Its not just the booze. FASD + maltreatment & neglect EUFASD2016 conference London
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Prenatal exposure to alcohol causes irreparable brain damage creating "swiss cheese brains" with gaps and impaired functionality. Infant maltreatment and neglect post birth exacerbates the challenges. Using 4 avatars to illustrate typical scenarios Helen Oakwater raises issues, questions and offers some reframing for parents and professionals. Bottom line. DO NOT CONSUME ANY ALCOHOL IF AT RISK OF PREGNANCY otherwise you condemn your child (and yourself) to a tougher life with learning and health issues from birth to death.
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Its not just the booze. FASD + maltreatment & neglect EUFASD2016 conference London
- 1. How consequences of maltreatment and neglect overlap with FASD symptoms A workshop with Helen Oakwater 15 September 2016: EUFASD Conference “It’s not just the booze” @helenoakwater #EUFASD2016
- 2. • Adoptive Parent • Siblings aged 2,4,5 now 25+ • Teacher (11-18: PE & maths) • NLP & mBIT Coach & Trainer • Post Grad Attachment & Adoption (Family Futures) • Government Task Force • Trustee Adoption UK • Explorer & Learner • Swimmer, Diver, Yogi • “UNDERSTANDING” • tears & sadness • guilt & shame • anger & fear 2 Helen Oakwater: its personal @helenoakwater #EUFASD2016
- 3. Frame setting What’s “normal”? What’s not? PARENTING: Good enough v Deficient CHILD DEVELOPMENT: Normal v Distorded
- 4. Frame setting: Intention ‘Foetal Alcohol Spectrum Disorder’ ‘FASD’ not alphabet soup terms Pragmatic & useful FASD: “swiss cheese brain” (This presentation is part of a full FASD training day, so I will not repeat or cover specific FASD material - you can join the dots)
- 6. Parenting Excellent Brain Good Parenting Toxic Brain FASD NORM Nice ORdinary Mainstream Good enough Deficient
- 7. Secure Attached Cycle “NORMAL” CHILD DEVELOPMENT Baby experiences discomfort or a need Baby protests, usually by crying Baby calms TRUST develops Baby plays and interacts with mother Baby rests Mother picks baby up, eye contact, talks to and soothes baby
- 8. I am safe I am loved I am cared for I am valued I can trust adults I’m special I’m okay It’s a safe place People love me People care for me There is a place for me here I am important to them The world is okay ATTACHMENT BETWEEN CHILD AND OTHERS + Child’s View of Self and World
- 9. Parenting Excellent Brain Good Parenting Toxic Brain FASD TIM Traumatised Infant Maltreated Good enough Deficient
- 10. THE INADEQUATE PARENTS constantly focussing on their own problems, they turn their children into “mini adults” who take care of them THE CONTROLLERS they use guilt, manipulation, and even over helpfulness to direct their children’s lives THE ALCOHOLICS *(DRUG ABUSERS)* mired in a denial and chaotic mood swings, their addiction leaves little time or energy for the demands of parenthood. Toxic Parenting CLASSIFIED BY DR SUSAN FORWARD IN HER BOOK “TOXIC PARENTS” 1989 ** In 1989 Dr Forward did not include drug abusers though similar issues would apply now
- 11. THE VERBAL ABUSERS whether overtly abusive or subtly sarcastic, they demoralise their children with constant put downs and rob them of their self confidence. THE PHYSICAL ABUSERS incapable of controlling their own deep seated rage they often blame their children for their own ungovernable behaviour THE SEXUAL ABUSERS whether flagrantly sexual or covertly seductive, they are the ultimate betrayers, destroying the very heart of childhood - its innocence. Toxic Parenting CLASSIFIED BY DR SUSAN FORWARD IN HER BOOK “TOXIC PARENTS” 1989
- 12. The Infant Perspective SEE Darkness HEAR Shouting & slamming doors TASTE Milk & vomit SMELL Sour milk & excrement TOUCH Nappy rash FEEL Hungry & cold
- 13. The Infant Perspective ONE PIECE OF METAPHORICAL “SENSORY SHRAPNEL” One incident of NEGLECT Stored in implicit memory & sensory database.
- 14. NEGLECT multiple pieces of ‘blue shrapnel’ “The house was a bit messy”
- 15. “Our little secret” Different Maltreatments Assorted Shrapnel
- 17. Sensory Experience Multiple maltreatment experiences Stored in implicit memory & sensory database “Myriad of sensory shrapnel”
- 18. Disturbed Attachment Cycle “DISTORTED” CHILD DEVELOPMENT Baby protests even louder Baby rests Baby experiences discomfort or a need Baby protests, usually by crying Mother does not responds to baby’s cry or else responds inconsistently Baby gives up. Trust does not develop. RAGE or APATHY develops instead… Baby plays with self or becomes apathetic
- 19. I am not safe I’m scared I am not cared for I am unlovable I’m ignored I’m not valued I’m bad It’s a terrifying hostile world People hurt you Dangerous place There is no place for me I am not important The world is not okay POOR ATTACHMENT BETWEEN CHILD AND OTHERS I’m alone - Child’s View of Self and World
- 20. Parenting Excellent Brain Good Parenting Toxic Brain FASD AAMY Alcohol Affected Maltreated Youngster Good enough Deficient
- 21. 6 Stages of Alcohol Intoxication EUPHORIA EXCITEMENT CONFUSION STUPOR COMA DEATH
- 22. Euphoria EUPHORIA From www.drug-rehabs.org mild euphoria & feeling of pleasure inhibitions decrease excessive talkativeness increased confidence levels increased sociability alcohol diminishes functioning of Central Nervous System lowered attention span impairment of sensory & motor coordination slow processing of information & lack of efficiency Blood Alcohol Concentration (g per 100ml of blood) BAC 0.03 -0.12
- 23. Excitement EXCITEMENTinstability in emotions impairment of perception, memory and comprehension loss of judgement skills lowered self-control decreased sensory response increased reaction time vision and speech reduced vision acuity & peripheral vision, slow glare recovery & slurred speech impaired balance, disturbed sensory motor coordination vomiting, nausea and drowsiness. adult becomes unusually passive or argumentative From www.drug-rehabs.org BAC 0.09 -0.25
- 24. Confusion CONFUSIONintellectual as well as psychological symptoms enhanced mental confusion disorientation exaggerated emotional states (euphoria and pleasure fades to anxiety and restlessness) excessive grief, fear, phobia, rage, paranoia & other emotions muscle incoordination increases staggered gait & ataxia disturbance in vision, perception and vertigo apathy/ lethargy towards everything deterioration in personal hygiene or appearance From www.drug-rehabs.org BAC 0.18 -0.34
- 25. Stupor STUPORdecreased response to stimuli marked muscle incoordination urine or stool incontinence gradual loss of motor functions impaired consciousness- state of stupor loss of memory drinker unable to recall certain events or names From www.drug-rehabs.org Blood Alcohol Concentration BAC 0.25 -0.40
- 26. Coma COMAperson goes to complete unconsciousness or coma reflexes completely depressed severe respiratory and circulation impairment internal temperature low skin is cold & clammy From www.drug-rehabs.org Blood Alcohol Concentration BAC 0.35 -0.50
- 27. Death DEATHperson dies due to cardiac arrest From www.drug-rehabs.org Blood Alcohol Concentration: (g per 100ml of blood) BAC 0.45+++
- 28. Disturbed Attachment Cycle “DISTORTED” CHILD DEVELOPMENT Baby protests even louder Baby rests Baby experiences discomfort or a need Baby protests, usually by crying Mother does not responds to baby’s cry or else responds inconsistently Baby gives up. Trust does not develop. RAGE or APATHY develops instead… Baby plays with self or becomes apathetic
- 29. Insecure attachments Caregivers characteristics Ambivalent insensitive under involved inconsistent anxious uncertain Disorganised frightening frightened helpless abdicates responsibilityAvoidant rejecting hostile cold conditional intrusive controlling
- 30. Insecure attachments Childs Behavioural Characteristics Ambivalent hyperactivation of attachment coercive passive dependent NEED + ANGER Disorganised fear/compliance compulsive caregiving controlling aggressive RAGE + FEAR + SADNESS Avoidant defended emotions inhibited compliant self sufficient independent ANGER + FEAR
- 31. Parenting Excellent Brain Good Parenting Toxic Brain FASD BOB Booze Only Baby Good enough Deficient
- 32. Secure Attached Cycle “NORMAL” CHILD DEVELOPMENT Baby experiences discomfort or a need Baby protests, usually by crying Baby calms TRUST develops Baby plays and interacts with mother Baby rests Mother picks baby up, eye contact, talks to and soothes baby
- 33. The Infant Perspective SMELL TASTE HEAR SEE TOUCHEXTERNAL INTERNAL& FEEL
- 35. NEWSLOWEST Triune Brain (Maclean) 3 PARTS: EVOLVED RESPONDING TO EVOLUTIONARY NEED ASE (REPTILIAN BRAIN) HINDBRAIN B Brain Stem, physical survival, breathing, excretion, blood flow, temperature, other autonomic functions MOTIONAL LIMBIC SYSTEM E Hippocampus, amygdala, hypothalamus. HINKING NEOCORTEX T Cerebral cortex, forebrain FASTEST OLD Seat of emotions Seat of reason
- 36. What is Trauma? Psychological trauma is generally defined by two conditions. An individual experiences either: Overwhelming affect (experience of feeling or emotion) They are unable to integrate The feeling / belief that they might die or
- 37. Types of Trauma Post Traumatic Stress Disorder (PTSD) e.g. Shell shock Complex Trauma Developmental Trauma Disorder (DTD) Secondary Trauma i.e Witness / hear / live with ADULTS CHILDREN
- 38. AGE DEVELOPMENT The ‘Path’ of Trauma Complex & Single Issue Trauma Normal Single Event Complex (multiple) traumas
- 39. Parenting Excellent Brain Good Parenting Toxic Brain FASD NORM Nice ORdinary Mainstream Good enough Deficient complete well wired brain
- 40. 40 Smoke Detector IDENTIFYING DANGER Cook Three Brain System Watchtower
- 41. 41 THALMUS “relay station” AMYGDALA threat? HIPPOCAMPUS relates new input to past experiences ANTERIOR CINGUATE coordinates emotions & thinking HYPOTHALAMUS sends stress hormones to defend against threat MEDIAL PREFRONTAL CORTEX “LOW ROAD” “HIGH ROAD”COOK SMOKE DETECTOR WATCH TOWER YES NO 0.1sec faster internal body signals external source see, hear, feel, smell, taste YES NO Has danger passed? ? ? Oakwater’s diagram based on Bessel Van Der Kolk’s description in The Body Keeps The Score “Normal” amygdala/brain Functioning
- 42. Trauma Triggered Behaviour? Observed behaviour? Internal World? THEN NOW
- 43. Parenting Excellent Brain Good Parenting Toxic Brain FASD TIM Traumatised Infant Maltreated Good enough Deficient complete “miswired" trauma adapted brain
- 44. 44 Smoke Detector IDENTIFYING DANGER Cook Three Brain System Watchtower
- 45. 45 THALMUS “relay station” AMYGDALA threat? HIPPOCAMPUS relates new input to past experiences ANTERIOR CINGUATE coordinates emotions & thinking HYPOTHALAMUS sends stress hormones to defend against threat MEDIAL PREFRONTAL CORTEX “LOW ROAD” “HIGH ROAD”COOK SMOKE DETECTOR WATCH TOWER YES NO 0.1sec faster internal body signals external source see, hear, feel, smell, taste YES NO Has danger passed? ? ? Oakwater’s diagram based on Bessel Van Der Kolk’s description in The Body Keeps The Score “Normal” amygdala/brain Functioning
- 46. 46 THALMUS “relay station” AMYGDALA threat? HIPPOCAMPUS relates new input to past experiences ANTERIOR CINGUATE coordinates emotions & thinking HYPOTHALAMUS sends stress hormones to defend against threat MEDIAL PREFRONTAL CORTEX Cortisol Adrenaline “LOW ROAD” “HIGH ROAD”COOK SMOKE DETECTOR WATCH TOWER YES NO 0.1sec faster internal body signals external source see, hear, feel, smell, taste YESNO Has danger passed? ? ? Oakwater’s diagram based on Bessel Van Der Kolk’s description in The Body Keeps The Score “overreactive” amygdala in “traumatised” brain Possibility of “Looping” because amygdala is ‘oversensitive” due to excessive exposure to trauma. Creating “Faulty alarm system”. NO
- 47. Parenting Excellent Brain Good Parenting Toxic Brain FASD AAMY Alcohol Affected Maltreated Youngster Good enough Deficient “swiss cheese” “miswired" trauma adapted brain
- 48. 48 Self Regulation Impulse Control Learning Difficulties Memory etc FASD : ADHD : ODD : CD : XYZ Observed behaviour Overlapping Diagnoses Cant or Wont? Now or Later? Root Cause Symptom Trauma Triggered Behaviour?
- 49. 49 KNOWN / COMFORT ZONE ?? DANGEROUS TERRITORY? Learning boundary RISKY NEWUNKNO W N
- 50. 1. Regulate (you & them) 2. Relate 3. Reason Three step process “Dysregulated children in school will not learn”: Dr Bruce Perry Simple Consistent Open
- 51. What is Trauma? Psychological trauma is generally defined by two conditions. An individual experiences either: Overwhelming affect (experience of feeling or emotion) They are unable to integrate The feeling / belief that they might die or
- 52. Parenting Excellent Brain Good Parenting Toxic Brain FASD BOB Booze Only Baby Good enough Deficient “swiss cheese” brain + wiring determined by environment & parenting
- 53. Parenting Excellent Brain Good Parenting Toxic Brain FASD NORM Nice ORdinary Mainstream Good enough Deficient complete well wired brain
- 54. 54 Parenting styles required Therapeutic Reparenting Good Enough (Winnicot) Excellent Normal Parenting Poor Normal Parenting Aamy & Tim Bob Norm Norm Toxic Parenting
- 55. Why Therapeutic Reparenting What’s “normal”? What’s not? PARENTING: Good enough v Deficient CHILD DEVELOPMENT: Normal v Distorted (DEVELOPMENTAL PARENTING)
- 56. “Normal parents” “Good Enough is enough” They understand and witnessed their child's past “His-story” “Her-story” Permanently parenting another persons child Blank pages, missing data Unknown traumas, events, triggers Inaccurate / misleading story or lies General lack of understanding Therapeutic Reparenting “Normal” Parenting
- 57. Melt the trauma Recalibrate and calm the body Rewire the brain Truth telling so child’s story matches their sensory experiences and body memories Therapeutic Reparenting Therapeutic = Melting trauma
- 58. Therapeutic Reparenting Recognizing missed developmental experiences (broken and missing bricks) Provide them in age appropriate ways Parent the child you have, not the fantasy image Reparenting = Filling in the Gaps
- 59. “It takes a village to raise a child, a town to raise a challenging child and an entire city to raise a traumatised child.” Helen Oakwater What do traumatised children need?
- 60. Therapeutic Reparenting FASD Recognise, accept and parent the child you have not the fantasy image Grieve for your loss and shattered expectations Become a Leading Learner Extreme self care Futureproof: You and them
- 61. Therapeutic Reparenting Theraplay model Structure HIGH - repeat, visual, map it out Nurture HIGH - arousal level, window of tolerance Engagement HIGH - (exec functioning poor) Challenge LOW - low stress Futureproof: You and them
- 62. FLO W Boredom Anxiety CHALLENGE SKILL Flow: Mihaly Csikszentmihalyi “CREATIVITY: FLOW AND THE PSYCHOLOGY OF DISCOVERY AND INVENTION” (PRONOUNCED CHICK-SENT-ME HI)
- 63. 63 “Insanity is doing the same thing over and over again and expecting different results” “You can’t solve a problem with the same level of thinking that created it”
- 64. 64 • Knowledge • Attitude • Skills Competencies require: Einstein
- 66. NEWSLOWEST Triune Brain (Maclean) 3 PARTS: EVOLVED RESPONDING TO EVOLUTIONARY NEED ASE (REPTILIAN BRAIN) HINDBRAIN B Brain Stem, physical survival, breathing, excretion, blood flow, temperature, other autonomic functions MOTIONAL LIMBIC SYSTEM E Hippocampus, amygdala, hypothalamus. HINKING NEOCORTEX T Cerebral cortex, forebrain FASTEST OLD Seat of emotions Seat of reason
- 67. FREE RESOURCES - articles, links, podcasts, etc LEARNING PLATFORM & TOOLS ONLINE TRAINING - various audiences FUTURE-PROOFING - evidence & thinking REAL and honest EXPERTS in various fields (coaching, leadership, communication skills, trauma, etc) LEADING LEARNER principles FABParents.co.uk
- 68. How consequences of maltreatment and neglect overlap with FASD symptoms A workshop with Helen Oakwater 15 September 2016: EUFASD Conference “It’s not just the booze”