1. Re-Attaching the Brain: A Developmental Treatment Approach for Treating Sexual Behavior Problems in Children and Adolescents
Kevin Creeden, M.A., LMHC
Whitney Academy
East Freetown, MA
.org

2. A Developmental Framework
Development happens across a variety of areas: neurological, physical, emotional, social, cognitive, academic, moral, etc.
Development proceeds from the existing competencies

3. Developmental Framework
A variety of developmental models can be used in conceptualizing effective treatment
Maslow (1968), Bowlby (1973)
Strayhorn (1988), Erickson (1963)
Common developmental issues

4. Common issues Sense of belonging: trust, safety, closeness, dependence
Differentiating self from other
Self-regulation of physical and emotional responses: delaying gratification
Developing cognitive skills

5. Common Developmental Issues
Cognitive flexibility/adaptive problem solving
Moral development
Empathy
Creativity

6. Clinical Assumptions Trauma in early childhood has a
neuro-developmental impact
The individual’s own trauma experiences and their current behavior are linked through a variety of trauma associations and cues

7. Without addressing trauma associated symptoms the integration of new learning and new narratives will not effectively occur
There is a physiological response to trauma cues that effects processing, cognitions, emotional response, and behavioral response
It is impossible to discuss trauma in children without addressing the quality of parental attachment (van derKolk, 2003)

8. Engaging in abusive behavior is primarily focused on meeting relational needs
Safety is the primary goal
Competency in relationships and developmental tasks are key protective factors
Children do well if they can

9. Kids Have to Think That You Care
Before
They Care What You Think

10. Resiliency Factors
Positive attachment to emotionally supportive and competent adults
Development of self-regulation and cognitive abilities
Positive self-concept
Motivation to act effectively

11. Brain Development and Trauma
Brain abnormalities are associated with childhood abuse and neglect
(Teicher, 2002; DeBellis, 2001)

13. Neocortex: Site of higher cognitive functions and sensory integration
Hypothalamus: controls appetite, hormones, and sexual behavior
Hippocampus: crucial to memory and learning facts
Amygdala:
responsible for anxiety, fear and emotions
Cerebellum: seat of motor control and coordination
Brain stem: responsible for sensory input and physiological responses

16. Brain Structure Function Impairment Amygdala
fear conditioning; aggressive behavior; triggers fight/flight
Increased arousal, impaired fear conditioning
Hippocampus
Retrieval of verbal and emotional memory
Memory impairment, especially verbal memory
Left hemisphere
Regulate analytical responses; mediate emotional responses; language processing
Difficulties in accurate, effective reading of situation; language processing
Corpus Collosum
Communication and integration between hemispheres
Poor integration and modulation of responses to daily interactions
Cerebellar Vermis
Production and release of neuro-transmitters
Problems regulating physical activity, attention, emotions
Prefrontal cortex
Center for executive functions
Poor organization, rigid problem solving; increased impulsivity

17. Trauma symptom assessment
Assessment Issues
Trauma symptom assessment
TSCC; TSI
Screening for processing difficulties
SCAN:A; Bender; RCFT; WCST

18. Discriminate attachment styles for the parents and child
Family of origin issues and expectations of the parents, foster parents, or other caregivers
FAM:III; Stress Index for Parents of Adolescents (SIPA); Clinical interview; TSI
Discriminate attachment styles for the parents and child
Relationship Questionnaire (Bartholomew and Horowitz, 1991)

19. Behavior specific assessment: sexual knowledge, attitudes, cognitive distortions, focus of fantasies.
Personality assessment to examine issues of depression, aggression, anti-social attitudes

20. Phase Oriented Treatment
Stabilization, including education and identification of feelings/somatic states
De-conditioning traumatic memories and responses
Restructuring traumatic personal schemes
van der Kolk, et al , 1996

21. Maslow’s Hierarchy of Needs

22. Treatment Interventions
Stabilization, deconditioning, and establishing supportive relationships can be re-framed as “containment”
WORKING ON TRAUMA
thinking, feeling, and
talking about trauma
Attachment
Self-regulation
Structure
Allen, 2001

23. Structure Consistency and predictability in the schedule
Consistency in expectations
Consistency in responses
Consistency in environment
Use of rituals

24. Self-Regulation
Active learning and practice of a variety of activities and techniques
Deep breathing and “counting to 10”
Visualization and “safe place”
Yoga or tai chi
Music, journaling, art
Daily exercise
Brain gym
Biofeedback

25. Transformations
Sensory Stimulation Transformation of information Dispositional representations Enacted behavior
Crittenden, 2005

26. Sensory Areas Proprioception Vestibular Auditory Visual Tactile
Olfactory
Gustatory

27. Proprioception
Sensations derived primarily from large muscles and joints; especially during movement against resistance
Can help person feel grounded
DEEP Pressure: often over-rides over arousal

28. Proprioception examples
Weighted blankets or vests
Wall push ups
Walking
Isometric exercise
Brain gym
Exercise balls
Clay work

29. Vestibular
Sensation derived from stimulation of vestibular mechanism in the inner ear
Provides a sense of equilibrium and balance
Contributes to a sense of one self in space
“boundary issues”

30. Auditory Directly connected to vestibular
Sound, music, rhythm serves as a “pacemaker”
Different sounds connected to mood, pace
Consider different sounds in transition in environments like residential centers and schools

31. Gustatory Includes oral motor as well as taste
Stimulation can help with attention, comfort, and overall organization

32. Tactile Touch, pressure, vibration, temperature, pain
Provides sense of body image, boundaries, self
Fundamentally connected to safety, comfort, self-soothing, attachment

33. General Characteristics
Calming
Mild
Rhythmic
Simple
Familiar
Consistent
Soothing
Low demand
Alerting
Strong
Fast paced
Non-rhythmic
Complex
Novel
Unpredictable
High demand

34. Anxiety and Agitation Deep breathing Isometric exercise Rocking
Using weighted blanket
Stress balls
Calming music
Chewing gum
Rocking chairs or gliders
Yoga
Mindfulness
Biofeedback
Rowing

35. Grounding Approaches Strong tastes Sour candy or hot candy Chewing gum
Ice tapping
Hot/cold shower
Pacing
Tapping
Movement: yoga, tai chi

36. Depression Weighted vest Movement and exercise Beanbag tapping
Warm pad
Scented lotion
Stroking/brushing
Calming techniques are often not helpful

37. Developmental Model Self-Regulation Attachment Cognitive skills
Social Skills
Adaptive Living Skills
Healthy Sexuality

38. Self-regulation (2) Identifying triggers
Connecting sensations w/ thoughts, feelings, behaviors
Identifying choices
aspects of BrainWise

39. Attachment styles: Bartholomew
Secure
Preoccupied
Avoidant
Dismissive
Self Others
pos (+) pos (+)
neg (-) pos (+)
neg (-) neg (-)
pos (+) neg (-)

40. Domains of Impairment: Complex Trauma
Cook, Spinnazzola, et al (2005)
Attachment
Distrust
Social isolation
Attunement difficulties
Boundary problems
Problems with perspective taking

41. Addressing Attunement
Eye contact
Thoughtful use of touch
Mirroring
Being “in sync”
Listen, reflect, check

42. Brain Wise: The 10 Wise Ways
Wizard Brain over Lizard Brain
Constellation of Support
Recognize Red Flag Warnings
Exit the Emotions Elevator
Separate Fact from Opinion

43. Wise Ways Ask Questions Identify Your Choices
Consequences: Now and Later; Affecting Others
Set Goals and Form a Plan
Communicate Effectively

44. 6. Domain: Healthy Sexuality
Elements: Understanding Rules and Limitations of Sexual Behavior at Whitney
Interventions: Present and discuss Whitney Sexual Behavior Rules
Elements: Self-Regulation (see above)
Elements: Maintaining appropriate personal space (see above)
Interventions: Kornblum: Chapter 2
Recreational therapy
Elements: Accurate Sexual Information
Interventions: Sex ed curriculum (medical)
Elements: Sexual Behavior in context of relationships
Interventions: Sex ed curriculum (clinical)
Elements: Cognitive distortions
Interventions: BrainWise curriculum: Separate Fact from Opinion
Elements: Role models and masculine identity
Interventions: Circles curriculum
Family therapy
Group therapy

45. Domain: Self-Regulation
Elements: Behavior Management
Interventions: Level System
Individual behavior management plan
Elements: Sensory Integration
Interventions: Complete Sensory Profile
Introduce to Sensory Room
Develop individualized sensory/self-regulation tools
Elements: Self-regulation skill training
Interventions: Daily stress buster exercises
Use of biofeedback tools: Wild Divine; pulse meters, etc.
Dialectical Behavior therapy exercises: (Linnehan)
Elements: Safe Place
Interventions: Describe, write about, build, develop safe places both real and imagined (visualization)
EMDR: safe place installation (individual)
Elements: Adaptive Problem Solving Skills
Interventions: BrainWise curriculum