Welfare Resource Center Collaboration: Creating a Team Approach 19

20 921: Reactive Attachment Disorder: Parenting and Therapeutic Interventions The Pennsylvania Child Welfare Resource Center Focus of Mental Health Treatment Attachment –Attachment-based therapy Treatment of complex trauma –Art, play, equine and psychotherapy focused on healing trauma(s) –Eye Movement Desensitization Reprocessing (EMDR) Occupational therapy to address sensory integration and self-regulation issues Medications for specific concerns –Sleep, depression, anxiety, hyperactivity 20

21 921: Reactive Attachment Disorder: Parenting and Therapeutic Interventions The Pennsylvania Child Welfare Resource Center Collaboration with Caseworker and Mental Health Therapists Experts in the field of mental health are needed Caseworker can identify resources in your region Maintain focus on safety, attachment and trauma Ask for specific ideas to address the behaviors exhibited by your child Keep safety (for child and all family members) and supervision needs at the forefront of discussions 21

22 921: Reactive Attachment Disorder: Parenting and Therapeutic Interventions The Pennsylvania Child Welfare Resource Center Collaboration with Birth Parents Gives children what they need to shift gears more smoothly Validates feelings Provides structure to promote higher levels of security Creates connection and belonging National Resource Center for Permanency and Family Connections, 2012 Develops a deeper understanding of their identity and wholeness Preserves connections to child’s cultural and ethnic heritage Reduces feelings of abandonment Provides access to medical information Child Welfare Information Gateway,

23 921: Reactive Attachment Disorder: Parenting and Therapeutic Interventions The Pennsylvania Child Welfare Resource Center Collaboration with Medical Personnel Pediatricians can: –Track the child’s growth and development –Offer guidance and treatment if the child is experiencing problems with eating, sleeping, or anxiety –Provide referrals to specialists and further evaluation when needed 23

24 921: Reactive Attachment Disorder: Parenting and Therapeutic Interventions The Pennsylvania Child Welfare Resource Center Collaboration with Occupational Therapist Helps with sensory processing Expect “homework” to extend and reinforce the work done in the OT sessions Maintain the schedule of appointments to maximize the rate of progress Follow the guidelines for using regulation supports if prescribed by the OT –Weighted vests and blankets Collaborate with caseworker and educators when the regulation supports could help the child in settings outside the home 24

25 921: Reactive Attachment Disorder: Parenting and Therapeutic Interventions The Pennsylvania Child Welfare Resource Center Collaboration with Educators Educators can help to: 1.Document the diagnosis 2.Request a meeting about eligibility for or implementation of a 504 Plan and/or an Individualized Education Plan (IEP) Check out 3.Ensure that accommodations identified in the 504 Plan and/or the IEP are being met as required by law Check out if advocacy ishttp://www.parentednet.org/ needed for your child 25

26 921: Reactive Attachment Disorder: Parenting and Therapeutic Interventions The Pennsylvania Child Welfare Resource Center Collaboration with Educators Ensure that the recommended behavioral prevention and intervention strategies are consistently used at school –Cue for calming throughout the day –Time in not time out –Short and sweet response to misbehaviors –Shift expectations regarding remorse –Shift expectations about consequences 26

27 921: Reactive Attachment Disorder: Parenting and Therapeutic Interventions The Pennsylvania Child Welfare Resource Center Remember!!!! Children diagnosed with RAD can heal, but they need: Consistency, love and safety in relationships The “right” interventions at home and school Specialized, multifaceted treatment A team approach 27

28 921: Reactive Attachment Disorder: Parenting and Therapeutic Interventions The Pennsylvania Child Welfare Resource Center What’s the #1 Take Away Idea for You? Understanding of RAD Facilitate attachment Parenting strategies Collaboration tips 28

29 921: Reactive Attachment Disorder: Parenting and Therapeutic Interventions The Pennsylvania Child Welfare Resource Center Getting Support For a list of attachment centers and therapists in your area specializing in RAD: –Association for Treatment and Training in the Attachment of Children Support groups –Attachment & Trauma Network –Attachment Disorder Support Group 29

30 921: Reactive Attachment Disorder: Parenting and Therapeutic Interventions The Pennsylvania Child Welfare Resource Center Useful Websites Association for Treatment and Training in the Attachment of Children –www.attach.orgwww.attach.org Attachment and Trauma Network –www.radzebra.orgwww.radzebra.org Education Center –http://www.ed-center.com/504http://www.ed-center.com/504 30

31 921: Reactive Attachment Disorder: Parenting and Therapeutic Interventions The Pennsylvania Child Welfare Resource Center Useful Websites The Institute for Attachment and Child Development –www.instituteforattachment.orgwww.instituteforattachment.org National Child Traumatic Stress Network –http://www.nctsn.org/http://www.nctsn.org/ Parent Education Network –http://www.parentednet.org/http://www.parentednet.org/ Trauma Center –www.traumacenter.orgwww.traumacenter.org 31

32 921: Reactive Attachment Disorder: Parenting and Therapeutic Interventions The Pennsylvania Child Welfare Resource Center Additional Readings Bomber, L. M. (2007). Inside I’m Hurting: Practical Strategies for Supporting Children with Attachment Difficulties in School. London, UK: Worth Publishing, Ltd. Cline, F., & Fay, J. (2006). Parenting with Love and Logic. Colorado Springs, CO: NavPress. Perry, B. (2006). The Boy Who Was Raised as a Dog. New York: Basic Books. Siegel, D., & Hartzel, M. (2004). Parenting from the Inside Out: How a Deeper Self-Understanding Can Help You Raise Children Who Thrive. NY: Penguin Books. Siegel, D., & Solomon, M. (2003). Healing Trauma: Attachment, Mind, Body, and Brain. NY: Norton & Company, Inc. Thomas, N. (1997). When Love Is Not Enough: A Guide to Parenting Children with RAD. Glenwood Springs, CO: Families by Design. 32


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