Raising Kids Who Have High and Complex Needs – The Importance of Self Care

Raising children who have high and/or complex needs, such as those who have developmental and medical conditions, a disability, and those who are recovering from family trauma, presents a set of stressors that can be poorly understood by others, including other family members, and leave you feeling overwhelmed and unsupported.

This is often compounded by feelings of guilt and shame about those times and situations when you don’t feel at your best and perform at your best in the caregiving role.

Raising children who have high and/or complex needs is a tough gig. It can leave you feeling like a failure. It can distort your perception of yourself and the child in your care.

It is important to consider the role and importance of wellbeing when caring for children with high and/or complex needs. In a state of wellbeing we:

  • think at our best
  • feel at our best
  • perform at our best.

This is illustrated in the diagram below, representing Yerkes-Dodson’s Law (1908), which also shows that in a state of distress – that is, when our nervous system is too highly activated – we are incapable of performing at our best in any task or role that we undertake; including caregiving. The consequence of not performing at our best is further shame and distress, which compounds the problem.



©Colby Pearce

Achieving and maintaining a state of wellbeing when raising a child with high and/or complex needs is vital. There are many suggestions and methods about how this might be achieved, but my concern is that they often involve activities that the already overwhelmed parent or caregiver finds hard to implement. If it is hard to implement, it will not get done!

In my programs, including the Triple-A Model of Therapeutic Care and the CARE Therapeutic Framework, I favour a less demanding approach to achieving and maintaining wellbeing that is based in what we know from science about how our thinking works.

In life, we are only consciously aware of a proportion of the information that our brain registers via our sensory inputs. That is, we selectively attend to certain aspects of our experience and environment, and miss other (equally obvious) aspects of our experience and environment. This is well-demonstrated in the video below, which represents the work of Simons and Chabris (1999) on selective attention:

There is a filter at work. The filter is our thoughts. We selectively notice those aspects of our experience and environment that are consistent with our thoughts, and overlook those aspects that are not. For another example of what I am referring to, think about what happens when you buy a new car, or a coat in a certain style, or have your hair cut a certain way. You see a lot of the same car, coat or hair style; right? You also don’t notice (that is, pay attention to) cars of a different make and model, other types of coat, or other hair styles.

So, if our thoughts influence what we notice about our experience and environment, it is important to consider the following. Have a look at the image and think about what stands out for you.

When I show this to various audiences they almost always respond that the simple arithmetic equation in the bottom left hand corner is wrong. 4+4 does not equal 9. They do not comment that nine out of ten equations are right. That is, our brains appear to look for problems to solve and overlook what is right.

This is not unique to you who are caring for a child with high and/or complex needs. We all have a tendency to do this.

However, if you put this in a parenting context, where you are raising a child with high and/or complex needs you are vulnerable to noticing a lot of problems and missing the things that are going right; both in terms of your performance of the role and the gains the child is making.

This selective focus on problems to solve is unhelpful and self-defeating when raising a child with high and/or complex needs. It can leave you overwhelmed with problems to solve, thereby undermining your wellbeing and capacity to solve them. Even worse, it can also impact on how the child sees themself.

It is important to get better at noticing the things you already do that help the child with high and/or complex needs, and the signs that they are benefitting from your endeavours on their behalf. In doing so, I anticipate that you will experience feelings of wellbeing that sustain you through tough times and support your best endeavours on behalf of the child in your care with high and/or complex needs.

In the Triple-A Model of Therapeutic Care and the CARE Therapeutic Framework we support carers to pay closer attention to the things they already do that help, and the signs of progress and recovery in the children they are caring for.

For more information about our programs, or to discuss an implementation project, contact me at colby@securestart.com.au.

References:

Simons, D & Chabris, C (1999). Gorillas in Our Midst: Sustained Inattentional Blindness for Dynamic Events. Perception. 28. 1059-74.

Yerkes R.M. and Dodson J.D. (1908) The relation of strength of stimulus to rapidity of habit-formation”. Journal of Comparative Neurology and Psychology18: 459–482. 

Posted in AAA Caregiving, Adoption, Attachment, kinship care, Parenting, Schools, Training Programs, Trauma, trauma informed, trauma informed care, trauma informed practice, Trauma Informed Schools, Wellbeing | Tagged , , , , , , , , , | Leave a comment

How does parenting influence attachment: The CARE Model

Consider infants. They are not born with a sophisticated language system. They cannot successfully be reasoned with about who their parents are and, therefore, who they should form an attachment to, and who not to. Rather, they form an attachment to the person or persons who they experience to care for them, physically and emotionally, on a continuous basis. A key concept here is what infants experience.

In the same way that infants’ attachment to their primary attachment figure(s) develops in association with their experience of who cares for them, the type of attachment relationship or attachment style is very much dependent on infants’ experience of the care they receive. That is, an infant’s attachment style is strongly influenced by the type of care they receive. By care, I refer to how consistent, accessible, responsive and emotionallyconnected infants experience their primary attachment figure(s) to be:

  • Consistency
  • Accessibility
  • Responsiveness
  • Emotional- Connectedness.

Consistency

In the 1930s psychologist B.F. Skinner developed an apparatus to study the conditions under which our repertoire of behaviour develops. Referred to later as the Skinner Box (Skinner, 1948), the box-like apparatus incorporated a button or lever that electronically controlled the release of food into the box via a feed chute. In his original experiments, Skinner used rats or pigeons, which were placed into the Skinner Box and studied for what they learnt about accessing food by pressing the button or lever.

Skinner hypothesised that behaviours become learnt and integrated into our behavioural repertoire when, in the performance of the behaviour, a desired outcome is achieved. He referred to this desired outcome as reinforcement (Skinner, 1938).

Skinner’s first task was to determine whether rats and pigeons could learn what was required to access food in a novel environment (i.e. the Skinner Box). He discovered that they could. He then began to study the learning process the animals went through under different reinforcement conditions (Ferster and Skinner, 1957).

First, Skinner randomly allocated a new group of animals to one of three learning conditions. In condition one the animals received a food reward for each and every press of the button or lever in the Skinner Box. Skinner referred to this condition as continuous reinforcement and the animals received food on a consistent basis. The animals in this condition were the quickest to learn that they could access food by pressing the button or lever, but pressed the button or lever at a slower rate than the animals in the second condition.

The animals in the second condition received a food reward inconsistently, such as on the first, third or even fifth time they pressed the button or lever. It was unpredictable. Skinner referred to this condition as intermittent reinforcement. The animals in this condition were slower to learn that they could access food by pressing the button or lever than the animals in the continuous reinforcement condition. In contrast to the animals that received a food reinforcement on a consistent basis, the animals in the intermittent reinforcement condition were more active in pressing the button or lever and spent more time doing so, reflecting an apparent understanding that the button or lever could not always be relied upon for the delivery of food.

The animals in the third condition never received food for pressing the button or lever. These animals did not incorporate pressing the button or lever into their behavioural repertoire, as it never led to a desired outcome. In effect, they never learnt that they could rely on the button or lever for food.

What has all this got to do with human infants, I hear you ask? Well, what Skinner demonstrated in his experiments using the Skinner Box is that the optimal condition for learning is one where an action is consistently followed by a desired outcome. That is, what human infants learns about how dependable their attachment figures are for satisfaction of their needs is dependent on how consistently they receive a satisfying, caregiving response to their cues and signals.

Accessibility

‘Accessibility’ means that the parent is present and available, physically and emotionally, to the infant and child (Delaney, 2006). Harlow’s monkeys fared relatively better when they had reliable access to a warm mothersurrogate that offered them contact comfort. Having access to this important source of needs provision appeared to play an important role in buffering against the emotionally harmful and behaviourally restricting effects of stressful situations. The same is true of human infants who have yet to learn that their attachment figure continues to exist and be accessible when they do not have direct sensory experience of them.

To fully appreciate the importance of accessibility it is helpful to consider the concepts of ‘object constancy’ and ‘object permanency’ (Bower, 1967; Piaget, 1954). In the early part of the first year, infants appear to believe that the only things that exist are what they can see, hear, smell, touch or taste at that moment. When something is removed from their sensory experience, it is as if it ceases to exist. When the same object is re-presented to the infants they react as if it is the first time they have ever seen it. This may, in part, explain an infant’s distress when a warm and interactive carer leaves the room and their interest in (but not necessarily recognition of) the caregiver who returns to the infant. As the first year progresses, infants increasingly recognise stable properties or characteristics of persons and objects with whom they interact on a continuous and consistent basis (object constancy). That is, infants increasingly recognise continuously existing people and objects based on the continuity and consistency of the infant’s experience of them. Certain people and objects become familiar aspects of the infant’s world with stable and predictable characteristics and qualities. Most often, this is reassuring to infants, as it represents an emerging capacity to perceive their world as consistent and predictable. Other people and objects are less predictable or have predictable characteristics that invoke distress in infants.

Hand in hand with the concept of ‘object constancy’ is the related concept of ‘object permanence’. In association with the process by which infants recognise certain people and objects as having stable and recognisable properties based on their continuous experience of them, infants develop the capacity to form a mental picture of an object or person that is independent of their direct sensory experience of the person or object. This further reinforces the infant’s sense of the continuous existence of the person or object independent of sensory experience of them (object permanence). This can be a source of comfort and reassurance to infants, allow them to explore their physical world without anxiety and promote their tolerance of separations. It also has wide and lasting implications in terms of how infants relate to people and objects with whom they come into contact through their exploration and experience.

In order for infants and small children to fully develop a belief in there being a person (or persons) who satisfies their needs and helps them cope with the world, that person (or persons) needs to be a continuous and consistent feature of the infant’s life; that is, accessible to them.

Responsiveness

Remember the tale of four mice at the beginning of this book? The tale of the fourth mouse reflects further experiments conducted by Skinner, in which animals placed in the Skinner Box were subject to painful electric current that could only be turned off by pressing the lever. Skinner observed that the animals learnt that they could switch off the electrical current in this way, usually by jumping around until they accidently pressed the lever. In much the same way, in usual circumstances infants learn about the extent to which they can depend on their caregivers to alleviate their distress by way of the response of their caregiver to the infant’s distress.

Responsiveness refers to a process by which the attachment figures sensitively, accurately and directly addresses the needs of the infant (Delaney, 2006). Responsiveness involves the attachment figure observing the infant, the context and the infant’s signals, and responding to the infant’s needs with understanding. Consistency is an important determinant of the infant’s experience of the responsiveness of their attachment figures. Responsiveness plays an important role in shaping the infant’s mental representation of what a caregiver is and what can be expected of a caregiver. Consistency, accessibility and responsiveness are interrelated aspects of the infant’s experience of CARE. The infant’s experience that needs are consistently understood by an accessible attachment figure promotes feelings of wellbeing and dependency on the attachment figure. Experiences of understanding that arise under conditions of parental responsiveness promote experiences of self-worth and wellbeing that act as a powerful buffer against distress that can arise in conditions of adversity.

Emotional-Connectedness

The fourth aspect of the infant’s experience of CARE that plays an influential role in the development of attachment relationships and attachment style relates to the infant’s experience of emotional connectedness to their attachment figures. This is commonly referred to in the attachment literature as affective attunement and describes the process by which attachment figures tunein to the expressed emotion of the infant and reflects the same or a very similar emotion back to the infant. This connection to the infant’s emotional experience is communicated by attachment figures through tone of voice, facial expression and gesture. It is readily observed during playful interactions and when the infant is distressed. This shared emotional experience is not merely pretended by the attachment figure. Rather, through tuning in to the emotions of the infant the attachment figure experiences an instinctive and congruent emotional response; much like when you cannot help laughing at the laughing baby video, or tearing up in response to distress in a loved one. That these episodes of emotional union between infant and attachment figure(s) occur is supported by research that tracked the heart-rate curves of mothers and infants during play and found that they parallel each other(Reite and Fields, 1985). Heart-rate is considered to be a sign of physiological arousal and changes in arousal are a key component of emotional experience (Livingstone and Thompson, 2009). Affective attunement is not considered a one-way process, as even very young infants tune in to the expressed emotion of the attachment figure. This is vividly illustrated in the so-called ‘still-face experiments’ (Tronick et al, 1978) whereby, after a short period of playful interaction with their five-month old baby, mothers were instructed to adopt a ‘dead-pan’ expression. The infants immediately recognised this change and were distressed by it, only for their distress to be relieved a short time later when the mother tuned in to their distress, thereby re-establishing a connection, and returned to happy, playful interaction.

Through repeated attunement experiences, children’s emotions are validated and regulated through the responsiveness of the caregiver, thus promoting children’s experience and perception of emotional connectedness with others and facilitating the safe exploration of a range of emotions, emotional self-awareness and, later, a capacity for empathy.

As mentioned earlier, the type of attachment infants form to their primary attachment figures is strongly influenced by their experiences of CARE. Securelyattached infants have experienced their primary attachment figures as consistent, and as consistently accessible, responsive and emotionally connected. Insecure-avoidant infants are most likely to have experienced their primary attachment figures as inconsistent, distant, unresponsive and emotionally unavailable. Insecure-ambivalent infants are most likely to have experienced their primary attachment figures as inconsistent, inconsistently accessible and responsive and overly reactive to the infant’s distress. Disorganised infants are most likely to have experienced their primary attachment figures as inconsistent, inaccessible, unresponsive, emotionally disengaged and the source of fear and distress.

Source: Pearce, C. (2016). A Short Introduction to Attachment and Attachment Disorder – Second Edition. London: Jessica Kingsley

For more information the CARE Model and its relationship with attachment and attachment disorders, continue reading via A Short Introduction to Attachment and Attachment Disorder (Second Edition), details of which can be accessed via the link or by clicking on the image below.

Colby Pearce - Attachment

References

Bower, T.G.R. (1967). The development of object-permanence: Some studies of existence constancy. Perception and Psychophysics, 2(9): 411-418

Delaney, R.J. (2006). Fostering Changes: Myth, Meaning and Magic Bullets in Attachment Theory. Oklahoma: Wood ‘N’ Barnes

Ferster, C.B. and Skinner, B.F. (1957). Schedules of Reinforcement. New York: Appleton-Century-Crofts

Livingstone, S.R. and Thompson, W.F. (2009). The emergence of music from theory of mind. Musicae Scientae – Special Issue 2009-2010, 83-115

Piaget, J. (1954). The Construction of Reality in the Child. New York: Basic Books

Reite, M. and Fields, T. (eds) (1985). The Psychobiology of Attachment and Separation. Florida: Academic Press

Skinner, B.F. (1938). The Behavior of Organisms: An Experimental Analysis. New York: Appleton-Century

Skinner, B.F. (1948), Superstition in the pigeon. Journal of Experimental Psychology, 38, 168-172.

Tronick, E., Heidelise, A., Adamson, L., Wise, S. and Berry Brazilton, T. (1978), The Infant’s Response to Entrapment Between Contradictory Messages in Face-to-Face Interaction. Journal of the American Academy of Child Psychiatry, 17 (1), 1-13

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What is Attachment Disorder?

Over the last three decades, the term ‘attachment disorder’ has entered into common usage among professionals and carers who interact with children who display markedly disturbed and developmentally inappropriate relatedness to others. With greater awareness of the consequences of attachment disruption has come endeavours to develop interventions for children who have an attachment disorder and supports for those who care for them. In any such endeavour it is important that the children involved are representative of the condition. This allows for the development of specific interventions that can be tested for their effectiveness without the potentially confounding influence of children who do not have the condition being included in the recipient client group.

In the fifth and latest edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) (American Psychiatric Association, 2013) two diagnoses are relevant to the discussion of what an attachment disorder is, what it looks like and when the diagnosis should be used. The first diagnosis is Reactive Attachment Disorder (RAD). RAD might be considered when children show limited dependency on others for comfort, support, protection and nurturance, and limited response to comfort from an adult in a caregiving role. That is, these children are observed to be inhibited, emotionally withdrawn and inordinately self-reliant. Children with RAD must also show disturbances of emotion and emotional responsiveness to others. They are prone to unexplained irritability, sadness and fearfulness, even during nonthreatening interactions with adult caregivers, and are not readily comforted by adult caregivers.

A second diagnosis, Disinhibited Social Engagement Disorder (DSED), is also relevant to any discussion of attachment disorders. DSED might be considered when a child displays culturally inappropriate, overly familiar behaviour with relative strangers. They may display reduced or absent reticence to engage or even go off with unfamiliar adults, overly familiar verbal and physical behaviours and diminished or absent checking back with an adult caregiver, including in unfamiliar situations. Whereas children with RAD appear to avoid dependency on others, children with DSED treat everyone as if they are a potential source of care.

Notwithstanding the differences in the presentation of children that might be diagnosed with either of these disorders, there is a common feature. The condition is understood to have arisen as a result of grossly deficient care, as evidenced by at least one of the following:

  • A persistent lack of having basic emotional needs for comfort, stimulation and affection met by caregiving adults;
  • Repeated changes of primary caregiver, with limited opportunity to form stable, selective attachments (as happens with frequent changes in foster-care arrangements); or
  • Rearing in settings that severely limit opportunities to form selective attachments (as happens in institutional care environments with high child-to-caregiver ratios).

Source: Pearce, C. (2016). A Short Introduction to Attachment and Attachment Disorder – Second Edition. London: Jessica Kingsley

For more information about attachment disorders, including about the conditions under which is arises, therapeutic re-parenting, and treatment, continue reading via A Short Introduction to Attachment and Attachment Disorder (Second Edition), details of which can be accessed via the link or by clicking on the image below.

Colby Pearce - Attachment

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What is Attachment?

‘Attachment’ is a term used to describe the dependency relationship children develop towards their primary caregivers. In ordinary circumstances, an infant’s emerging attachment to their primary caregivers begins to show during the latter half of their first year post-birth, and develops progressively over the first four years. It is most readily observed when children are sick, injured, tired, anxious, hungry or thirsty, and at reunion after temporary separations (Bowlby, 1969; Ainsworth et al, 1978).

Although early attachment research focused on the mother–infant dyad, it is now generally accepted that children form multiple attachment relationships. An ‘attachment figure’ is defined as someone who provides physical and emotional care, has continuity and consistency in the child’s life, and an emotional investment in the child’s life (Howes et. al., 1999). This can include parents (biological, foster, adopted), grandparents, siblings, aunts and uncles, and alternate caregivers (e.g. child-care workers).

Given that children are able to form multiple attachments, the question has been asked as to which attachment relationship is most influential on children’s developmental outcomes. The literature provides considerable support for an integrative model of attachment: that is, children’s social–emotional development is best predicted by their network of attachment figures rather than by a single attachment relationship per se. (Howes, 1999).

What is Attachment Theory?

Attachment Theory is the term used when referring to knowledge about attachment. Attachment Theory has developed across more than half a century in association with observations made of children interacting with their caregivers and associated scientific endeavour. Attachment Theory represents an integration of observation and scientific endeavour, and reflections about this.

During the 1930s and 1940s, psychoanalyticallyoriented clinicians in the United States and Europe were making observations of the illeffects on personality development of prolonged institutional care and frequent changes of mother-figure during infancy and early childhood. Among them was John Bowlby, a psychiatrist who, prior to receiving his medical training, studied developmental psychology (Bretherton, 1985).

At this time the most popular thinking among psychoanalyticallyoriented clinicians was that infants’ goal-directed behaviour was governed by two kinds of drive: primary and secondary. The alleviation of hunger and thirst was thought of as a primary drive and, therefore, as one of the main determining factors in the infants’ goal-directed behaviour. As such, infants were considered to form a close bond to their mother because she feeds them. Relational aspects of the infant-mother interaction (referred to as ‘dependency’) were considered to be secondary drives and, therefore, of secondary importance in the infant-mother bond.

Bowlby believed that this did not fit with his observations of institutionalised children. For if it were true, infants of one or two years of age would take readily to whomever fed them – that simply being fed would be sufficient for the development of a close bond between infants and their primary caregiver – and this was not what was being observed. It was also inconsistent with emerging scientific evidence from animal studies, including the work of Harry Harlow (1958).

Harlow separated infant rhesus monkeys from their mothers within 6–12 hours of birth and raised them with the aid of two forms of ‘mother surrogate’. One was shaped out of wire, whereas the second was shaped from wood and wrapped in towelling to make it soft. Both were warmed by an electric light globe positioned behind the mother surrogate. The main difference was softness. Infant rhesus monkeys were raised with the aid of the two mother surrogates in different combinations. In one combination, infant rhesus monkeys had access to both forms of mother surrogate, but only the wire mother surrogate fed it via an artificial teat from which it could nurse. In another combination, infant rhesus monkeys had access to both mother surrogates but were fed by the cloth-covered mother surrogate only. In both combinations, infant rhesus monkeys demonstrated a clear preference for the soft, cloth-covered mother surrogate, regardless of whether it fed them, spending up to 18 hours per day clinging to the soft mother surrogate. Similarly, when exposed to a fear-evoking situation or stimulus, the infant rhesus monkeys that were raised with both forms of mother surrogate would rush to the soft mother surrogate for comfort, regardless of whether it ‘fed’ them or not. In addition, Harlow’s research demonstrated that those infant rhesus monkeys that spent the early weeks of their life without a soft mothersurrogate that they could cling to showed marked disturbance in their emotions and behaviours, which was only ameliorated by the introduction of the soft mothersurrogate. Further, all infant rhesus monkeys displayed an apparent attachment to a heated gauze pad placed in the bottom of their cage and became distressed when it was removed for cleaning. Harlow’s research clearly demonstrated the pre-eminence of that most basic quality of the caregiving relationship, contact comfort, over physical nourishment in the development of the infant-mother bond.

Consistent with such contemporary challenges to the popular thinking among psychoanalyticallyoriented clinicians, Bowlby began to formulate a new theory that recognised the primary influence of relational variables in the development of the infant–mother relationship, and of the relationship itself on the successful adaptation of the young child to life. Relying heavily on naturalistic observation, but also drawing on the results of scientific research, Bowlby developed what we now know as ‘Attachment Theory’.

Among his associates at the Tavistock Clinic in London in the early 1950s was Mary Ainsworth. Her prior interest was in ‘security theory’, which proposed that infants and young children need to develop a secure dependence on their parents before launching into unfamiliar situations. Through observational studies of mothers and their infants in Uganda and the United States, and her later studies using an experiment called ‘the strange situation’ (which is discussed later in the chapter), Ainsworth made a significant contribution to the classification of different types of attachment, and the identification of the pivotal contribution of the mother’s sensitivity to her infant in the development of attachment patterns (Ainsworth et al., 1978) .

Source: Pearce, C. (2016). A Short Introduction to Attachment and Attachment Disorder – Second Edition. London: Jessica Kingsley

For more information about attachment, including about the attachment patterns identified by Ainsworth and others via the Strange Situation protocol, how parental care influences the attachment patterns and how attachment influences outcomes for children, continue reading via A Short Introduction to Attachment and Attachment Disorder (Second Edition), details of which can be accessed via the link or by clicking on the image below.

Colby Pearce - Attachment

References

Bretherton, I. (1985). Attachment Theory: Retrospect and Prospect. In I. Bretherton and E. Waters (eds), Growing points of attachment theory and research. Monographs of the Society for Research in Child Development, 50 (1-2), 3-35.

Harlow, H.F. (1958), The nature of love. American Psychologist, 13, 673-685.

Ainsworth, M, Blehar, M, Waters, E. and Wall, S. (1978). Patterns of Attachment: A Psychological Study of the Strange Situation. New Jersey: Laurence Erlbaum and Associates

Bowlby, J. (1969). Attachment and Loss – Volume I: Attachment. New York: Basic Books

Howes, Hamilton and Althusen (in press), cited by Howes, C. (1999). Attachment Relationships in the Context of       Multiple Caregivers. In J. Cassidy and P. R. Shaver (eds). Handbook of Attachment: Theory, Research and Clinical Applications (pp.671-687). New York: The Guilford Press.

Howes, C. (1999). Attachment relationships in the context of multiple caregivers. In J. Cassidy & P. R. Shaver (eds). Handbook of attachment: Theory, research and clinical applications (pp. 671-687). New York: The Guilford Press.

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Parenting

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Use Your Words: Supporting Expressive Language Development and Use

“Use your words” is an oft-used statement among parents of young children who are taking their first steps in using language to communicate. Using their words is an important part of children developing their expressive language skills, and their socialisation.

As a very young infant, a child’s capacity to express themselves is limited to crying and, shortly thereafter, smiling. As the child grows, they develop and use a range of gestures and behaviours to communicate with others about their experience. Increasingly, they babble with communicative intent. Later, they use speech.

A child’s use of these methods of communication, and their developmental progression to formal speech, is influenced by two key factors:

  1. Whether their efforts to communicate are met with an understanding response from adults in a caregiving role; and
  2. Modelling of the use of expressive gestures and speech by their carergiver(s).

In a conventional nurturing care environment, an infant’s caregiver(s) spends a lot of time considering and responding to the following question: What is going on for baby? Applied consistently, the infant has the experience that their experience is understood, important and will be addressed by their caregiver(s). This encourages the infant to express themselves and trust in the sensitive responsiveness of their caregiver(s).

In a conventional nurturing care environment, an infant’s caregiver(s) speak and gesture in a manner that reflects their understanding of What is going on for baby. That is, they reflect back the infant’s emotions and model the use of gestures that communicate the infant’s experience and intentions. Importantly, they also use words that go with the infant’s experience.

If you are unsure of what I am referring to, consider a person in your family who has a pet (usually a dog or cat), or even yourself, if you have one. Do you/they speak to your/their pet as if the pet were speaking to you/them. Do you/they speak their mind? I find that people I speak to about this generally identify with doing this. That is, we speak to our pets using words that they cannot themselves use to express themselves.

Getting back to the young child, in a conventional nurturing care environment where their caregiver(s) models communication and responds consistently to the child’s efforts to communicate, the infant learns what goes with what and uses their learning. For example, they learn to point at objects of interest or those that are desired after seeing their caregiver(s) modelling this for them. They learn to clap when they are proud of themselves. Importantly, they learn what words go with what experience, such as learning what feeling words go with each feeling, in response to their caregiver(s) putting their feelings into words (You are happy! You are sad.).

So, when an adult in a caregiving role says to them “use your words”, a child who has experienced conventional nurturing care will have the words and the trust in the responsiveness of adults in a caregiving role that supports their use of words to communicate about their experience.

What happens, then, among children who have not experienced conventional nurturing care during the early developmental period, such as having an adult who consistently responds to them in a way that supports their understanding and use of language to communicate about their experience? At least two things:

  1. These children have a limited vocabulary for expressing themselves (often referred to as poor ‘inner-state-language’); and
  2. Their use of language to express themselves is restricted, both by limited language development and low expectations of the understanding and responsiveness of adults in a caregiving role.

Among children who have had a tough start to life, we often refer to behaviour as their language. This is problematic for a range of reasons, not least because they chronically feel misunderstood by others. Too often, this results in fear and mistrust and (further) undesirable behaviour; responses to the latter compounding their fear and mistrust and experience of being misunderstood.

In order to support the use of words to communicate about their experience among children who have had a tough start to life we need to:

  1. Recognise that they are communicating about their experience via their behaviour; and
  2. Support the development of their inner-state-language by speaking their mind.

This starts with a question. But it is the only question you must ask. You ask it to yourself. You ask: What is going on for the child; right here, right now? Then you say the answer. You say what you see. In doing so, you are filling in the gaps in the child’s experience, whereby you are helping them with words that go with their experience, and modelling their use.

You say it as a statement, preferably of 10 words or less. A statement facilitates for the child the experience of being heard and understood. Trust flows from this, and the child is more likely to communicate with you thereafter using newly acquired words. A question about the child’s experience, on the other hand, is experienced by the child as you not knowing what their experience is and compounds their experience of being unheard and misunderstood.

So, when you are communicating with a child who is recovering from a tough start to life and you find yourself wanting to ask them a question about their experience or wanting to tell them to use their words, pause for a moment. Think about what the child would say, if they had the words or would use them. Say the answer.

Use your words.

For more information about my programs that support expressive language development and use among children who are recovering from a tough start to life, engage me to deliver a training program or access my books and resources.

Colby Pearce - Attachment
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Kinship CARE Project Term 3 Sessions

Visit the Kinship CARE Project Page for more information and to register.

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We Love Collaborating

Secure Start® is looking to collaborate with organisations who share our vision of supporting happy, connected children.

Our recent and ongoing collaborations include:

The implementation of the Triple-A Model of Therapeutic Care in Donegal, Ireland. In its fourth year, the Triple-A implementation is a collaboration of Secure Start and TUSLA (The Child and Family Agency). The implementation has reached 50+ child protection and out-of-home care staff and upwards of 120 foster carers. The implementation continues via twelve local trainers, including six foster carers.

The Kinship CARE Project. In its second year, the Project is a collaboration of Secure Start and the Department for Child Protection in South Australia. So far, 50+ kinship care support workers and approaching 200 kinship carers have received training in the CARE Therapeutic Framework.

The development of trauma-informed resources for Goodstart Early Learning. One of our most recent and exciting collaborations was one in which we recently designed and produced resources for trauma-informed practice in the areas of childhood trauma, physical abuse, and neglect, for Goodstart’s 648 early learning centres around Australia.

At Secure Start, we have considerable expertise in:

  • Program development and implementation
  • Program evaluation
  • Content writing
  • Consultation
  • Supervision.

Past collaborations include:

  • Adelaide to Outback GP Program – Supervision
  • Adelaide Northern Division of General Practice – 0-12 Psychology Clinic
  • Mark Oliphant College – Psychology Clinic
  • University of South Australia – Psychology Training Clinics

For more information, and to discuss a potential collaboration, email me at colby@securestart.com.au.

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The CARE Therapeutic Framework

The CARE Therapeutic Framework is an evidence-informed framework for understanding what key experiences children need to have to grow up happy, healthy, and well-adjusted, and achieve their developmental potential.

Drawn from psychological science, the CARE Therapeutic Framework was first published as a conceptual model in the Second Edition of A Short Introduction to Attachment and Attachment Disorder.


The CARE Therapeutic Framework represents what is the desired therapeutic environment promoted in the Triple-A Model of Therapeutic Care; the author’s therapeutic foster care program that is currently in its fourth year of implementation among TUSLA general and relative foster carers in Donegal, Ireland. Recently, Triple-A received favourable mention in a report by the independent inspection authority for health and social care services in Ireland*.

(*see HIQA Monitoring Event No. 0020090, April 2018).

The CARE Therapeutic Framework is the stand-alone Model of Care for South Australia’s Kinship CARE Project and other Secure Start programs; including Child CARE, a program for long day care and early learning centres.

The CARE Therapeutic Framework places Connection are the centre of all endeavour for and on behalf of children. The CARE Therapeutic Framework recognises the central role played by connection in supporting physical and mental health and regulating behaviour. In addition, the CARE Therapeutic Framework seeks to enrich children’s experience of the consistency of their care environment and the accessibility, responsiveness and emotional connectedness of their caregiver(s) – the CARE Model.

The Care Therapeutic Framework is both a Model of Care and a Model of Practice. The CARE Therapeutic Framework incorporates complementary training for professionals who support caregivers of children. Caregiver fidelity to the Framework is supported by their own experience of CARE from professionals trained in the Framework.

The CARE Therapeutic Framework is a strengths-based approach that draws participants’ attention to conventional aspects of caregiving and relating that support optimal developmental outcomes for children.

The CARE Therapeutic Framework does not seek to replace other approaches. Rather, the CARE Therapeutic Framework offers a back-to-basics approach that forms a solid foundation to build on. As a strengths-based approach, the CARE Therapeutic Framework complements other strengths-based approaches.

The CARE Therapeutic Framework includes:

  • An embedded self-care framework
  • An evaluation framework.

The CARE Therapeutic Framework supports the development of a tailored therapeutic CARE Plan, for your setting and for individual children. CARE promotes trusting connections and growth!

The CARE Therapeutic Framework is suitable for:

  • Schools
  • Alternate Care Settings
  • Long day care and early learning centres

For a short introduction to the CARE Therapeutic Framework, please click here.

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Child CARE: Our New Program for long day care and early learning centres

What is Child CARE?

Child CARE is a four-session (plus optional call-back) interactive training program designed to support:

  • Wellbeing
  • Growth and development
  • Optimal behaviour
  • Recovery from adversity

Among children in early-learning and long day-care.

Child CARE offers a framework for understanding why children behave the way they do and how to establish a therapeutic care environment that supports growth and addresses factors that give rise to common behaviours of concern.

CARE stands for:

  • Consistency
  • Accessibility
  • Responsiveness
  • Emotional Connectedness

Children need CARE!

What does the Child CARE program offer?

The Child CARE program facilitates the development of a tailored therapeutic CARE Plan for your setting and for individual children.

What is involved?

  • Five interactive workshops (including call-back)
  • An embedded self-care framework
  • An evaluation framework
  • An optional call-back addressing the management of ongoing behaviours o concern using CARE.

Each two-hour, interactive workshop includes:

  • Practical activities and demonstrations
  • Audio-visual content
  • Individual and group reflection activities

What does it cost*?

Standard implementation (excluding call-back):

$4,950 (GST inclusive)

Full implementation (including call-back):

$5,500 (GST inclusive)

*Additional costs may apply for implementations outside Adelaide  metropolitan area.

Key Contacts:

Georgina Johnson (Relationships Manager):

georgina@securestart.com.au

Rebecca Pearce (Practice Manager):

admin@securestart.com.au

Trainer: Colby Pearce

Colby Pearce - Attachment

Our principal Clinical Psychologist, Colby is well-known in Australia, the United Kingdom, and Ireland for his informative books and programs. He is also regarded as a lively and accomplished presenter.

View and download the pamphlet here.

Posted in AAA Caregiving, Adoption, Attachment, Children's Behaviour, Fostering, kinship care, Parenting, Training Programs, trauma informed, trauma informed care, trauma informed practice, Trauma Informed Schools | Tagged , , , , , , , | Leave a comment