Family Futures have developed a Multi-Treatment Approach to helping children with attachment difficulties and their parents.

UNLOCKING THE PAST

OUR APPROACH

This is based on the following principles:

• That a new family is the most important resource a child has, and all therapeutic work should seek to build and strengthen the family relationships
• The traumatic effects of a child's early experiences remain unexplored and inaccessible to them.  As a consequence, they defend themselves against painful feelings and act out experiences that they are unable to understand or verbalise
• That change is possible if parents and children are helped to work together to understand their pasts and form positive attachments in the present
• The role of the therapeutic team is to facilitate this process and provide on-going support.
• Therapeutic help for families who foster or adopt children with attachment problems needs to be intensive and long term.

THE AIM OF THE PROGRAMME

• To address directly and change the child's attachment patterns
• To incorporate a holistic approach which integrates all treatment approaches: psychological, psychiatric, neurobiological, educational, dietary and paediatric
• To increase parents' confidence and parental skills
• To incorporate the extended family and professional support in maintaining positive changes
• To provide ongoing support to the family, as appropriate

THE KEY AREAS COVERED BY THE PROGRAMME

Overall, the Attachment Programme is designed to address the complexity of contemporary placements. In order to do this, the programme has eight essential elements which are dealt with simultaneously, these are:

• The child's early history and patterns of attachment
• The parents' relationship as a couple and their expectations of themselves and of each other as parents.  For single parents and carers: the impact of current or previous relationships.
• Contact with birth relatives and siblings
• The current behaviour difficulties displayed by the child at home and/or at school
• The parenting strategies used by the parents to deal with the above difficulties
• Patterns of interaction and communication as a family.
• The neuro-physiological, medical-psychological and educational impact of early trauma, which are dealt with holistically
• The management of the wider family-support network, including the extended family members, schools, social services and significant others.

In our experience, in order to achieve any significant change in children and families coping with the complex issues encompassed by adoptive or foster family life, the complexity has to be acknowledged and all eight elements need to be addressed. This may require a concerted and intensive period of intervention, involving family members, for up to five days. With this approach, it is possible to achieve a sufficient momentum for change to reverse the negative spiral in which many families in crisis find themselves. Ideally, families should participate in the programme during the first year of a permanent placement. However we can also work with children in short-term placements, to prepare them for a new family and also with families who have been formed many years prior to referral.

The follow-up programme is designed to maintain and build upon the positives gained during the intensive week.  Our standard follow-up is a   tailor-made programme of at least two years' duration which will include Theraplay, sensory integration therapy, nutritional programmes, intensive parent mentoring and school based interventions, alongside therapeutic family based work.

Family Futures do not use therapist holding of children or other intrusive forms of therapy.

SENSORY INTEGRATION AND OCCUPATIONAL THERAPY

What is sensory integration?
“Sensory experiences include touch, movement, body position, vision, smell, taste, sound and the pull of gravity. The process of the brain organising and interpreting this information is called sensory integration. Sensory integration provides a crucial foundation for later, more complex learning and behaviour”.
(Sensory Integration Network UK and Ireland, 2003).

Jean Ayres, the founder of the sensory integration approach described sensory integration as the ‘organisation of sensation for use’ (Ayres, 1979).

Some children are over-responsive to sensation and so feel as if they are being constantly bombarded with sensory information. They may try to eliminate or minimize this perceived sensory overload by avoiding being touched or being very particular about clothing. Some children are under-responsive and have an almost insatiable desire for sensory stimulation. They may seek out constant stimulation by taking part in extreme activities, playing music very loudly, or moving constantly. They sometimes don’t notice pain or objects that are too hot or cold, and may need high intensity input in order to become involved in activities. Still others have trouble distinguishing between different types of sensory stimulation.

The five senses of sight, touch, taste, hearing and smell are those which respond to information from outside our bodies.  Two further important sensory systems are the vestibular sense and the proprioceptive sense.

The vestibular sense processes and interprets information about balance, gravity and movement sensations.  It receives information from the inner ear about the position of our head and body in space.  Movement and gravity stimulate receptors to register every movement we make.

Some children will display over sensitivity to vestibular information displayed by excited, emotional or negative reactions to movement sensation.  A child who is over sensitive to movement may be intolerant of movement and may have a fear of falling.

Some children will display an under sensitivity to movement and may seek out activities that stimulate their vestibular sense as they have a higher tolerance for movement, they may be observed to seek out jumping, running, spinning and rocking.

The proprioceptive sense processes and interprets information about the body’s position in space and body parts in relation to others.  Proprioception is stimulation to the sensory receptors inside the joints and muscles.  It provides information about our body position or movement.  Proprioception contributes to body scheme and awareness, muscle tone, motor planning and co-ordination.  Proprioception is closely linked with the tactile and vestibular systems. 

Children with poor proprioception have difficulty interpreting body position and movement sensations.  The child may have poor body awareness, motor control, manipulation skills and are often seen as being ‘clumsy’.

“Children who have been adopted or fostered are likely to present with a combination of sensory processing and attachment difficulties because of a history of separation, loss, abuse, and neglect. Their capacity to tolerate sensory stimulation from the environment and others is affected. Intolerance of everyday events may be because there is an association with early loss and trauma, or because they find the actual sensory experience unpleasant”.  (Bhreathnach, 2005)

Children may therefore present with sensory integration difficulties when the brain is not able to organise sensory information for use.  Information received may not be accurate and there may be difficulty in combining the information from the other senses.  As a result a child may have difficulty with motor skills, learning, emotional responses and behaviour.

What is paediatric occupational therapy?
Paediatric occupational therapists are interested in how a child is functioning in all aspects of daily life including at home, school and play/leisure.  The impact of sensory integration difficulties is key to discovering how to best help the child who is struggling in daily activities.

Paediatric occupational therapists also work with teachers and learning support assistants in schools to give advice in a consultancy role.

Paediatric occupational therapists who use a sensory integration approach when working with children have had further specialised training, incorporating research from neuropsychology, neurology, physiology, child development and psychology along with training in specific therapeutic techniques.

What will happen at a paediatric occupational therapy assessment and treatment program?
A paediatric occupational therapy assessment involves the child attending a session at Family Futures with usually a parent present for most of the session – the session is usually a half day in duration. The assessment may be spread over more than one session depending on the child’s needs.  A school visit, discussion with school or discussion with Family Future’s specialist teacher may be part of the assessment too, depending on the concerns raised.

During the assessment, the child will be asked to do a range of activities that include gross motor skill tasks that look at balance and ball skills.  Fine motor tasks will be looked at including drawing and writing.  Visual perceptual testing which looks at how well a child is interpreting visual information (relevant to all aspects of school work and daily life) may be included depending on the concerns raised from home and school.

The child will also have the opportunity to try out some of the play equipment.  Most children really enjoy the assessment session and have fun for at least part of the session!  There is also opportunity to talk to the parents prior to the assessment about their concerns.  During the session, children are asked about any particular tasks that they are finding difficult, many children mention things such as skipping, handwriting and concentrating.

Treatment may take various forms including direct individual sessions where a child comes to a clinic room which is specially set up with particular equipment, that allows the therapist to present specific sensory and movement challenges to the child which gradually increases in difficulty. It is characterised by a playful atmosphere where the child is encouraged to generate ideas for activities, it is a safe space for them to develop skill in motor tasks and as a result is confidence building.  This sensory integration treatment programme will be integrated into Family Future’s full treatment programme.

The key focus of sensory integration is to treat the underlying problems rather than specific skills training, however it is recognised that at times there are specific functional tasks that a child is struggling with and it may be more useful to address them in conjunction with a sensory integration approach.

Parents are also integral to sessions, as the therapists’ role is to problem solve and model ideas for replicating the sensory work at home. Part of the focus may be on the parent/carer child engagement and would be facililtated by the therapist through the provision of therapeutic spaces within the treatment room environment. Advice would be provided to parents about how they could replicate this at home.

Sensory Integration UK (2003) list some of the common signs of difficulties with sensory integration and processing to include:

• Physical clumsiness
• Difficulty learning new movements
• Activity level unusually high or low
• Poor body awareness
• Inappropriate response to touch, movements, sights or sounds
• Poor self esteem
• Social and/or emotional difficulties

Other signs also seen include:

• Distractibility, impulsivity, limited attention control.
• Delays in speech, language and/or motor skills.
• Specific learning difficulties and/or perceptual difficulties
• Poor self care skills.

References:
Bhreathnach, E (2007).  Sensory Attachment Intervention Course Level One.

Sensory Integration Network United Kingdom and Ireland (2003). www.sensoryintegration.org.uk

THE IMPORTANCE OF OPTIMUM NUTRITION FOR TRAUMATISED CHILDREN

Good Nutrition is the cornerstone of good health, for adults and children alike. However, for the adopted child who has experienced early trauma nutrition is even more important, crucial even. In an ideal world the biological mother is well-nourished, free from toxins from drugs (pharmaceutical and recreational) and pollutants and experiences minimal stress. This sets the scene for a healthy pregnancy where the foetus can grow and develop in optimal circumstances. After birth, nourishment from breast-feeding, unconditional love, care and protection provide the best environment for the child’s early experience and development.

Unfortunately, for the children seen at Family Futures, this is rarely the case. Whilst a low intake of essential nutrients can prevent optimal functioning and development, trauma has real physiological effects on the body, affecting brain development and causing disruption to the body’s equilibrium which further depletes the vitamins, minerals and other essential nutrients that may already be in short supply.

Trauma Before Birth – the Effect on the Foetus
The child’s experience of trauma can begin even before birth. Anything that creates a stress on the body can be considered trauma, as it will upset the body’s finely tuned balance and generate a response to counteract this. Whilst we are designed to adapt to a degree of stress, repeated traumatic experiences can create a perpetual state of imbalance in the body and depleted vitamin and mineral levels.

It was once thought that the placenta provided protection for the foetus from toxins, however, the thalidomide disaster has shown how untrue this is. (Holford P, Lawson, S 2004). Alcohol consumption during pregnancy can result in Foetal Alcohol Syndrome with noticeable facial abnormalities, as well as chromosomal damage that may be a factor in physical and mental retardation. Mothers who continue to take drugs such as cocaine and heroin whilst pregnant give birth to addicted babies who have to endure the stress of withdrawal. Cannabis smoking can have behavioural effects on the unborn child, whilst cigarette smoking has been shown to result in low birth weight, poor learning abilities and behavioural problems.

In addition to what a mother may be ingesting during pregnancy (or not ingesting in the case of a poor diet due to lack of education or poor socio-economic circumstances), she may be experiencing severe stress or trauma herself. A large part of the stress response is governed by the adrenal glands, which regulate hormone secretion to allow the body to respond appropriately to stress. Repeated stress or trauma, can cause the function of these glands to become sub-optimal. During pregnancy, the adrenal glands of the child, which are at adult size at time of birth, may take over from the mother’s if she cannot respond properly.  This results in the birth of a child whose ability to cope with trauma is already diminished.

Early Development and Trauma – the Growing brain
When a child is born, his brain is not yet fully developed and early experience affects how the brain matures. The brain of the traumatized child will develop differently to a child who does not experience early trauma. This development cannot be undone or “re-programmed” (Cairns, 2002) therefore the way the child processes his external environment later on in life is in the context of a brain that has developed in response to trauma. Brain development is dependent on use, therefore the parts that get used in response to trauma develop whilst those that should develop in response to love and attachment may fail to mature.(Perry, 1995)

The brain develops in four stages which begin prior to birth until the age of about six.  Whilst some brain development in the traumatised child may already be “hard-wired” optimum nutrition is essential to maximise the continued development of the brain and brain chemicals.

As well as affecting brain formation, trauma also affects the adrenal glands as already mentioned. A traumatized child is likely to have poor adrenal function and an imbalance of stress hormones, which as well as affecting mood and behaviour can affect the immune and cardiovascular systems. Poor adrenal status is often related to imbalances between calcium and magnesium, sodium and potassium and low B vitamin status as these nutrients are crucial in our stress response and adrenal health.

It is important to remember that the nutrients that are most essential to provide resilience to trauma such as calcium, magnesium, B vitamins and vitamin C also have a host of other functions in the body. Trauma will place extra demands on the body in terms of a stress response which means that these nutrients are quickly used up or cannot be utilised properly and this can create other health problems. For example, when adrenal function is impaired, calcium may be dumped into body tissues such as hair meaning it cannot be utilised for bone formation, which is crucial to the growing child.

The body is a complicated, integrated system within which nutrients act synergistically with one another as co-factors to many thousands of reactions to promote optimum function, harmony and good health, both mental and physical.

Following is the link to the British Association of Nutritional Therapists: -
http://www.bant.org.uk/bant/jsp/index.faces

ARTICLE
Working with the Elephant in the Room
By Alan Burnell & Jay Vaughan