Matching emotional intensity

"I found it interesting reading that when a child is worked up in therapy, the therapist matches their emotional level and then helps them calm down. Can you give me an example of this, say, with Kitty, even if this may or may not be a regular part of her therapy? Would it be something like her, say, coming in and going on a rant about all the things she hates, how mean people are, etc, and yelling and screaming her comments at the therapist, and the therapist yelling and screaming things back? Can you elaborate a little?" - Anonymous

Despite how it sounds, "matching emotional level" does not mean the therapist yelling and screaming back at a dysregulated child who is yelling and screaming. I'll include the info from Dan Hughes at the bottom of this post, but I find his descriptions aimed toward mental health professionals (vs therapeutic parents), so very dry and high-level/complex. 

Kitty's therapist follows Dan Hughe's philosophy and matches Kitty's emotional level in pretty much every session.  When she comes into a session, Kitty usually jumps into fight/ flight/ freeze mode pretty quickly.  She gets agitated and starts venting and yelling.

The therapist stays focused on Kitty and matches Kitty's intensity, but not her anger. Meaning if Kitty is tired and depressed then the therapist tends to be more "laid-back" and soft-spoken as she draws Kitty out. If Kitty is agitated and upset, then the therapist's focus is more intense and engaged. 

The therapist is always calm and regulated (and helps Hubby or me if we get upset - which is easy to do when you're being screamed at by your child who is completely irrational). She never makes the mistake we make  --we try to explain things rationally or ask Kitty to understand reality when Kitty is dysregulated and in the "survival" part of her brain and unable to access the "thinking" part of her brain.

The therapist is empathetic and non-judgmental as she asks Kitty questions about what she's feeling. The therapist displays curiosity and asks questions about what Kitty says. As Kitty explains her feelings to the therapist, Kitty learns to identify them for herself. 

The therapist never says things like "You had every right to be angry.  She was mean to you." or "You need to calm down.  You shouldn't be mad, because she didn't mean to do that."  The therapist doesn't agree or disagree, instead she restates Kitty's thoughts and often helps her identify her feelings for her.   "You sound really angry at your sister.  She really hurt your feelings." 

The therapist will also try to verbally get Kitty to self-regulate.  The therapist doesn't tell Kitty to calm down (that would just trigger Kitty's need to be defiant).  Instead, she will ask Kitty to notice how the emotion feels in her body. Honestly, this also triggers Kitty, but I think it does help Kitty notice the feeling.  

By staying calm and regulated herself, the therapist helps Kitty get regulated.  I do feel that I am now able to stay calm and regulated when Kitty is raging about 90% of the time.  It helps me a lot to remember why Kitty is acting the way she is. In addition to whatever stressor she's upset about at the moment and whatever trauma that has triggered, once she's become dysregulated, she's not in the thinking part of her brain. Plus, she is emotionally/developmentally much younger so is reacting the way a younger child might -- I often repeat my mantra in my head, "She's only 6! She's only 6! She's only 6!" [Therapeutic Parenting Based on Emotional/Developmental Age]

Ex. Kitty is really stressed about moving to Biomom's house.  Totally normal of course.  Friday night, we were on a way to dinner with the family and she snapped at Bob - accusing her, and then the whole family of wanting Kitty to leave and being happy about it.  Hubby pulled Kitty aside to talk to her and she immediately went into fight/ flight/ freeze.  He tried to calm her down, but just couldn't.  Mostly because he's male and an authority figure.  She wanted to run.

I took over at that point.  It took almost an hour for me to calm Kitty down.  Some of this was that I started by trying to rationally explain to Kitty why her perception of what was happening was distorted (she was worried about moving and trying to distance herself from us so it wouldn't hurt as much).  Once I stopped that and switched to matching her emotional intensity, I finally got her to come inside.  She said she wasn't hungry, but I encouraged her to take food "to eat when she got hungry later."  She ended up eating happily with the cousins.  Switch flipped. 

{Often when Kitty gets upset, she'll be raging and upset, then something distracts her (someone saying something silly or odd, a squirrel runs by, food is mentioned..) and with that change in focus, it's like she flipped a switch. The previous behavior/upset didn't happen and she doesn't know what you're talking about, even with tears on her cheeks and crescent marks from her fingernails in the palms of her still clenched hands. It's kind of scary.} 

Dan Hughes - Arousal Regulation in Traumatized Children (2007).
 

Co-Regulating Child’s State of Arousal: Use of Self

•  Matching Vitality Affect
•  Match tone
•  Match intensity
•  Match prosody (the patterns of stress and intonation in a language)
•  Don’t match the emotion

Match or lead the expression of affect.
When an adult matches a child’s nonverbal affective expression of his or her underlying emotion, the child often is able to experience the adult’s empathy for his or her experience and better regulate the underlying emotion. The adult’s affective communication of his or her experience of the child’s emerging experience enables the child to become aware of—and deepen—his or her own experience.

When children (and probably adults as well) give expression to their inner lives, they do so with an expression of affect that reflects both the information and energy that characterize the focus of their attention. The particular emotion associated with an event that they are describing is conveyed with a unique facial expression, voice prosody, and gestures and movements that best convey the particular meaning of that event for the child. The rhythm and intensity of the nonverbal expression conveys “how” and “how much” the event affected the child. When the adult matches that affective expression (often without feeling the child’s underlying emotion), the adult is able to convey that he or she “gets it,” and the child feels “felt.” In other words, the child experiences the adult’s experience of empathy for him or her in a way that words would never communicate alone. For example, if a child screams “I hate my dad!” in a therapy session, and the therapist replies, with the same intensity and rhythm as the child’s expressions, “You are really angry with your dad right now!” the child is likely to feel that the therapist does “get” his experience. If, however, the therapist says “you are really angry with your dad right now” in a flat tone of voice, the child is not likely to experience the therapist as “getting it.”

Along with conveying empathy for the child’s experiences, matching the affect also helps the child to regulate his or her experience. When a child experiences intense anger, that expression of anger is demonstrated by an intense affective expression in his or her voice, face, and gestures. If the child does not experience a similar response from an adult, the intensity is likely to escalate, as the child may struggle to regulate the emotion. If the child lacks general affect-regulation skills, any increase in intensity only increases the risk
of dysregulation. By matching the intensity and rhythm of the affective expression (and remaining regulated him- or herself), the adult is able to help the child to remain regulated. By finding the adult with him or her in the intense experience, and communicating with the adult about it, the child often finds him- or herself becoming less distressed and agitated.

Children may have trouble identifying an experience because it is new. They may be uncertain how to communicate it or worry that maybe they should not have it. This is especially true of children raised in circumstances where aspects of their inner lives are not seen or encouraged or when they have experienced traumatic events. In those situations, if a therapist is able to make sense of the child’s experience and take the lead in its nonverbal affective expression, the child is often able to experience it more deeply and communicate it more fully him- or herself.
            - Hughes, D. (2009). Attachment-Focused Treatment for Children. In Clinical pearls of wisdom. Kerman, M. (Ed.). New York: Norton. 169-181.

Questions to ask an attachment therapist

???

Of course, it depends on your child's issues, but for us, we loved our attachment therapist (who also did somatic therapy and for trauma, EMDR).  
Finding an Attachment Therapist - http://marythemom-mayhem.blogspot.com/2012/08/books-and-methods-review-methods.html

1.    Is it OK for me to be in the room during therapy?  You should be in the room the whole time (prevents triangulation, false allegations, and for attachment therapy, you want the child bonding with YOU, not the therapist).  At the very least you should be able to observe the therapy session.
   
   
2.  How much experience do you have working with kids of trauma?  The therapist needs to be experienced with kids of trauma (book learning is fine, but very few therapists "get" what it's like living 24/7 with a child with a serious mental illness or attachment issues).  Even if your child is not diagnosed with a severe mental illness or attachment disorder (like RAD), the therapist should be able to identify and treat it.
   
   
3.   How do you handle a dysregulated child?  A good therapist matches (without joining) the energy level of the child, and then helps them regulate.
   
   
4.   What treatment methods do you use?  (or combination of methods) Talk Therapy does NOT work for trauma!  
   Options may be:
   Attachment Therapy, 
   Brain Gym, 
   Brain Integration Technique/ Crossinology, 
   Biofeedback/ Neurofeedback,
   Cognitive Behavioral Therapy (CBT), 
   Dialectical Behavior Therapy (DBT), 
   EMDR,
   Family therapy,
   Filial therapy, 
   NeuroReorg, 
   Play therapy, 
   Sleep Phase Chronotherapy,
   Somatic therapy,
   Tapping (EFT), 
   Tension & Trauma Releasing Exercises(TRE), 
   Theraplay,
   Therapeutic Parenting-Behavior Management
   
   
5.   Whose methodology do you follow? Our attachment therapist trained under Daniel Hughes.  
   Some other options:
   Beyond Consequences 
   
   Foster W. Cline
   Gregory C. Keck
   Karyn Purvis - TBRI/ Connected Parenting
   Nancy Thomas 
   Ross W. Greene
   
   
6. How would you handle parent bashing by our child?  There should never be any parent bashing by the therapist.  The child can be supported in venting, but the therapist should NEVER make the parent feel they are bad parents.  It's a difficult line for the therapist to walk!
   
   
7. How do you treat complex trauma, sexual reactivity, attachment issues, aggressive behavior, animal abuse, sibling abuse...?
   
   
8.  How do you support the parents?  Parents must be supported!  Whether from the therapist (some do half the therapy time with the child and half with the parent), encouragement to get their own therapist, or advice on books to read or places to go for support.  Parents need advice, guidance, and support.
   
   
9. Do you offer meetings with the parents without the child present? A lot of times this isn't covered by insurance.
   
   
10. I will need advice/ support/ resources/ information on how to help my child, what do you suggest?  I had a therapist accuse me of wanting him to train me to be a therapist (we eventually fired him).  Another therapist recognized that I wanted to become a therapeutic parent for my child and continue the work we did in therapy (or at least not derail it).  She gave me advice in one on one sessions, suggested books to read, and connected me with a local support group.
    
    
11. What is the best way to communicate with you? I don't like to talk about my child or issues we might be having in front of the child.  Personally, I prefer to send way too lengthy e-mails or meet with the therapist alone for a little while. Some therapists are not willing to read e-mails or return phone calls.
    
    
12. Do you have on-call hours or times you're available on the phone in addition to appointments? 
    
    
13. How collaborative is your relationship with parents?  Do you seek input about how the child is doing at home?  If the parents report a lack of progress or want to discuss a concern that the child doesn't want to discuss what happens then?
    
    
14. What do we do if our child is having a crisis?
    
    
15. What do you do if the child reports abuse?  What if the child is known to make false allegations? 
    
    
16. How do you gauge success?  If progress isn't being made what happens next?
    
    
17. Are you willing to provide documentation/testimony? We used this with the school, to get into psych hospitals and residential treatment, and to get other services (like crisis management). We even had a therapist willing to come to the school and train their staff (nurse, behavior staff, teachers, administrators) in how to handle our child. Unfortunately, the school refused the offer.

Please post any other questions you think should be asked in the comments!

BEHAVIOR MANAGEMENT Outline

Therapeutic Parenting

Therapeutic Parenting - This Doesn't Feel Right! by Christine Moers

Therapeutic Parenting is the term used to describe the type of high structure/high nurture intentional parenting that fosters the feelings of safety and connectedness so that a traumatized child can begin to heal and attach. Learning to parent therapeutically is the single most important thing you can do to help your traumatized/attachment-disordered child. - Attachment & Trauma Network, Inc. 

Some posts about Therapeutic Parenting:
Structure and Caring Support 
Why Doesn't My Child Feel Safe?
Connected Parenting (TBRI)

**This series had originally been titled Preschool Behavior Management, but the reality is that most children of trauma are developmentally behind their peers and a 16 year old may be emotionally only 4yo - meaning we should parent based on the child's emotional age, not their physical age. **

"Happiness is something you decide on ahead of time.”
Finding the Joy

“Each day is a gift, and as long as my eyes open I'll focus on the new day and all the happy memories I've stored away ... just for this time in my life. Old age is like a bank account ... you withdraw from what you've put in. So, my advice to you would be to deposit a lot of happiness in the bank account of memories.”

**This is a working document.  Items are always being added/updated.  Constructive input is always appreciated!**

          Chapter 1--    PARENTING BASED ON DEVELOPMENTAL / EMOTIONAL AGE

a.    Preoperations Stage

b.    Magical thinking/ Distorted Reality

c.    Concrete/ Black and White Thinking 

Chapter 2--    DISCIPLINE vs.BEHAVIOR PROBLEMS

a.     Behavior Problems

i.              Lack of Impulse Control

ii.            No Understanding of Consequences

b.    Consequences vs. Punishment

i.              Natural and Logical Consequences

Chapter 3--    STRUCTURE, SUPPORT, ROUTINES, AND BOUNDARIES

a.    Structure and Support

b.    Low Tolerance/ Overwhelm

c.    Traumaversaries

d.    Role Modeling

e.    Reciprocity

f.     Teaching New Values

g.    RULES

i.         “No”

ii.            Rules should be simple and few
iii.     Positive and Concise

iv.           “Don’t”

v.           Clear messages

vi.            Fresh starts

vii.           Choices

viii.         “Okay?”

              Chapter 4--    NURTURING

a.    Emotional regulation

b.    Calming techniques

c.    Holding a child

d.    Let the child know what is happening

e.    Four types of communication

f.     Greetings

g.    Positive interactions (letter parties)

h.    Compliment sandwich

i.      Speak Softly

               Chapter 5--   DISCIPLINE and GUIDANCE

a.    Definition of discipline
      - Stress/ HALT
      - Perceived safety

b.    Distraction/ Re-direction

c.     Praise appropriate behavior
d.  Concise communication

e.     Encourage use of language
f.    Ignore negative behavior

g.    Timeouts

h.     Time-ins
i.   Bedtime

j.  Physical Affection
k.   Shadowing

l.    “4 Foot Rule”

m.      Fight/ Flight/ Freeze

n.      Teachable Moments
o.   “This is where you say________”

p.      “No” practice

q.    "Overreacting" 
r.   Prescribing

s.    “hmm… how are you going to handle that?”

t.    Behavior charts/ star charts

u.     The five Ps

v.    Age-Appropriate activities

w.     Waiting time/ Transition time

x.    Environments

y.    Off Limit Areas

z.   Off Limit Activities

aa.    “Off Limit” People

bb.    Reasons Children

                Chapter 6--    ABUSE

a.    Physical

b.    Verbal

c.    Night terrors

d.    Fight/Flight/Freeze
e.  Overwhelm/ Low Tolerance window

f.    Shut down/ Dissociation

g.     PTSD - Hypervigilance

           Chapter 7--    MISC

a.    Mental Illness/ co-morbid
b.    Allergies/ other physical causes for behaviors
c.    Food Issues
d.    Lying/ stealing – developmental
e.     Media
f.    Potty Issues
g.  RAD stink/ dysregulation

PRESCHOOL BEHAVIOR MGMT Chap 7 MISC

Therapeutic Parenting 

PRESCHOOL BEHAVIOR MGMT

CHAPTER 7

MISC

Disclaimer:  Most of this information is not my own, a lot is from my favorite attachment guru Katharine Leslie.  

a.    Mental Illness/ co-morbid

b.    Allergies/ other physical causes for behaviors

c.    Food Issues

d.    Lying/ stealing – developmental

e.     Media

f.    Potty Issues
g.  RAD stink/ dysregulation

a.  Mental Illness/ Co-morbidity
I firmly believe that people with "issues" (including alcoholism, substance abuse, trauma and mental illness) are often attracted to each other (Bear is a good example of this), leading to children with increased odds of a genetic predisposition toward addiction and mental illness.  Add in things like fetal alcohol syndrome and children born addicted to drugs (due to mother's  drinking/ substance abuse during pregnancy), abuse and/or neglect...  Plus, children with "issues" are harder to parent, especially if the parent(s) have their own "issues," frequently leading to abuse and neglect of the child.

A lot of times a child's genetic predisposition to mental illness can be triggered by trauma to have an earlier onset.  Co-morbidity (more than one diagnosis) is also very common for our kids.  If you look at the Chart of Overlapping Behavior Characteristics of the symptoms and characteristics of many different childhood disorders, you can see why children are often misdiagnosed and receive the wrong treatments.

b.  Allergies/ other physical causes for behaviors - 
In addition to effecting the body (rashes, mouth sores, swelling, hives, trouble breathing, tremors...), allergies can also cause behavior issues.  Common foods, chemicals, medication, or common allergic substances could be the culprits that cause some children or adults to feel unwell or act inappropriately. If your child is always sick, hyperactive, a slow learner, or cranky, we can't automatically assume that it is trauma or psychologically based!  Allergies, foods and meds have caused constipation, unusual reactions to medications, and behavior issues.  I have a friend whose child literally bounces off the walls when she eats apples.  Due to what turned out to be a gluten sensitivity, Ponito had chronic severe ear infections without any apparent symptoms other than a little crankiness (which for my generally easy-going child was a big deal).

Some people find that changing diet can help alleviate some of these issues.  A gluten free/ casein free diet is often recommended for children on the autism spectrum.  Other common options include no red dyes, no processed foods, all raw foods, vegetarian, vegan, adding in supplements (I have friends that swear by Niacin to help their child manage and even prevent impulsivity and rages)... 

c.  Food Issues – Food issues usually have nothing to do with food, hunger or even control, and tend to be more about attachment and trauma.  My daughter eats to make herself feel better (emotional eating).  My son eats lots of sweets because he has an addictive brain (he also had problems with tobacco, alcohol and drugs).  He also hoarded, probably because there was not enough food when he was a child.  This is definitely not an issue now, but their brains don't always "get" that they are safe now.

d.  Lying and Stealing - There are a lot of typical developmental issues that cause lying and stealing.  I wrote a pretty thorough post on the subject here.

e.  Media -  I subscribe to the “Garbage In, Garbage Out” philosophy.  I have removed anything I don’t think is GOOD for them (not just "not bad").  We purchased a Clearplay DVD player and any videos rated higher than PG must be played on that (and most PG movies benefit from it too).  We don’t allow any TV shows rated higher than PG (no PG – 14), and we completed banned certain channels.  No Cartoon Network at all (no Spongebob – too violent and rude), no shows like iCarly which is pretty much rude all the time.  Nothing on Nick at Nite.  Most of the more violent cartoons and pretty much everything on the Military or History Channels.  We even dumped ABC Family channel which played some good movies because they were advertising really inappropriate shows (Degrassi, stuff about teenage moms…).  I’ve also had the children switch to all Christian music (there are all kinds – rap, heavy metal, pop…). 

Maybe some kids can handle the innuendo, adrenaline-inducing, emotionally-triggering, violence…  mine can’t.  My kids are developmentally much younger and have very black and white thinking that makes it hard for them to understand when it is (and is not) appropriate to emulate what they see on TV.  We decided that to treat them as though they were their chronological age, or as if they are able to handle things we have recognized as triggers, is just cruel and unfair.  It is definitely hard to follow through on this!!  Most people don’t understand it, and my kids certainly don’t love it, but we’ve had fewer meltdowns and the language and attitudes have improved, for both my kids of trauma and my “neurotypical kids.”

f.  Potty Issues –
There are many different causes for "potty issues" (enuresis - wetting and encopresis - pooping).  Sometimes there is more than one cause.  "Potty issues" can be bed wetting, refusal to poop, daytime wetting or pooping, pooping or wetting in inappropriate places or at inappropriate times, "painting" with poop...).  Dysregulation, trauma triggers, a need for control... can cause issues and regression.

Developmental - lack of readiness for potty training.  
My Potty Training Philosophy is that it is better for children to switch straight from diapers to underwear when they have all of the signs of readiness (Showing an interest in the potty.  Able to take own clothes on and off.  Staying dry for an hour or so - Children who are not physically ready will “dribble” all the time, rather than hold the urine).

Physical causes - Potty issues can be caused by:

chronic constipation (can also cause urinary tract infections), urinary/ bladder/ kidney infections, problems with the "plumbing" (Kitty and my sister had to have surgery to correct issues with their "plumbing" - the "tubes" leading from the bladder being too small and the valves from the kidneys not working correctly), allergies can cause severe gastrointestinal issues, med changes can cause problems with sleep, hormones (trauma can trigger early onset of puberty meaning hormones can come into play at a much younger age!), even hernias (my nephew had a hernia at age 8 that caused him to wet his bed at night)...

Emotional causes - This subject will always make me think of Christine Moer's  "Pee Song."

• Some children develop an irrational fear of the potty or "losing" part of their body (poop).  I have seen a child "hold it" all day to avoid having to use the restroom at daycare, waiting instead until she was put in a diaper at night causing serious intestinal issues.
• Distracted, forgets, or doesn't like transitions (stopping what they're doing and going potty) or may be too focused on what they are doing to stop and use the restroom.
•  Doesn't want to draw attention to themselves.  The child may be afraid or uncomfortable asking or interrupting to ask to go.  
• Dissociation from physical self or lowered awareness of body - not knowing they need to go until it is too late - this can include not realizing or not caring that they have wet or messed their clothing.   
• Sexual abuse can cause a fear of bathrooms (might reminds them of the place they were abused), unwillingness to be naked (for toileting, baths, or showers), and unwillingness to touch themselves in places they were abused (causing issues with wiping and hygeine as well).  
• Outdated defense mechanism - a sexually abused child, may have made him/herself "unattractive" by being "dirty" or smelly. Sometimes old defense mechanisms outlive their usefulness, but the child can't stop.
•  Regression or delayed development.  Frequently children with trauma issues will remain stuck in earlier developmental stages or will regress - especially when dysregulated or triggered. The child may not be ready for potty training yet (or any more). It might be a way for your child to tell you they need the support and attention you would give a younger child - like kids who start baby talking, "forget" how to do things they used to be able to do, and wanting to be fed by you.
• Way of expressing without words that they are unhappy or in emotional distress. Sometimes it really is a way of saying, "I'm pissed," or "Poo on you!" It also could mean "This is a poopy situation!" or "I don't give a poo!"
  
• Entertainment and attention. Enjoys watching others jump around and get upset. Draws attention to them (negative attention is still attention!).
• Feeling in control of their environment - a lot of kids feel that they can't control what's going on in their lives, but they can control what goes in to and out of their bodies. 
• Pushing you away before you can reject them - Many kids of trauma "know" they are unworthy or unlovable and believe that when you find out you will leave like everyone else - so to get control of that they find ways to push you away - If you find out I'm not perfect you'll leave.
• For reasons we don't always understand!  I worked with a fully potty-trained child in a daycare situation who liked to change her clothes... frequently.  When told she couldn't just change her clothes for no reason (teacher didn't have time to stop everything and let her change multiple times a day) - the little girl "made" a reason!  It took us awhile to figure it out, and the first thing I tried (stopped allowing her to change into her pretty princess panties and cute outfits and providing her with gender neutral clothes from the class stash) caused her to step up her game, until eventually she even started finger-painting with poop. We had to back up and stop making it a control issue. 
• Some combination of the above - Dysregulation, illness, hormones, med changes, trauma triggers... all can suddenly trigger or worsen issues. 

So what do you do about it? This is why part of our job as a therapeutic parent is to be a detective. Figuring out why it's happening can help figure out how to stop it.

• Avoid shaming or making it a control issue.
• Remain as calm and matter-of-fact as possible. 
• Expect the child to help clean up, but try to keep within their developmental abilities. Remember an emotionally delayed child should only be expected to do what is developmentally appropriate for their emotional age. For example, you wouldn't expect a 2-year-old to mop up all the potty water from an overflowing toilet, disinfect the room, cleaning supplies and themselves.
• A child in fight/ flight/ freeze is acting purely instinctually - the thinking part of the brain is not online so it is best to address things when they child is more regulated. 
• Keep a change of clothes (or 3) with the child (back pack, locker, cubby...) or in the nurse's office or somewhere the child can access it. Waterless, antibacterial handsoap can often help with odors and cleaning.
• Give the child some socially acceptable words/ euphemisms they can use to explain to others what happened. My 16yo daughter called me from school once asking me to bring her a change of clothes, because she'd, "lost an argument with the water fountain."
• Make a schedule. Does the child need reminders to go potty? Assistance getting up in the middle of the night to go to the bathroom?
• Make an appointment - have a doctor make sure the cause isn't a medical issue.
• Wear gloves. This was less from worry about germs or the ick factor and more about the fact that the smell of poo really adheres to your skin. When cleaning up yet another overflowing potty I always wear gloves!
• Keep hygiene lessons brief - but do give them. Not changing underwear/clothes/ sheets with pee or poo in it can burn the skin and lead to infections. Kids may not understand that. I also gave lessons (with clothes on!) in how to wipe and clean. (Also in how to change out a toilet paper roll!).
• Check often. My daughter slept in a loft bed. I frequently had to give it a smell test. I also had to watch for wet pull-ups, which for some reason she liked to hide.
• A trick for bed wetters - We had a plastic covered mattress (of course) and made the bed as usual (fitted and flat sheet). Then we covered that with a plastic layer of some sort (I liked shower curtain liners - preferably ones that didn't make crinkly/ crunchy noises). Made the bed again (fitted and flat sheet). Repeat for several layers. Keep some clean pjs (and pull-ups if used) by the bed - we used a little wooden chest. When the child woke up in the middle of the night to wet sheets, all they needed to do was strip the top set of sheets and their pjs, the plastic sheeting generally kept the urine from getting everywhere. Put on new pjs - kept in the box/ drawer/ whatever right next to the bed. Grab a new blanket if needed (we kept folded up comforters/ blankets on a shelf at the bottom of the bed. Voila! Back in bed ready to sleep in minutes. Could be done multiple times in one night if needed. In the morning, the child could put the whole mess in the washer (with some hydrogen peroxide and/ or vinegar or whatever you like to use).

g.  RAD Stink - You've heard of the "smell of fear"?  This is the smell of dysregulation.  It usually smells like a combination of poo and the worst body odor you can imagine.  Yes, sometimes our kids' hygiene is not the best, but this doesn't go away, even with thorough washing and a change of clothes (although we have found that using a combination of antibiotic waterless hand soap under the armpits and a change of clothing can frequently keep the school from sending her home yet again!).  

PRESCHOOL BEHAVIOR MGMT Chap 6 ABUSE

Therapeutic Parenting 

PRESCHOOL BEHAVIOR MGMT

CHAPTER 6

ABUSE

Disclaimer:  Most of this information is not my own, a lot is from my favorite attachment guru Katharine Leslie.  

           a.    Physical Abuse

           b.    Verbal/ Emotional Abuse

           c.    Night terrors

           d.    Fight/Flight/Freeze

           e.    Overwhelm / Small Tolerance Window

           f.     Dissociation

           g.     PTSD - Hypervigilance

a.  Physical Abuse - Children should NEVER be physically forced or restrained in any way (except VERY brief restraint in emergency circumstances if unavoidable to prevent the child from harming themselves or others).  This includes holding the child in any way so that he or she cannot move, or placing your legs over a child to force them to lie still during nap.  You must not withhold food, drink, or the restroom.  You should avoid withholding any part of the regular day, such as a planned activity, game, or art project. 

b.  Verbal/ Emotional Abuse has been shown to cause more severe long-term damage than physical abuse!

•          Shaming - Shaming should be avoided at all costs (our kids do enough of this to themselves).  
•          Criticism - Criticism should never be public or demeaning, embarrassing or humiliating.  Walk up to the child and talk to him or her softly - preferably away from the group, or just use eye contact or a subtle gesture (when my children get loud or hyper, I hold my hand out flat and lower it – signifying lowering the volume.  At first I also said “Please take it down a notch”).
•         Belittling – these are subtle ways of ridiculing a child.  They can be any question that you don’t expect an answer to – ex.  “How many times do I have to tell you?”  “What do you think you’re doing?” “Do you ever listen?”  “Helllooo!”
•        Avoid Threats – A threat is any consequence we say is going to happen, when we know it really won’t.  If you’re not going to follow through it’s a threat, and threats give away your authority and credibility as do repeating an instruction, and giving warnings and not following through.  It can seriously damage the child’s trust.

Some Common Reactions to Abuse 

c.  Night terrors - Despite what the following quote says about night terrors not being common in adolescents, my children are very prone to these.  Many doctors and psychiatrists do not understand night terrors at all (I've had some dismiss the possibility entirely for Kitty).  To me it makes total sense that kids with trauma issues, particularly PTSD would have these.  Kitty will sit up and scream in the middle of the night and talk to herself.   She's been known to sleepwalk as well.  Bear has spoken of being kicked by the devil who was laughing at Bear.

An important thing to note:  people with night terrors usually do not remember having them upon awakening.

A night terror, sleep terror or pavor nocturnus is a parasomnia or sleep disorder, causing feelings of terror or dread, and typically occurs during the first hours of stage 3-4 non-rapid eye movement (NREM) sleep.^[1] Night terrors tend to happen during periods of arousal from delta sleep, also known as slow-wave sleep.^[2][3][4] During the first half of a sleep cycle, delta sleep occurs most often, which indicates that people with more delta sleep activity are more prone to night terrors.^[3] However, they can also occur during daytime naps.^[5]

Night terrors have been known since the ancient times, although it was impossible to differentiate them from nightmares until rapid eye movement was discovered.^[4] While nightmares (bad dreams that cause feelings of horror or fear) are relatively common during childhood, night terrors occur less frequently according to the American Academy of Child and Adolescent Psychiatry.^[6] The prevalence of sleep terror episodes has been estimated at 1%-6% among children and at less than 1% of adults.^[7] Night terrors can often be mistaken for confusional arousal.^[2]Sleep terrors begin between ages 3 and 12 years and then usually dissipate during adolescence. In adults, they most commonly occur between the ages of 20 to 30. Though the frequency and severity vary between individuals, the episodes can occur in intervals of days or weeks, but can also occur over consecutive nights or multiple times in one night.^[3][5]

Night terrors are largely unknown to most people, creating the notion that any type of nocturnal attack or nightmare can be confused with and reported as a night terror.^[4]

Mayo Clinic:  Sleep terrors differ from nightmares. The dreamer of a nightmare wakes up from the dream and may remember details, but a person who has a sleep terror episode remains asleep.
Children usually don't remember anything about their sleep terrors in the morning. Adults may recall a dream fragment they had during the sleep terrors. Also, nightmares generally occur in the last half of the night, while sleep terrors occur in the first half of the night. 

d.  Fight/ Flight/ Freeze - A child who is dysregulated and/or in fight/ flight/ freeze mode is “thinking” with the reptilian part of the brain (survival!).  Their behavior is a purely instinctual response to what the brain believes is a life or death situation.  The rational part of the brain just isn't online.  Their eyes frequently glaze over, they are out of control, and it is like the child isn't "home."  Afterwards they do not remember what happened just before or during an episode.  Holding a child responsible for what happens when in a true fight/ flight/ freeze is pointless- it’s better to just move on after it's over and try to figure out what triggered it so you can avoid it in the future. 


A “meltdown” is different from being in Fight mode which usually looks more like a rage.  During a meltdown, the child has some control over how far things go. It is still possible to "reach" the child and de-escalate the situation and calm him/her down. 

Our bodies' nervous system is very basic - it doesn't know the difference between say, excitement and anxiety. Medications, calming techniques, and maturity can help the body stay calm and keep from sending "AiieeeAiieeeAiiee" signals to the brain stem. Bear tends to go into "Fight mode" when he's upset, worried, anxious, afraid...  Whereas Kitty tends toward "flight" or "freeze" and she dissociates (distracts herself).  

e.  Overwhelm/ Low tolerance

Kids of trauma usually have a very small window of tolerance.  They react to what appears to be routine problems with meltdowns, rages, dissociation... It is believed that they may be lacking some crucial skills in the domains of flexibility/adaptability, frustration tolerance, and problem solving.  As therapeutic parents, we try to solve the problems that triggered explosive episodes, and teach our child the skills he/she needs to avoid the escalation.  

It is sometimes necessary to simplify a child’s life a LOT to lessen the feeling of “overwhelm.”  This can be like "childproofing" – avoiding and removing things and events that can be triggers.  It can help to strip the child’s room to only a bed, one or two stuffed animals, a book, and not much else.  In times of extreme stress, we’ve removed all of our child’s clothing and the child has to bring dirty clothes to “check out” clean ones.  This helped with hygiene issues, and lessened the amount of times that could make a room feel messy or cluttered. This gets harder as the kids get older, but it is important!

{A good post to check out Ross W. Greene - The Explosive Child)

f.  Dissociation

"Dissociation is a term in psychology describing a wide array of experiences from mild detachment from immediate surroundings to more severe detachment from physical and emotional reality. It is commonly displayed on a continuum.

The major characteristic of all dissociative phenomena involves a detachment from reality – rather than a loss of reality as in psychosis. In mild cases, dissociation can be regarded as a coping mechanism or defense mechanisms in seeking to master, minimize or tolerate stress – including boredom or conflict. At the nonpathological end of the continuum, dissociation describes common events such as daydreaming while driving a vehicle. Further along the continuum are non-pathological altered states of consciousness."  -- Wikipedia

Magical thinking/ Distorted Reality Dissociation 
Around age 5 or 6, children go through the "magical thinking" stage.  They can want something so badly that they believe it, so it is true. I firmly believe that they could pass a lie detector on this. It becomes their reality and I don't think they even remember that wasn't how it happened.  Operating in this distorted reality can make the child appear to be Lying.

This can also be a symptom of mental illness (depression, obsessive-compulsive disorder and schizophrenia). 

{When Bob was 4, she came home from preschool with a necklace that I didn't recognize.  When I asked her about it, she said Grandma had given it to her for Christmas.  Ummm... nope!  Turns out it belonged to another preschooler and she'd wanted it so badly that she'd managed to convince herself that it was hers.} 

You can see how this might work with the Denial Stage of Grief as well. 

Fight/ Flight/ Freeze Dissociation
Kitty is especially likely to dissociate when something has triggered her PTSD.  In the middle of a fight, flight or freeze reaction, Kitty can "flip a switch" and have no memory of an event or something she has just said or done.  Plus, she thinks of the rest of the world as liars, because her perception of events is often so incredibly distorted that she hears things that weren't said.  
{For example, Hubby saying, "Who left the butter out?,"  became in Kitty's mind a yelling, diatribe of all of her faults, and she reacted accordingly, with a huge meltdown.  She really believes that Hubby has verbally attacked her, and nothing we say will change that perception.} 

Shut down Dissociation
Unlike the fight/ flight response, this is a more long-term response to continued trauma.  A child may shut down both her physical and emotional sensations as a reaction to not getting her needs met as a young child and to protect herself from perceived future harm. 

Surprisingly, physically and emotional feelings are often linked.  

Our daughter, Kitty, had very little affect, her emotional feelings were shut down to protect herself.  She seemed to only experience one emotion - anger. She often appeared to be operating as if she was in the middle of a war zone, completely overwhelmed and focused on survival (rather than healing or learning). , She was so emotionally shut down that we suspected Dissociative Identity Disorder (Multiple Personality Disorder).

Years of trauma caused her to dissociate to such an extent that she no longer had physical feelings (she was not ticklish and she would frequently tell people to pinch her arms and legs to show she couldn't feel it).  

To get our child's physical and emotional sensations back, we had to work on it from both sides - physical (Neurofeedback and somatic therapy) and emotional (Attachment Therapy, EMDR, Therapeutic Parenting, and providing a Safe, Structured, nurturing environment).

Imaginary Play/ Hallucinations? Dissociation
Another form of "dissociation" can take the form of the child talking to him/herself or an imaginary friend. This could be a form of imaginary play (playing school or "mama") which is pretty typical for young children. Unfortunately, it could also be a sign of auditory or visual hallucinations. 

{For years, Kitty used to do what we called "stalking" in the backyard (walking determinedly in a big loop). I couldn't actually hear what she was saying, but it rarely looked like a pleasant conversation. Occasionally, I saw her violently turn around as though someone was right behind her that had said something offensive, and begin yelling at... no one? herself?

Needless to say, it freaked me out. I'd never heard of another child doing it. Her therapist thought it might be a form of dissociation (which she also did a lot), especially in fight/ flight/ freeze situations}

g.  PTSD/ Complex PTSD/ Hypervigilence
Kids of trauma are often easily triggered, extremely sensitive to emotions, unable to regulate their emotions... causing them to react as if they are in a warzone.  You can't learn and attach if you don't feel safe and you're living in a war zone!  Hypervigilance (obsessively monitoring the environment) is super common among kids with PTSD.  It relaxes when they start to feel safe, but probably doesn’t ever really go away.  

Children of  trauma NEED structure and caring support to feel safe and start to heal.   This feeling of safety is often not based in reality – it is a perceived feeling of safety.  You can think of it as a learned defense mechanism that they need help getting rid of now that they are in a safe environment. 

CHAPTER 7 - MISC