Reconstructing Bonds: Forming Attachments in the Aftermath of War Joan K Vanderlaan BSN, MN .

Reconstructing Bonds: Forming Attachments in the Aftermath of War

Joan K Vanderlaan BSN, MN

www.MilitaryChild.org

Sesame Street Video ClipTalk, listen, connect

Changes, adult section

www.MilitaryChild.org

www.MilitaryChild.org3

Sesame Street Video – Changed Parent

I remember he really couldn’t really remember me, which was hard for me. Because it was like you’ve known him and he’s been there for you, he was the guy that named you. And him not being able to remember your name was very hard to take and frustrating. All you could really do was … you really couldn’t do anything at all, just watch and pray.

Explore how the alternations in a service member with PTSD or TBI can disrupt development attachments with very young children and change attachments with older children.

Be aware of symptoms related to TBI and PTSDDiscuss the concept of ambiguous loss and how that relates to child/parent attachment in the aftermath of warDevelop parenting styles and strategies that can assist the Changed Parent in forming a close relationship with his/her children after return from war.Identify resources that can be used to enhance parenting skills and ultimately strengthen attachment bonds at all stages of the child’s development.

Learning objectives



The Bowlby–Ainsworth Perspective: Some Relevant Issues

Attachment theory is concerned with the development of infant/child–caregiver relationships, the maintenance of such relationships through the lifespan, and the role those relationships play in future close relationships and individual development. Chapter 7 Attachment Ties in Military Families: Mothers’ Perception of Interactions with Their Children, Stress, and Social Competence: Germán Posada, Nancy Longoria, Casey Cocker, and Ting Lu) S. MacDermid Wadsworth and D. Riggs (eds.), Risk and Resilience in U.S. Military Families, DOI 10.1007/978-1-4419-7064-0_7, © Springer Science+Business Media, LLC 2011

Biological Bases of Attachment Behavior

“Attachment behavior has the predictable outcome of increasing the proximity of the child to the attachment figure (usually the mother). Some attachment behaviors (smiling, vocalizing) are signaling behaviors that alert the mother to the child’s interest in interaction and thus serve to bring her to the child. Other behaviors (crying) are aversive, and bring the mother to the child to terminate them. Some (approaching and following) are active behaviors that move the child to the mother. “ (Handbook of Attachment, pg 4, emphasis mine)



Ainsworth Maternal Care Variables

sensitivity to the infant’s signals and communications

cooperation with baby’s ongoing behavior

acceptance of the baby’s needs

physical and psychological accessibility

Chapter 7, pg 138 Attachment Ties in Military Families: Mothers’ Perception of Interactions with Their Children, Stress, and Social Competence: Germán Posada, Nancy Longoria, Casey Cocker, and Ting Lu) S. MacDermid Wadsworth and D. Riggs (eds.), Risk and Resilience in U.S. Military Families, DOI 10.1007/978-1-4419-7064-0_7, © Springer Science+Business Media, LLC 2011

Outcomes beneficial to the child

FeedingLearning about the environmentSocial interactionLess likely to be killed by predators

“Attachment is considered a normal and healthy characteristic of humans throughout the lifespan, rather than a sign of immaturity that needs to be outgrown.”

(Handbook of Attachment, pg 5)


Links exist between exploratory & attachment systems

Exploratory system gives survival advantages to the child - provides information about the workings of the environment

use tools build structures obtain food negotiate physical obstacles



The Exploratory System

Attachment & Exploratory Balance

Secure base from which to explore (Ainsworth 1963)

Attachment-exploration balance (Ainsworth, Bell & Stayton 1971)



Dynamic Equilibrium

Mother provides “a secure base from which to explore.” The mother’s monitoring of infant-mother proximity frees the infant from such monitoring and permits greater attention to exploring.



Infant-Father Attachment

“Individual differences in quality of infant-father attachment are related to paternal behavior: Infants are more likely to be securely attached to fathers who have been sensitively responsive to them.”



Sense of Safety & Security - Young

Derived from maintaining a bond with an accessible and responsive caregiver.

Perceived threats to caregiver’s availability causes feelings of anxiety and anger

Persistent disruption of attachment bond results in feelings of sadness and despair

(Handbook of Attachment, pg 24, emphasis author’s)


Sense of Safety & Security - OlderPerceive threats to caregiver’s availability when lines of communication are disrupted by

prolonged absenceemotional disengagementsignals of rejection or abandonment

Can produce feelings of anxiety, anger, and sadness similar to younger children after physical separation



Chad, 17 yrs old “Dad was in Kandahar for six months. I emailed him there. We talked about how we were going to go fishing when he got back, maybe get a car and fix it up for the drag races. We were talking about how he was going to retire, but that’s not happening now. He’s staying in for a few more years. He wants to get his chief ranking. Before Kandahar, he was quiet, but he always wanted to do stuff with us. Now he’s always running around all over the place, trying to keep himself busy. He lives on the base with me… My dad and I live here on the base so I can finish high school here. We share a house, and we hang out, but we don’t talk.”Off to War – Deborah Ellis, pg 56)


Threats to Availability – Child/Parent

Threats of suicide by parent can lead to..Child experiencing anxiety about

physical accessibilityfear of violenceprospect of loss

Child interpreting an implied message that he or she is responsible for the parent’s desperation and despair



Witnessing Violence – Parent/Parent

Seeing parents argue violently maythreaten child’s confidence in

parent’s availabilitycreate fear in the child about harm to

one or both parents

“Parents who are living with constant conflict and fear are likely to have reduced capacities to attend to the child.”



Symptomatic Expressions of Aggression

“Parents are likely to be most frightening to their children when their unusual behavior occurs in unpredictable ways.”

Threats to availability

Threats to safety



Traumatic Brain InjuryNeurologic injury

Possible physical, cognitive, behavioral, and emotional symptoms

Range MildModerateSeverePenetrating

Battlemind Training System Office


Mild Traumatic Brain Injury (mTBI)Type of concussionResults from a “blow to the head”Does NOT result in obvious physical injury

Don’t have to be knocked out to have a mTBIMay be dazed, confused, had your “bell rung”If knocked out, for less than 30 minBattlemind Training System Office


Symptoms of mTBIHeadacheConfusionDizzinessBlurred vision or tired eyesRinging in the earsChange in ability to smell or tasteSensitivity to sound or lightNausea/vomitingIrritability (possibly anger or aggression)FatigueChange in sleep patternsMood changesTrouble with memory, concentration, attention, or thinkingBattlemind Training System Office


Invisible InjuriesHardest for children to understand

Why does a parent seem angry or sad? Why does he forget things or just seem “out of it”?

Help the child understand an injury may change the way a parent feels, talks, and acts.

Validate the child’s confusion, and make sure that he knows he is not to blame.Sesameworkshop.org/tlc


Sesame Street Video – Changed Parent

Too many people talking. Too many decisions about dinner. Do you want a coke. And that will never end. That will always be my biggest mental weakness, I can’t intake a lot.


Post Combat Stress

Also referred to asPost Traumatic Stress

Can result in a diagnosis ofPost Traumatic Stress Disorder

Preferred terminologyPost Traumatic Stress Illness


Physical Symptoms of PCS

Fatigue and/or weaknessChest painPounding heartBreathing difficultySleep problems (insomnia or nightmares)Muscle tremors or twitchesGrinding of teethProfuse sweatingHeadachesDiarrhea/Intestinal upsets

Battlemind Training System Office – List not all inclusive


Behavioral Symptoms of PCS

WithdrawalPacing & RestlessnessEmotional outburstsAnti-social actsSuspicion & ParanoiaInability to restLoss of interest in hobbiesAlcohol consumptionSubstance abuseBattlemind Training System Office – List not all inclusive


Emotional Symptoms of PCSAnxiety or panicGuiltFearDenialIrritabilityDepressionIntense angerAgitationApprehensionIsolating & withdrawing from othersBattlemind Training System Office – List not all inclusive


Kaela, 13 yrs old“Dad had a lot of combat stress when he came home. He tried to hide it from us kids, but I could see that he was a lot quicker to get angry. Before he went, he was so patient with my brothers, more patient even than Mother Teresa would be, my mom says. When he came back he lost it. His patience was gone – not just with my brothers, but with me, too. He’d start in on me for making just the smallest sort of thirteen-year-old comment. He’d get so upset about the smallest, dumbest things.” Off to War – Deborah Ellis, pg 44-45)


What about the children?Common symptoms of mTBI or PCS are diametrically opposed to the behaviors young or older children need to form/maintain attachments

Young children need a consistent response to their behaviors Parent may be unable to respond consistently depending on degree or severity of his or her symptoms


What about the children? (cont)

Older children seek consistent communication pathways Parents may be unable to re-establish previous patterns of communication or shared activities


Kaela, 13 yrs old (cont) “The whole deployment has improved my relationship with my mom, but it didn’t start out that way. At first she would keep stuff from me. She didn’t want to worry me. She’d hear things from Afghanistan and keep them to herself. I knew she was bothered by something but didn’t know what it was. I thought she was angry with me. I was hurting and angry and lonely, and we weren’t talking to each other. This big space opened up between us until one day we had this huge fight. I told her, “Mom, you’re not helping me, you’re hurting me.” Since then, things have gotten a lot better. We’re communicating again.” Off to War – Deborah Ellis, pg 45)

Loss, Trauma, and Resilience by Pauline Boss, pg 9 www.MilitaryChild.org32

Ambiguous Loss

Physical Absence and

Psychological Presence

Physical Presence

andPsychological

Absence


Ambiguous Loss

“Ambiguous loss is a problem structurally when parenting roles are ignored, decisions are put on hold, daily tasks are not done, and family members are ignored or cut off. “

Loss, Trauma, and Resilience by Pauline Boss, pg 15


Ambiguous Loss

“In United States culture, the valued and expected goals are to fix, cure, win, and solve. Living with loss is discouraged. Rather, one is supposed to get over it and do so quickly.”



Absolute Reactions to Ambiguous Loss

Prematurely closing out the changed parent by acting as if they were dead

Denying the parent’s psychological absence and acting as if nothing changedLoss, Trauma, and Resilience by Pauline Boss, pg 165


Double Whammy“Lose one parent {to TBI or PCS} and the remaining parent becomes depressed and preoccupied with the missing mate. Child ends up losing both parents, but no one notices because they are still there in the home.”



Tips for Parenting to Enhance Attachment

Safety of the Child must be paramountRegardless of age



Encourage all parents to participate in Child Growth & Development Classes and Parenting Classes, or to read books on positive patenting techniques.

Knowledge of normal infant and toddler behaviors is not intuitive in today’s society.


Resources

Zero to ThreeBehavior & DevelopmentCare & Education

Offers podcasts, printable handouts, videos to watch on-line, free Parent Brochures and Guides

http://www.zerotothree.org/early-care-education/

http://www.zerotothree.org/early-care-education/


ZERO TO THREE is a national nonprofit that informs, trains and supports professionals, policymakers and parents in their efforts to improve the lives of infants and toddlers. All of our work is:

Grounded in research and experienceMultidisciplinaryCollaborativeCulturally responsiveClinically informedAccessible

Zero to Three


Illinois Early Learning Projecthttp://illinoisearlylearning.org/tipsheets/curiouschild.htmThe Curious Child"Where did Navy Pier come from?" "Why do we have to wear seat belts?"Do you know a child who is full of questions? Young children are naturally curious. They believe parents, caregivers, and teachers know a lot about the world. Asking questions and listening to answers are vital to their learning. The way you respond can affect what and how a child learns. Do you......reject questions?"Stop asking. Be quiet. Don't bother me." Responses like these may tell a child that curiosity is unimportant or annoying. If you are too busy, or uncomfortable about a question, you might say, "Let's talk about it later. Right now my mind is on something else." ..deflect questions?Answers like "Because I said so" give the child no information. It may be true that he must sometimes do something "because Daddy said." But too many responses like this can squelch his curiosity and creativity....give answers?A short explanation accepts her question and acknowledges your ability to answer. "We wear seat belts because it's safer and the law says to." It's also all right to tell her, "I don't know!" ...invite the child to find answers? Your response can encourage higher-order thinking. Depending on the question and the child's age, you might: Suggest ways to look for answers (reference books, the Internet, an expert, an experiment). "I wonder about Navy Pier, too. Let's look it up in ___." Invite her to brainstorm with you. "I don't know the answer. Let's write down some possibilities." When you brainstorm, don't throw away any ideas. (That's the next step.)

http://illinoisearlylearning.org/tipsheets/curiouschild.htm



Structure interactions with child based on “best” potentialBest time of day

for the parent for the child

morningafter napbedtime routine

Best activity - accommodatesparent’s symptomschild’s likes/developmental stage


StrategiesSituation: Child wants parent to attend their (name sport here) game.Parent is unable to tolerate crowds, loud noises, or closed in spaces.Possible solutions:


StrategiesSituation: Child wants parent to attend their (name sport here) game.Parent is unable to tolerate crowds, loud noises, or closed in spaces.Possible solutions: attend practicewatch game day video with childask about access to a press box or private box that minimizes the effects of crowd or noise


StrategiesSituation: Child wants to go to Chuck E Cheese with parent like before.Parent is unable to tolerate crowds or loud noises.Possible solutions:


StrategiesSituation: Child wants to go to Chuck E Cheese with parent like before.Parent is unable to tolerate crowds or loud noises.Possible solutions: call the manager and ask when is the least crowded time to comepick a new restaurant that is quieter but still a special treat for parent & child


StrategiesSituation: Child wants to “rough house” with parent like before the deploymentParent is agitated by physical contact.Possible solutions:


StrategiesSituation: Child wants to “rough house” with parent like before the deploymentParent is agitated by physical contact.Possible solutions: identify new physical activities where contact is controlled or predictable and parent is able to toleratefind physical activities that minimize physical contact but provide time together


StrategiesRe-assign parent and child activitiesService member parent could: Take child to library – routine, enjoyable event, quiet environmentWalk child to school in the mornings (even park car a block away and walk the last bit to avoid car congestion)Adjust nap time so toddler is waking up when parent available to play quietly or share snack time


My Child Psychologisthttp://mychildpsychologist.com/articles/ Welcome to MyChildPsychologist.com’s original articles. Dr. Dawn Koontz and Dr. Catherine Judkins write commentaries and summaries on anything child-related, most often issues related to child psychology. Please browse our entries! Dr. Dawn Koontz and Dr. Catherine Judkins are licensed clinical psychologists who received their graduate and clinical training in child and adolescent psychology

19 Really Cheap Activities for Summer Fun with the Kids Bedtime and Sleep Problems Managing Increased Independence in Toddlers

http://mychildpsychologist.com/articles/

http://mychildpsychologist.com/2012/04/06/19-really-cheap-activities-for-summer-fun-with-the-kids/

http://mychildpsychologist.com/2012/03/23/bedtime-and-sleep-problems/

http://mychildpsychologist.com/2012/02/24/friday-funnies-managing-increased-independence-in-toddlers/


Kids Growthhttp://www.kidsgrowth.com/resources/articledetail.cfm?id=1796

20 reasons why your child needs you to be an active father

Fathers play a critical role in the development of their children; however, many fathers are uncertain about the responsibilities and privileges associated with this role. Children need fathers who love and care for them on a consistent basis. The latest research indicates that fathers who are actively involved in raising their children can make a positive and lasting difference in their lives. In contrast, this same research reveals a number of potentially negative outcomes for children whose fathers are not involved. Listed below are 20 reasons why your child needs you to be an active father.

http://www.kidsgrowth.com/resources/articledetail.cfm?id=1796

Reconstructing Bonds: Forming Attachments in the Aftermath of War Joan K Vanderlaan BSN, MN .

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