Will I Ever See You Again? Dr. Elizabeth Jacobs 1/27/2016 Important numbers… “It is now clear that human beings of all ages are found to be at their Will I Ever See How many children in foster care? happiest and to be able to deploy You Again? Ages 0-5 = 41.7% their talents to best advantage when Attachment Ages 0-3 = longest time in foster care2 they are confident that, standing challenges for Ages 0-3 = highest reentry rate3 behind them, there are one or more foster children Ages 0-3 less likely to be reunified4 trusted persons who will come to Elizabeth Jacobs, Ph.D. their aid should difficulties arise.” John Bowlby, 1973. 1CASA of AZ, 2015 2 Prepared for AFCARS Report, 2014 3Dicker and Gordon, 2004 2016 Northwest Arizona Symposium 4Jacobs, 2015 2016 Northwest Arizona Symposium 2016 Northwest Arizona Symposium The Cycle of Attachment Then brings these behaviors Attachment defined as... Infant/child feels has a need: hunger, fear, into foster care so… frustration & elicits the help of the caregiver displaying an “attachment behavior” to get Children have difficulty forming attachments “…reciprocal process by which an emotional his/her attention. to their foster parents because their needs connection develops…(Erikson) are not met. Caregiver correctly reads needs Bio or foster parents have difficulty …between the child and his primary caregiver of child and tends to the need. responding correctly to the children because which occurs between 6 and 12 months. the behaviors seem odd.. Child is satisfied, returns to activity …so a new cycle is created... confident that help is there if needed. The child learns not to become attached… Will repeat this successful attachment behavior 2016 Northwest Arizona Symposium 2016 Northwest Arizona Symposium 2016 Northwest Arizona Symposium David Pelzer 2016 Northwest Arizona Symposium 1 Will I Ever See You Again? Dr. Elizabeth Jacobs 1/27/2016 Insecurely Attached Research results were pretty simple… Secure Attachment Makes future secure attachments less likely (Risk factor) The emotional bond is positive and All children attach to Either: care is consistent. A sense of trust Insecure-Resistant: child is uncertain. caregivers in one of two develops. Child may move away Vacillates between seeking and resisting ways: and explore knowing that the contact with caregiver. caregiver is available for help in Securely Or case of adversity or fear. Children Or Insecure-Avoidant: child expects rejection learn from caregiver how to handle from caregiver. Actively avoid caregiver. Insecurely stress. Becomes a secure base. …or so they thought… (Protective factor.) 2016 Northwest Arizona Symposium 2016 Northwest Arizona Symposium 2016 Northwest Arizona Symposium 100 billion neurons Until: A mid-1980’s Discovery at birth Researchers discovered an additional Insecure Attachment type : 700 - 1,000 “But wait, there’s more…” synapses per second Disorganized/Disoriented Repeated = strengthened – child is confused, dazed, may subtly Not repeated = pruned try to hit caregiver…. Neurological development also affects a child’s ability to attach to • Abuse/neglect cause continuous (toxic) stress Common to children who had been abused… • Child’s alarm system remains activated. caregivers…. • Synapses for fear and stress strengthened Conclusion: Children who are neglected and • Synapses for learning and self-controlled pruned abused are more likely to have this type of • Body and brain set permanently on high alert attachment disorder. But not always… • Becomes the foundation of the child’s brain Some children are resilient… Conclusion: Time is of the essence… 2016 Northwest Arizona Symposium 2016 Northwest Arizona Symposium 2016 Northwest Arizona Symposium 2016 Northwest Arizona Symposium 2 Will I Ever See You Again? Dr. Elizabeth Jacobs 1/27/2016 The unusual behaviors exhibited As a result of their neglect/abuse by traumatized children often lead foster children come into care with… to psychological diagnoses and are often treated with Psychotropic Medication further …unusual attachment behaviors they interfering with the child’s used to survive their abuse/neglect developing brain. which may be misunderstood. Classes of psychotropic medications: … and stress-related neural Anti-psychotics, Anti-depressants, connections which have interfered Anti-manic, Anti-seizure and Stimulants with normal brain development. Abuse/neglect affect brain development of young children. The younger the child, the better chance to • 41.3% > 4 different classes (Zito, J., et al., 2008) recover from this consequence • Long-term effects of these drugs are unknown. (Littell, M., 2001) Conclusion:2016 Northwest Time Arizona is of Symposium the essence… 2016 Northwest Arizona Symposium 2016 Northwest Arizona Symposium Martin, Age 8 Now a few words about… (What we once called…) Then, once in care, foster children … Background: DV, Parental Drug use, 2nd grade. Reactive Attachment Disorder (RAD) Very aggressive, threatens to have his father kill people, sheriff called to school numerous times. experience multiple case managers, DSM V now divides into two disorders… Psychotropic meds: CASAs, judges, GALs, therapists, foster 1. Reactive Attachment Disorder: 1. Depakote (>10): Anti-seizure, off-label: mania homes… 2. Zoloft: Anti-depressant, SSRI*. 6-17: OCD - Withdraw/fearful of adults …experience frequent moves and/or - Insufficient care (at least one): 3. Intuniv: Guanfacine, reduces BP, off-label: ADHD placements. *Emotional needs not met 4. Risperidone: Anti-psychotic. off label: Mania *Repeated changes of primary caregiver *Limited opportunities to attach (e.g., *Black box warning: “SSRI’s may increase institutions. suicidal thoughts in children and adolescents.” …and their resistance/inability to Side effects (partial list): attach to others becomes an 2. Disinhibited Social Engagement Disorder 1. Breathing diff., bruising agitation, insomnia, liver damage Indiscriminately social toward adults 2. Agitation, anxiety, diarrhea, dizziness, dry mouth, gas expected outcome… Same “insufficient care” as RAD 3. Dizziness; drowsiness; dry mouth; headache; tiredness.. 4. Insomnia, rapid HR, hallucinations,, TARDIVE DYSKINESIA 2016 Northwest Arizona Symposium 2016 Northwest Arizona Symposium Extreme2016 Northwest andArizona Symposiumrare… 2016 Northwest Arizona Symposium 3 Will I Ever See You Again? Dr. Elizabeth Jacobs 1/27/2016 Attachment (Bonding) Assessment Attachment disorder symptoms may Links to Psychopathology/criminality: include the following behaviors... Evaluates the quality of the caregiver-child relationship through: (developed by clinicians) “Insecure attachment patterns in infancy and early childhood are strong predictors of psychopathology and maladaptive Superficially charming Learning deficits behavior in adolescence and adulthood.” (Genuis, 1995). • Single or multiple interviews. • Video-taped caregiver-child observations Lack of eye contact Lacks cause/effect thinking* Foster children are almost 9 times more likely than home (Strange Situation – Mary Ainsworth) Overly affectionate Lack of conscience* reared children to evidence psychological disturbance. • Observations in the home Not cuddly Abnormal eating patterns (McIntyre & Kessler, 1986). • Courts docs Control problems* Poor peer relationships* Within the first year, 68% of children who age out of foster • Psychological testing Destructive Preoccupied with fire, blood, care system are in jail or dead. (Dr. Bruce Perry 2006) • Mental Health Assessment Cruel to animals* gore* Chronic lying* Nonsense questions/chatter 80% of prison inmates in Illinois have been through the …of children 0-6 years old. (0-12 mo: later Demanding foster care system (National Association of Social Workers) No impulse control* attachment is predicted by the mother’s Abnormal speech patterns sensitivity to the infant. As well as dependent, histrionic, borderline, and schizoid *also symptoms of ODD* and Conduct Disorder* personality disorder (Mikulincer & Shaver, 2012) Answers: “Who can best provide a secure base for this child by being predictable, consistent, No current therapy for attachment disorder 2016 Northwest Arizona Symposium 2016 Northwest Arizona Symposium 2016 Northwest Arizona Symposium and emotionally available?” so use therapy for ODD/CD. In summary, then, “Best Interest” requires Case Study - Rosie Miranda (As of 5/15/2015) that we consider: Event Case Plan Age Date Time 16 ½; came into care in 2004 at age 5 -- Neglect/Abuse Problem Amelioration Birth Sibs reunified 0 1/20/12 Home – 9 mo. Sexually molested by father and mother’s BFs Removed Family Reunification 9 mo. 10/20/12 Foster – 4 mo. All children TPRed; Miranda’s four sibs adopted Length of abuse/neglect results Time is of the essence. (Neglect) in neurodevelopment Expedite case plan 0-5. M. displays sexualized behaviors and aggression Reunified 13 mo. 2/22/13 Home – 5.5 mo. problems. Concurrent of S & A, if doubt. “Denial of placement in Maricopa Co.’s TGH” (5/15) Removed Family Reunification 19 mo. 8/5/13 Foster – 19.5 Odd, unique, survival behaviors Educate foster parents ( & as All requests outside of Maricopa Co. also declined (beaten) -- so far (from home or misinterpretation of problems arise). Involve high 10.7 years in care; 24 placements events.) Parents: level therapist Several potential adoptions; all incomplete. (www.apa.org/practice/refer.html) -- Mother mentally ill, both parents: drug users, missed/positive UAs, inconsistent/no show visits, not participating in services. As adoption