connection or correction!!

Andrea MurraySpeech Pathologist Infant Mental Health Clinician

CYMHS, Children’s Health Queensland Hospital and Health Service

Andrea Murray26/7/19

Connection or Correction!!“Use your words!!!”

Who am I?• Acting Director Speech

Pathology, CYMHS, CHQ

• Mental Health Clinician

• Infant Mental Clinician

“Hold in your heart the knowledge that this is a special place! Walk quietly, tread lightly, stay on the track”

Language Competence occupies a unique place in the lives of

children, as it is of interest as both a predictor variable and an

outcome variable.(Pam Snow, 2008)

“Learning to use expressive communication helps clear a path to a life full of mutually satisfying

relationships and paves the way for greater personal and professional opportunities in

adulthood. These are the stakes when it come to talking about communication skills”

Boys of Few Words –

Raising Our Sons to Communicate

and Connect

Adam Cox (2006)

Communication – Why is it important?

Speech Pathology Australia……

“Language is an essential tool for communication.

It is fundamental to sociability, the internalisation of social

codes, thinking and problem solving, feeling, self

regulation of behaviour and learning and academic

success. It is through language that the child learns to

express emotions and feelings, develop self image and is

able to influence the behaviour of others.”

• Communication

• What it is & why it’s important

• Communication, Relationships and Social and Emotional

Wellbeing

• Key principles

• Communication Breakdown

• Styles of Communication – child and adult

• Impact of Temperament

• Communication and Emotional Regulation

• Development of Emotional Competence

• Supporting regulation using a communication framework

Today we are going to

talk about..

So... what happened to Nathan?

• 18y old male

• CYMHS client

• Conduct Disorder

• Depression

• Substance Abuse

• Significant UNDIAGNOSED Communication Disorder

• In range for speech and language impairment

Functional Impact → Difficulty with: › Conversational language› Integrating and processing

information› Critical thinking and problem

solving skill› Self regulation› Poor emotional literacy› Social difficulties› Difficulty with abstract language

eg sarcasm, inference, ambiguity

Language Competence in early childhood predicts:-

• Social skills / Establishment of friendships →

protective factor

• Pro-social problem solving / conflict resolution skills →

protective factor

• Transition to literacy → academic success →

<self esteem & school attachment → protective factors

• Mastery of an increasingly complex range of written and spoken

discourse genres

→ access to post secondary training

→ < employment opportunities

→ protective factors

(Pam Snow Reflecting Connections Conference,Auckland May 2008)))

Possible outcomes:

• Unemployment

• Ongoing substance abuse problems

• Ongoing mental health problems

• Relationship Difficulties

• Domestic Violence

• Involvement with the law – possibly incarceration

• Health Issues

• Trans generational issues -Nathan as father??

Looking backwards to Nathans past.Where did it all begin?

•Prenatally?

• Infant?

•Toddler?

•Preschool?

•Primary school?

•Adolescence?

Looking backwards Language competence in adolescence reflects

• A range of early protective factors (Eg: Secure attachment, child-focussed parenting)

• Adequate exposure to and experience with a variety of linguistic forms and opportunities

• Exposure to prosocial role models

• Consistent and developmentally appropriate educational input

• Access to specialist services and interventions along the way if needed(Pam Snow Reflecting Connections Conference, Auckland May 2008)

Why wasn’t Nathans communication disorder identified earlier??

▪ Parents & carers identify speech difficulties most easily

BUT…Language impairments are harder to identify

AND… Language comprehension difficulties are often not identified by

parents and teachers.

▪ “Symptoms may be related to producing and understanding language but

appear to adults as non-compliance, inattentiveness or social withdrawal”

(Howlin&Rutter, 1987)

Communication and Attachment:What is Attachment ?

• Attachment is “an affectionate bond between two individuals that endures through time and space and serves to join them emotionally”

(Klaus and Kennell, 1976)

• This ‘bond’ that joins ‘them emotionally’ is at a primal level ie, long before verbal and reasoning capacities mature.

• As humans we have an instinct to form “secure” attachments

• “Attachment”, means “wanting to be near”

• Infants can only survive by maintaining proximity to a caring adult.

• There is a biological predisposition in infancy to maintain proximity to

parents/caregivers which exists across many species (Hofer,1994)

• Attachment is something that children and parents (adults) create together

in an ongoing reciprocal relationship (Levy & Orians, 1998)

What is Attachment ?

– its all about relationship!

• Care Seeking (Attachment)

Instinct to seek proximity to a specific person who will comfort

protect and/or organize one’s feelings.

• Care Giving (Bonding)Instinct to monitor a specific person - to

comfort, protect, and/or organize

that person’s feelings when necessary.

• ExplorationInstinct to follow one’s innate curiosity and desire for mastery, when it

feels safe to do so.

▪ The more safe an infant/child feels, the less the fear system is

activated.

▪ The safer you feel the free-er your exploration will be.

▪ When attachment system is activated, you stop wanting to

explore.

▪ Secure attachment is thus a precondition of an infants ability to

explore his environment and become autonomous.

Exploration

© 2000 Cooper, Hoffman, Marvin & Powell

CIRCLE OF SECURITY PARENT ATTENDING TO THE CHILD’S NEEDS

I need

you to

Support My

Exploration

• Protect me

• Comfort me

• Delight in me

• Organize my feelings

Welcome My

Coming To You

I need

you to

• Watch over me

• Help me

• Delight in me

• Enjoy with me

Always: be BIGGER, STRONGER, WISER, and

KIND.

Whenever possible: follow my child’s need.

Whenever necessary: take charge.

Circle of Security map…

Helps parents, carers and educators to:-

➢ Understand the child better

➢Recognise and follow children’s needs

➢Know how to be more emotionally available to them

➢Create secure opportunities for children to learn, grow and develop.

Role of Adult/Child communication in facililtating childs sense of safety and security: Requires…• Caregivers (parents/educators) sensitivity and responsiveness to needs

• Positive adult/child interaction

• Facilitation of a nurturing, caring and trusting environment

✓Moderate stimulation

✓Prompt response to distress

✓Non-intrusiveness

✓Warmth, involvement and responsiveness

✓Congruent and contingent communication

✓ Interactional synchrony – attunement

✓Positive affect (Including eye contact and smiles)

✓Verbal and non-verbal communication including gentle, nurturing touch

What is communication?

➢ 2 Active participants

➢ Reciprocal

➢ Turn-taking

Interaction InformationCommunication

Formula for Communication



I need

you to

Support My

Exploration

• Protect me

• Comfort me

• Delight in me


Welcome My

Coming To You

I need

you to

• Watch over me

• Help me

• Delight in me

• Enjoy with me


KIND.



Why is Attachment Important?Attachment has physiological, emotional,

cognitive and social implications.

“Early development entails the gradual transition from dependence on others to manage the world for us to acquiring the competencies needed to manage the world for oneself”

(Shonkoff & Phillips, 2000)

The initial bond and nature of the attachment relationship provides a mechanism to cope with the outside world.

• Provides safety and protection

→ ”To the degree that we feel connected to others, we feel safe and secure

To the degree that we do not feel connected to others, we feel less safe, and increasingly insecure

(Hoffman 2003)

• Allows exploration of the environment

→ which leads to healthy cognitive and social development

Why is Attachment Important?It provides a mechanism to cope with the outside world!

Why is Attachment Important? It provides a mechanism to cope with the outside world!

• Develops basic trust and reciprocity

➢ Child with a Secure Attachment has a predictive capacity (inner certainty) that primary caregiver (later on others) will be available both physically and emotionally at the required times.

➢ Child with an insecure ie Disrupted Attachment, does not have this inner certainty and life therefore involves considerable anxiety, mistrust and stress.

➢ → serves as a template for all future emotional relationships –“Internal Working Models”

Increasing the social connections in our lives is probably the single easiest way to enhance our wellbeing

( Mathew Lieberman; Social: Why our brains are wired to connect)

Why is Attachment Important?

It provides a mechanism to cope with the outside world!

It impacts on infant brain development.

• Relationship interactions, creates connections between the brain cells .

• Experience shapes brain development - connections between neurones develop as the

result of stimulation – “Practise makes permanent”

• Development results from genetic endowment (nature’s potential) and the experiences the

infant brain encounters (nurture) “Nature NEEDS Nurture” (Dan Siegel)

• Brain develops in relationship and impacts on all areas of the child's development incl:

Speech and language development; Motor development; Development of self regulation; Social and

Emotional development

“Babies are like the raw material for a self. Each one comes with a genetic blueprint and a range of possibilities.

There is a body programmed to develop in certain ways but by no means on automatic programme

– the baby is an interactive project, not a self- powered one!

The baby human organism has various systems ready to go, but many more that are incomplete and will only develop in response to other human input.

There is a sense that the baby is incomplete and needs to be programmed by adult humans.”

(Sue Gerhardt – Why love matters, 2004)

The “unfinished baby”

30

31

The experiences a young child has with adults forges connections between cells in the higher brain (Shonkoff & Phillips, 2000; Sunderland, 2006)

• Facilitates development of emotional competence

(Emotional literacy and capacity to self regulate)

1. Emotional literacyThe ability to identify and label emotions in self and others (Murray 2019)→ “..What human beings learn in their first interactions with

other human beings, (in the mother-infant relationship) is central to the formation of self concept…,of the capacity for empathy, the ability to read the states of the mind of other human beings…” Alan Schore

Why is Attachment Important?It impacts on infant brain development →


2. Develops the ability to self-regulate

• Self-regulation is “a child’s ability to gain control of bodily functions, manage emotions and maintain focus and attention” (Shonkoff & Phillips, 2000)

• Babies cannot control their bodily arousal→ at birth are sometimes referred to as an “external foetus” (Sunderland, 2006)

• Young children rely on caregivers to support them to understand, experience and manage their own feelings – organising their feelings

(Shonkoff & Phillips, 2000).

• “ From a biological perspective, the childs neuronal system – the structure and functioning of the developing brain is shaped by the parents more mature brain.” (Siegel,1999)

Developing the ability to self-regulate

➢Adult does, Child watches - (External regulation)

➢Adult and Child do together - (Co regulation - “Being With”)

➢Child does Adult watches - (Supported regulation - “Being With”)

➢Child does independently - (Self regulation)


Children’s Emotional Development and the Ability to Self Regulate

“ALL behaviour has purpose and means something - EVEN misbehaviour! I need you to help me with my feelings.

My behaviour may mean that I can’t manage strong emotions by myself yet.”

Stages of Development

Child does it ALONE

STAGE

4 (Self Regulation)

Child DOES ; Parent WATCHES STAGE

3

(Supported Regulation)

Parent and Child do it TOGETHER

STAGE

2

(Co-Regulation)

Parent DOES ; Child WATCHES STAGE

1

(External Regulation)

Newborn

A

G

E

A

l

l

t

o

o

h

a

r

d

Briefly discuss the Implications for practice of current research ie:

1. We are relational beings and develop optimally within relationship.

2. To the degree that we feel connected to others, we feel safe and

secure. To the degree that we do not feel connected to others, we

feel less safe, and increasingly insecure (Hoffman 2003)

3. When we feel safe and secure we can grow, learn and develop.

Pit Stop!!!

What can be done? - Build Resilience

• Resilience is not a static trait but develops over time.

• Children are not born resilient, children are born malleable -“capable of

being shaped or formed”(Perry 2000)

• Resilience is most often looked at from a developmental perspective and

seeks to identify variables most likely to produce positive outcomes (e.g.,

healthy development and adjustment)(Bonanno, 2004)

• Resilience can be enhanced (Rutter,1993)

• There are multiple paths to resilience (Condly,2006)

Build Resilience - What can be done? “Successful interventions are those that incorporate a multi-system

approach, are theory driven, and are in place for an extended period of time.”

Factors:

1. Positive and nurturing relationships with parents and other adults.

2. The ability to regulate emotions

3. Cognitive skills.

4. Self- esteem. (Sameroff , 2006)

Environmental

influences

Child

Characteristics

Educator

Characteristics

•Birth and medical history•Temperament•Developmental issues/needs•Childs feedback and responsiveness•Health•ACE back-ground•Appearance

•Age•Own history•Attitudes and beliefs•“Parenting” style•Skills/resources•Capacity – Cognitive; Emotional; Reflective•Health – Physical; Mental health

•Resources•Ethos of centre•Supports•Community•Socio-economic demographic

Things to consider -

Influencing Factors

Educator/child relationship

1. Positive adult/child interaction/communication

“It’s not about you (or what you do),

it’s all about me!” – “He/she becomes we!”

Sensitivity,

Attunement,

Reflection,

Responsiveness,

Resonance

Build Resilience – How?

Communication/Relationship Breakdown- What can get in the way?

• Lack of skills

• Style of communication

• Temperament and “Goodness of fit”

• Arousal levels (Yerkes Dodds Law/Windows of tolerance)

• Dysregulation

Common stances (Dan Hughes)• “ He could do it if he wanted to!”

• “He has to respect authority”

• “He is just manipulating”

• “He is just doing it for attention”

• “That’s an excuse he needs to get over it!”

• “Reinforcers don’t work”

• “Praise doesn’t work”

“Empathic Shift”

• The child's motivation is reorganized around

• positively motivated needs

• versus

• negative attributions.

“The more difficult or aberrant a childs behaviour, the greater

their cry for help”

(W. McCaskill)

“ The child’s(young person’s, parents, teachers…) behaviour is random,”

to

“All behaviour has meaning and purpose –even misbehaviour”

→ Shift focus of intervention to respond to

emotional needs and building skills rather

than only focusing on addressing behaviours.

Styles of Communicators :- Child "Adapted from It Takes Two to Talk (Manolson, 1992)

Own agenda: Seldom responds, Social: Usually responds

Often initiates. Often initiates.

Passive: Seldom responds Shy: Usually responds,

Seldom initiates Seldom initiates

Often initiates

Seldom initiates

Usually

responds

Seldom

responds

The impact of temperament

Dandelion

• Robust

• Easily adaptable

• Not easily affected by

environmental changes

• Independent

• Thrives and flourishes with-

out much attention – self

sufficient

Orchid

• Sensitive

• Takes time to adapt (“slow

to warm”)

• Does not like change in

environment

• Dependent

• Needs lots of nurturing to

thrive and flourish

Daisy

• Reasonably resilient

• Reasonably

adaptable

• Reasonably

adaptable to

changes in

environment

• Neither independent

not dependent

• Needs some

nurturing to thrive

and flourish

2. Support Emotional Development and capacity to Self Regulate

– How?

Think Inside out instead of outside in!!

“ The child’s behaviour is random” ,to…..

“A child’s behaviour always has meaning and purpose”

• Young childrens emotional repertoire is socially constructed -

they rely on caregivers to support them to understand, experience and manage their feelings

– organising their feelings (Shonkoff & Phillips, 2000).

• Need to shift focus to respond to child's emotional needs rather than focusing on addressing

behaviours.

Resource:Calmer Classrooms(Child Safety Commission Victoria, 2007)

• Understand the child.

• Manage own emotions/reactions.

• “I see you need help with”

• Provide structure and consistency.

• Set limits on unacceptable behaviour.

• Structure choices to remain in control.

• Consequences not punishment.

• Acknowledge good decisions.

Emotional Regulation

CRASH (Murray,2010)

Cajole

Reason

Argue

Shout/Scream

Humiliate

Emotional Regulation

SUPPORT (Murray 2011)

Stay calm

Understand what child is telling you

Put words to feelings and behaviours

Praise desirable behaviours always

Offer support and structure

Repeat the script next time – be consistant!!

Terminate – use Touch



I need

you to

Support My

Exploration

• Protect me

• Comfort me

• Delight in me


Welcome My

Coming To You

I need

you to

• Watch over me

• Help me

• Delight in me

• Enjoy with me


KIND.



Briefly discuss how your perspective and management strategy might

now be different when children are having “meltdowns” or

exhibiting challenging behaviors:

Pit Stop!!!

3. Reduce levels of stress and distress

“When a flower doesn’t bloom, you fix the environment in which it grows, not the flower”

Alex Den Heijer

Yerkes–Dodson law

Performance increases with physiological or mental arousal, but only up to a point.

When levels of arousal become too high, performance decreases.

Windows of Tolerance (Bruce Perry)

Learning has to start from the “bottom up” – or from the “inside out”.

• It begins with “safety” & dampening down the fear system

• “The removal of threat is not the same thing as the experience of

safety” – (Dr S Porges 2016)

• “Foster experiences by creating environments that are dense with the

feelings of safety” (Bonnie Badenock; Stephen Porges)

• “Self- Reg Haven” (Stuart Shanker)

https://self-reg.ca/2016/03/10/the-self-reg-view-of-resilience-2/

https://self-reg.ca/2016/03/10/the-self-reg-view-of-resilience-2/

61

How?

❑The child must feel safe. This will help the child stay regulated.

❑Higher parts of the thinking brain can then be accessed and learning can occur.

❑When children feel “connected” to adults, co-regulation of internal states can occur.

❑Use calming strategies and provide soothing to override the limbic brain.

❑Predictability enhances security (Routines, scripts, visual calendars)

62


Use scripts

Target Speech and Language Development

• “ Improving individual competence is an important strategy where social circumstance cannot be altered” (Sameroff, 2005)

• Oral Language competence in childhood and adolescence – the missing link in mental health promotion! (Pam Snow, 2008)

• Language Competence occupies a unique place in the lives of children, as it is of interest as both a

• predictor variable and an outcome variable

(Pam Snow, 2008)


4.Target Brain development including Cognitive Development

and Speech and Language Development

Positive Communication/adult/child interactionsRemember the ABC’s (Hanen, 2000)

• Active Participation

→ Eye contact? Face to face?

→Active Listening?

→Affect?

→ Body Language/Facial Expression?

→Words?

→Congruence between verbal and non verbal

• Balanced Turn-taking →Dominating? Passive?

• Common Focus → Follows child/YPs lead/need?

• Affective quality of interactions (Interest/disinterest? Warmth? Impatience? Hostility? Intrusiveness?)

• Relationship qualities – Attunement? Sensitivity? Rhythmicity? Capacity to Repair?

• Have developmentally appropriate expectations

• Do more by doing less!!

“I am here because you are worth it……” “You are here because I am worth it…..”

• Look for the positives

• Use descriptive praise

Build Resilience – How? 5. Intentionally enhance self-esteem

65

[email protected]

“The earliest years of infancy and childhood are

not lost,

but like a childs footprints in wet cement,

are lifelong!”

ACE Study

"One looks back with appreciation to brilliant teachers, but with gratitude to those

who touched our human feelings.

The curriculum is so much necessary raw material,

but warmth is the vital element for the growing plant

and for the soul of the child."Carl Jung

mailto:[email protected]

connection or correction!!

Documents