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SNT 1 Terminology and Diagnoses © 2013 Deborah A. Beasley, All rights reserved Terminology and Diagnoses Disorders and Special Needs This training is about treating and parenting difficult, severe behaviors in adopted, fostered, and special needs children, yet it is equally a work about love and healing the parent/child relationship in the most challenging of circumstances, including long-term effects of developmental and situational trauma. We view the list of disorders below in terms of the frequency and intensity of manifested symptoms within each diagnosis. Symptoms sometimes present with profuse ranges of co-morbid conditions and behaviors, and eventually may simplify to include symptoms and traits of a prominent condition or cluster of conditions. Disorders listed below are not the sum of diagnoses for childhood disorders or disabilities that influence behavior; however, I believe these are common disorders coaches and therapists face in their work with special needs children, and parents face with their child. ADD - Attention Deficit Disorder ADHD - Attention Deficit Hyperactivity Disorder OCD - Obsessive Compulsive Disorder ODD - Oppositional Defiant Disorder PDDNOS - Pervasive Developmental Disorder Not Otherwise Specified (Note that the newest edition of the Diagnostic Manual has removed the determination of NOS from all diagnoses) AS - Asperger’s Syndrome ASD - Autism Spectrum Disorder GAD - Generalized Anxiety Disorder Social Anxiety Disorder Separation Anxiety IC - Impulse Control Disorder PICA – Craving for and eating non-food, such as dirt, paper, detergent, drywall, sand, etc. Hoarding Disorder - Newly classified disorder Other Eating Disorders Page 1 of 6 SNT 1 Terminology and Diagnoses © 2013 Deborah A. Beasley, All rights reserved BP - Bipolar BP SPECTRUM SPD - Sensory Processing Disorder Intermittent Explosive Disorder CD - Conduct Disorder SM - Selective Mutism AD - Attachment Disorder RAD - Reactive Attachment Disorder NSSI - Non-Suicidal Self-Injury – cutting, pulling out of hair, eye lashes, eyebrows, etc. (Note: Newly classified disorder) PTSD - Post Traumatic Stress Disorder (Note: First time criteria for a subtype of PTSD for children 6 years old and younger, with criteria for adolescents and adults). Each disorder listed above has a relational, developmental, and environmental factor in common, which contributes to the disintegration of body, mind, or emotional function. Open Heart parenting equally utilizes relational, developmental, and environmental factors to integrate body, mind, and emotional function. Regardless of cause of the disorder or diagnosis, we approach all behavior and relational difficulties effectively using the Open Heart approach. The above list is not exhaustive. Affect –Regulation – The capacity for regulation of emotion (affect), as it relates to attachment, and stress modulation and is dependent upon the organized neuronal development of the right brain. Affect – Dysregulation – The incapacity to regulate emotion (affect), as it relates to relational and environmental stress, insecure or traumatic attachment. Attachment – Generally, an emotional bond developed through love, devotion, and affection and strengthened through fidelity and loyalty to a person, animal, cause, or thing. Parent/Child Attachment Healthy or maladapted attachment patterns form within the critical timeline of the first 3 5 years. The early templates of healthy or maladaptive attachment patterns create future internal models of organization/regulation or disorganization/dysregulation. Healthy attachment is the outcome of repeated, appropriate, solicitous, safe and loving care toward the child, meeting physical and emotional needs in a timely caring manner The timely meeting of the child’s needs allows development of appropriate levels of neuro-biological, and emotional regulation Page 2 of 6 SNT 1 Terminology and Diagnoses © 2013 Deborah A. Beasley, All rights reserved The parents ability to meet child’s needs, and the child’s experience of having needs met, forms the reciprocal attachment between caregiver and child Organized/Regulated - the result of the child’s ability to process thoughts, feelings, and emotions into conscious thoughtful actions. These responses provide us a window into the child’s ability to adapt and cope with everyday stressors. Behavioral responses are governed by the child’s ability to access their cognitive logical brain, thereby, overriding the negative impact of everyday stressors. Disorganized/Dysregulated - The result of the child’s inability to process thoughts, feelings, and emotions into conscious thoughtful actions. In this case, behavior reflects the unconscious, autonomic reactions initiated in the survival systems of the brain and body. These reactions provide us a window into the child’s inability to adapt and cope with everyday stressors. Continuum of Stress – a model of symptoms that occur when the mind and body have difficulty with or cannot integrate what it encounters in the environment. Stress – a shortened term for distress, or a neurophysiologic state of body/mind imbalance and overwhelm experienced by the child at an unconscious body level. Positive and negative behavior is the result of stress in the body/brain/mind system. Arousal States - the body/mind/brain reaction to positive and negative stress in the environment. Hypo (under) aroused – A neurophysiologic state of shut down or under responsiveness to a stimulus in the environment. Examples of hypo aroused behavior exhibit as withdrawn, flat affect (little or no emotional response), physically slow, uninvolved, disconnected, low energy Hyper (over) aroused – A neurophysiologic state of hyper responsiveness to a stimulus in the environment. Examples of hyper aroused behavior exhibit as the term implies; hyper, wild, giddy, into everything, poor attention, high energy Trigger - A trigger is a person, place, activity, emotional memory, perception, feeling, or thing, which elicits a strong neurophysiologic (brain/body) behavioral response in adults or children. The behavioral response may be positive or negative. As in, a pleasant memory which triggers warm feelings and a comforting smile, or seeing the picture of an abuser which triggers intense fear and internal alarm. Trauma - A single or repeated event, perceived by the mind and brain, and felt by the body, as life threatening and catastrophic, or perceived as a threat of bodily harm to the integrity of the person or another person (family member, child), witness to or victim of violence, or other emotionally shocking events. THE LIMBIC SYSTEM Page 3 of 6 SNT 1 Terminology and Diagnoses © 2013 Deborah A. Beasley, All rights reserved Brain structures involved in dealing with Fear, Stress, Trauma, and Survival. Intense behavior is the body’s attempt to release the sudden surge of energy flooding in from the endocrine system and the epicenter of fear, and regain balance and organization. Additional structures and systems comprise the whole brain, yet the limbic structures provide the system that integrates cognitive areas with sensory motor systems and these are important in understanding the origins of behavior. Flight, Fight, and Freeze – The ultimate body/brain survival response. The Brain on Fire! The flight, fight, and freeze response is a neurophysiologic sequence of interactions triggered and controlled by chemical signals in the brain when danger or threat is perceived in the environment, resulting in complex responses throughout the body and brain which cause the person to run away, freeze or hide, or prepare to fight for their life. Limbic System – The Life Preserver – Function of the Limbic System Organizes neurophysiologic (brain/body) life-saving responses to threats The limbic system, also called the primitive brain, governs all autonomic and primitive survival reactions. The limbic system is the Life Preserver of the body and mind in the high water of fear and trauma. Its sole function is to safeguard and preserve the integration of the whole person and personality. The components of the limbic system comprise a complex synergy of neural communication that protects physical, emotional, and psychological integrity during and after extreme distress, threat, trauma, and fear. Frontal Cortex – The Decision Maker - Function of the Pre-Frontal Cortex Specializes in higher levels of functioning that involve complex abilities of organization and regulation Sometimes called the new brain with functions to help govern personal and social behavior and inhibit impulsive or inappropriate behaviors that result in difficulties related to social interaction. Stephen Porges refers to the pre-frontal cortex as the Social Engagement System.i The pre-frontal cortex is responsible for critical executive functions such as, Determining actions (as through trial and error), Reconfiguring options to change one’s actions (adaptation and coping), And decision-making (choice), which affects goal-oriented behavior. The Pre-Frontal Cortex Influences memory, The ability for multi-tasking, Page 4 of 6 SNT 1 Terminology and Diagnoses © 2013 Deborah A. Beasley, All rights reserved Changing directional focus, or An ability to persevere when a task becomes difficult, rather than to throw ones hands up in futility. The frontal cortex also receives and processes visual information. Executive functioning additionally allows for the management and organization of stress and change in everyday life. The pre-frontal cortex is critically involved in the self-regulation of behavior. The pre-frontal cortex sits at the front of the brain.ii Amygdala - The Fire Alarm - Function of the Amygdala The amygdala is the epicenter of the root emotion of fear. It is a primal and subconscious alert mechanism, which continuously scans the environment and initiates the DANGER alarm to all other systems. The amygdala has held primary focus in the neurosciences for 30+ years. No other area of brain functioning has received more interest and study. I refer to the amygdala as the fire alarm because it serves as the singular locus of detection for a person’s fear and danger. Once alerted to danger in the environment, the amygdala activates all body and mind systems for survival. The fire alarm signals that the Limbic System is fully engaged and ready to protect. In other words, the brain is on fire. The amygdala sits in the right and left hemisphere, just above the brain stem at the back of the brain. Hippocampus - The Memory Keeper - Function of the Hippocampus Responsible for forming, organizing, and storing short and long-term memories, matches new memories with prior outcomes of similar events, and triggers effective emotional responses Much of the how the limbic system works involves emotion and memory. The hippocampus is associated with storing memories in context with emotions and senses, such as when the smell of homemade cookies brings back a memory of baking with a grandparent when you were a child, or a particular song reminds you of when you first fell in love. The hippocampus is also responsible for spatial awareness, which is a sense of, or ability to make a physical determination of where one is in relation to the objects around them. The hippocampus sits adjacent to, and on each side of the amygdala. Hypothalamus - The Soother - Function of the Hypothalamus Acts to mitigate the effects of stress in the brain body survival response process and enhances regulatory patterns The hypothalamus acts as cool quenching water to the amygdala’s flame, through the consolidated effort of the hypothalamic-pituitary-adrenal connection and the secretion of cortisol. Cortisol is the stress hormone, produced by adrenal glands positioned above the kidneys. Note the body mind connection. Page 5 of 6 SNT 1 Terminology and Diagnoses © 2013 Deborah A. Beasley, All rights reserved Cortisol helps regulate the accessibility of quick energy stores in the body, such as fats, sugars, and proteins. The natural release of cortisol follows a 24-hour rhythm called a Circadian Rhythm, and is responsible for balancing basic drives, like sleep wake patterns. Circadian Rhythms also influence sexual drives and eating patterns. In a properly functioning system, cortisol is the brains answer to soothe the overload of stress responses in the body, and helps restore energy levels after stressful events. The hypothalamus sits appropriately above the amygdala. i Social Engagement and Attachment A Phylogenetic Perspective, Stephen E. Porges, University of Illinois at Chicago, Department of Psychiatry Ann. N.Y. Acad. Sci. 1008: 31 - 47 (2003). © New York Academy of Sciences. Doi: 10.1196/anals.1201.004 ii Siddiqui SV, Chatterjee U, Kumar D, Siddiqui A, Goyal N. Neuropsychology of prefrontal cortex. Indian Journal of Psychiatry. 2008;50(3):202-208. doi:10.4103/0019-5545.43634. Page 6 of 6