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

• 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 & fear2

Helen Oakwater: its personal@helenoakwater #EUFASD2016

Frame setting

What’s “normal”? What’s not?

PARENTING: Good enough v Deficient

CHILD DEVELOPMENT: Normal v Distorded

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)

Parenting Excellent

Brain Good

Parenting Toxic

Brain FASD

NORM Nice ORdinary Mainstream

TIM Traumatised Infant Maltreated

AAMY Alcohol Affected Maltreated Youngster

BOB Booze Only Baby

Good enough

Deficient

Parenting Excellent

Brain Good

Parenting Toxic

Brain FASD

NORM Nice ORdinary Mainstream

Good enough

Deficient

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

I am safeI am loved

I am cared forI 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

Parenting Excellent

Brain Good

Parenting Toxic

Brain FASD TIM

Traumatised Infant Maltreated

Good enough

Deficient

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

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

The Infant Perspective

SEE

Darkness

HEAR

Shouting & slamming

doors

TASTE

Milk & vomit

SMELL

Sour milk & excrement

TOUCH

Nappy rash

FEEL

Hungry & cold

The Infant PerspectiveONE PIECE OF METAPHORICAL “SENSORY SHRAPNEL”

One incident of NEGLECT

Stored in implicit memory & sensory database.

NEGLECT

multiple pieces of ‘blue shrapnel’

“The house was a bit messy”

“Our little secret”

Different Maltreatments

Assorted Shrapnel

Sensory Experience

NEGLECT

MALTREATMENT

ABUSE

Sensory Experience

Multiple maltreatment experiences

Stored in implicit memory & sensory database

“Myriad of sensory shrapnel”

Disturbed Attachment Cycle“DISTORTED” CHILD DEVELOPMENT

Baby protests even louder

Baby restsBaby 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

I am not safe

I’m scared

I am not cared for

I am unlovableI’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

Parenting Excellent

Brain Good

Parenting Toxic

Brain FASD AAMY

Alcohol Affected Maltreated Youngster

Good enough

Deficient

6 Stages of Alcohol Intoxication

EUPHORIA

EXCITEMENT

CONFUSION

STUPOR

COMA

DEATH

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

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.orgBAC 0.09 -0.25

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.orgBAC 0.18 -0.34

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

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

Death

DEATHperson dies due to cardiac arrest

From www.drug-rehabs.org

Blood Alcohol Concentration: (g per 100ml of blood) BAC 0.45+++

Disturbed Attachment Cycle“DISTORTED” CHILD DEVELOPMENT

Baby protests even louder

Baby restsBaby 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

Insecure attachments

Caregivers characteristics

Ambivalent insensitive

under involved inconsistent

anxious uncertain

Disorganised frightening frightened

helpless abdicates

responsibilityAvoidant rejecting

hostile cold

conditional intrusive

controlling

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

Parenting Excellent

Brain Good

Parenting Toxic

Brain FASD

BOB Booze Only Baby

Good enough

Deficient

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

The Infant Perspective

SMELL TASTE HEAR SEE

TOUCH EXTERNAL INTERNAL& FEEL

Parenting Excellent

Brain Good

Parenting Toxic

Brain FASD

NORM Nice ORdinary Mainstream

TIM Traumatised Infant Maltreated

AAMY Alcohol Affected Maltreated Youngster

BOB Booze Only Baby

Good enough

Deficient

NEWSLOWEST

Triune Brain (Maclean)3 PARTS: EVOLVED RESPONDING TO EVOLUTIONARY NEED

ASE (REPTILIAN BRAIN) HINDBRAINBBrain Stem, physical survival, breathing, excretion, blood flow, temperature, other autonomic functions

MOTIONAL LIMBIC SYSTEMEHippocampus, amygdala, hypothalamus.

HINKING NEOCORTEXTCerebral cortex, forebrain

FASTEST OLD

Seat of emotions

Seat of reason

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

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

AGE

DE

VE

LOP

ME

NT

The ‘Path’ of Trauma

Complex & Single Issue Trauma

Normal

Single Event

Complex (multiple) traumas

Parenting Excellent

Brain Good

Parenting Toxic

Brain FASD

NORM Nice ORdinary Mainstream

Good enough

Deficient

complete well wired

brain

40

Smoke Detector

IDENTIFYING DANGER

Cook

Three Brain System

Watchtower

41

THALMUS“relay station”

AMYGDALAthreat?

HIPPOCAMPUSrelates new input to past experiences

ANTERIOR CINGUATEcoordinates emotions & thinking

HYPOTHALAMUSsends stress hormonesto defend against threat

MEDIAL PREFRONTAL CORTEX

“LOW ROAD” “HIGH ROAD”COOK

SMOKE DETECTOR

WATCH TOWER

YES

NO

0.1secfaster

internal body signals external sourcesee, hear, feel, smell, taste

YES

NOHas

dangerpassed?

?

?

Oakwater’s diagram based on

Bessel Van Der Kolk’s description

in The Body Keeps The Score

“Normal”amygdala/brain

Functioning

Trauma Triggered Behaviour?Observed behaviour?

Internal World?

THEN NOW

Parenting Excellent

Brain Good

Parenting Toxic

Brain FASD TIM

Traumatised Infant Maltreated

Good enough

Deficient

complete “miswired" trauma

adapted brain

44

Smoke Detector

IDENTIFYING DANGER

Cook

Three Brain System

Watchtower

45

THALMUS“relay station”

AMYGDALAthreat?

HIPPOCAMPUSrelates new input to past experiences

ANTERIOR CINGUATEcoordinates emotions & thinking

HYPOTHALAMUSsends stress hormonesto defend against threat

MEDIAL PREFRONTAL CORTEX

“LOW ROAD” “HIGH ROAD”COOK

SMOKE DETECTOR

WATCH TOWER

YES

NO

0.1secfaster

internal body signals external sourcesee, hear, feel, smell, taste

YES

NOHas

dangerpassed?

?

?

Oakwater’s diagram based on

Bessel Van Der Kolk’s description

in The Body Keeps The Score

“Normal”amygdala/brain

Functioning

46

THALMUS“relay station”

AMYGDALAthreat?

HIPPOCAMPUSrelates new input to past experiences

ANTERIOR CINGUATEcoordinates emotions & thinking

HYPOTHALAMUSsends stress hormonesto defend against threat

MEDIAL PREFRONTAL CORTEX

CortisolAdrenaline

“LOW ROAD” “HIGH ROAD”COOK

SMOKE DETECTOR

WATCH TOWER

YES

NO

0.1secfaster

internal body signals external sourcesee, hear, feel, smell, taste

YESNOHas

dangerpassed?

?

?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

Parenting Excellent

Brain Good

Parenting Toxic

Brain FASD

AAMY Alcohol Affected Maltreated Youngster

Good enough

Deficient

“swiss cheese” “miswired" trauma

adapted brain

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

KNOWN /COMFORT

ZONE

?? DANGEROUS TERRITORY?

Learning

boundary

RISKY

NEWUNKNOWN

1. Regulate (you & them)

2. Relate

3. Reason

Three step process

“Dysregulated children in school will not learn”: Dr Bruce Perry

Simple Consistent

Open

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

Parenting Excellent

Brain Good

Parenting Toxic

Brain FASD

BOB Booze Only Baby

Good enough

Deficient

“swiss cheese” brain + wiring determined by

environment & parenting

Parenting Excellent

Brain Good

Parenting Toxic

Brain FASD

NORM Nice ORdinary Mainstream

Good enough

Deficient

complete well wired

brain

54

Parenting styles required

Therapeutic Reparenting

Good Enough (Winnicot)

Excellent Normal Parenting

Poor Normal Parenting

Aamy & Tim

Bob

Norm

Norm

Toxic Parenting

Why Therapeutic Reparenting

What’s “normal”? What’s not?

PARENTING: Good enough v Deficient

CHILD DEVELOPMENT: Normal v Distorted

(DEVELOPMENTAL PARENTING)

“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

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

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

“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?

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

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

FLOW

Boredom

Anxiety

CHALLENGE

SKIL

L

Flow: Mihaly Csikszentmihalyi

“CREATIVITY: FLOW AND THE PSYCHOLOGY OF DISCOVERY AND INVENTION”

(PRONOUNCED CHICK-SENT-ME HI)

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

• Knowledge • Attitude • Skills

Competencies require:

Einstein

Adult Child

FABParents Approach

NEWSLOWEST

Triune Brain (Maclean)3 PARTS: EVOLVED RESPONDING TO EVOLUTIONARY NEED

ASE (REPTILIAN BRAIN) HINDBRAINBBrain Stem, physical survival, breathing, excretion, blood flow, temperature, other autonomic functions

MOTIONAL LIMBIC SYSTEMEHippocampus, amygdala, hypothalamus.

HINKING NEOCORTEXTCerebral cortex, forebrain

FASTEST OLD

Seat of emotions

Seat of reason

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

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”