The NEATS: N eurobiology, E xecutive function, A ttachment, T rauma, & S elf-regulation

1. The NEATS:Neurobiology, Executive function, Attachment, Trauma, & Self-regulation Jane F. Gilgun, Ph.D., LICSW School of Social Work University of Minnesota, Twin Cities 1404 Gortner Avenue St. Paul, MN 55108 USA jgilgun@umn.edu ssw.che.umn.edu/Faculty_Profiles/Gilgun_Jane.html

2. Topics • Perspectives on the NEATS • Neurobiology • Executive Function • Attachment • Trauma • Self-Regulation

3. Perspectiveson the NEATS • Ecosystems • Developmental • Competency-Based

4. Influences on Child & FamilyFunctioning Social history

5. Children Can’t Do What Parents Can’t Do • Children mirror parents • Parents’ Issues • Neurobiological • Executive Function • Attachment • Trauma • Self-Regulation

6. Child & Family Ecomap Key ++++ strong connection ….. … weak connection ///////// conflicted connection no connection

7. Behaviors Associated with Neurological Conditions • Impulsivity • Distractibility • Self-organization • Behavioral activity levels • Awareness of effects of behaviors on others • Intelligence

8. Neurobiology • Anatomy of Brain • Frontal lobe and executive skills • Emotion circuits • Applications

9. Neurons: Basic Signaling Units

10. Frontal Lobe & Executive Functions • Planning and executing of movements

11. Frontal Lobe & Executive Functions • Planning and executing of movements • Two main subdivisions • Motor cortex • Prefrontal cortex

12. Frontal Lobe & Executive Functions • Planning and executing of movements • Two main subdivisions • Motor cortex • Prefrontal cortex • Executive functions • Working memory • Has connections to emotion and long-term memory structures and circuits

13. Emotion Circuit • Sensory input • Thalamus • Amygdala • Hippocampus • Prefrontal cortex • Other structures as well

14. Amygdala • Almond-shaped • Site of emotional learning

15. Amygdala • Almond-shaped • Site of emotional learning • Matures very early in life • Receives signals from the thalamus, whose information is relatively undifferentiated • Also receives signals from the neocortex, whose information is highly differentiated

16. Amygdala • Almond-shaped • Site of emotional learning • Matures very early in life • Receives signals from the thalamus, whose information is relatively undifferentiated • Also receives signals from the neocortex, whose information is highly differentiated • Turns on all sorts of systems, including the autonomic • Stress does not harm amygdala

17. Amygdala • The amygdala part of a system that prompts releases of adrenaline and other hormones into the blood stream. • This may disrupt rational thought.

18. Hippocampus • A horseshoe shaped region of the subcortical brain • Has roles in emotion and memory

19. Hippocampus • A horseshoe shaped region of the subcortical brain • Has roles in emotion and memory • Has a very high density of receptor cells for cortisol which is a hormone secreted in response to stress • Cortisol can change the shape of the nerve cells in the hippocampus and even kill them

20. Hippocampus • Creates memories that are representations of pooled information, including relationships between bits of information • Information is highly differentiated

21. Hippocampus • Creates memories that are representations of pooled information, including relationships between bits of information • Information is highly differentiated • Represents contexts of experiences • Stressful life events can damage the hippocampus

22. Child Conditions Relatedto Brain Functioning • ADHD • Childhood Depression • Obsessive-Compulsive Disorders • Tourette Spectrum Disorders • Bipolar Disorders • Autism Spectrum Disorders • Fetal Alcohol Spectrum Disorders • Sensory Integration Issues

23. Implications for Practice • Neurological evaluations • Complete medical and social histories • Structure • tasks broken down into simple steps • calm environments • care providers who under-react and who have strong support systems for themselves

24. Summary • Neuroscience important to work with children and families • Plasticity of human brain • Interaction of genes and environment • Medication can sometimes slow down or speed up brain functions

25. Case Example, John, 7 Mother’s Descriptions • Walked at 10 months, running ever since • Constant motion, crashes into things • Never listens • Ask him to put his clothes in hamper • He plays on floor, clothes not in hamper • Oblivious • Taught his 2 y.o. brother how to use matches

26. Case Example, John, 7 Teacher’s Views • Blurts out in class • Fidgets, gets out of his chair • Forgets to bring home books he needs to do his homework • Difficulty waiting his turn & following rules • Other kids think he is weird • Do not want to play with him

27. Case Example, Martha, 10 • 10th birthday • Fascinated by waitress’s hair • Quiet and cooperative in school • Daydreamed • Forgets where she puts things • Can’t made simple decisions • Can’t organize self • Sobbed: What’s wrong with me?

28. Executive Function Definition a set of inter-related processes responsible for purposeful, goal-directed behaviors. Neural pathways are in the neocortex with connections to many other areas of the brain

29. Case Examples • Jimmy, 8, climbs on the roof • Frankie, 2, can follow two-step directions • Janie, 5, screams, “You liar” at kindergarten • John, 7, teaches his 2 y.o. brother how to use matches • Sally, 8, is very good at playing Simon Says

30. Implications for Practice • structured environments • clear expectations & simple directions • patient, under-reacting adults • arrangement of play and leisure time with other children • one-on-one time with adults • important for adults to set examples • Parental support

31. Attachment • Strategies for maintaining proximity • Strategies vary according to • Developmental levels • Quality of attachments • Two main types • In infancy, shapes inner working models

32. Purposes of Attachment • Survival in infancy • Quality of life as we get older • Optimal Development • A base from which to experience and internalize • Safety and security • Regulation of emotions, body functions, body rhythms • To explore environment • To which to return when stressed, frightened

33. Synchrony and Asynchrony • Synchrony • Contingent reciprocity • Mutual regulation • Asynchrony • Breaks in reciprocity • Significance of repair

34. Case Examples, Ronnie, 2 • Father leaves the room • Ronnie cries • Father returns to the room • Ronnie laughs, runs to father • Father and son hug • Ronnie has trouble getting a puzzle piece into place

35. Case Examples, Amelia, 18 mos • Mother leaves the room • Amelia doesn’t seem to notice • Mother returns to the room • Amelia glances up and resumes playing • Mother sits on a chair

36. Case Examples, Jack, 26 mos • Father leaves the room • Ronnie screams and throws self on floor • Father returns to the room • Ronnie laughs, runs to father • Slugs father in the face • Father slaps Jack on the face

37. Trauma Definition • events that are • life-threatening or • psychologically devastating to the point where • persons’ capacities to cope are overwhelmed • and that result in changes in brain circuitry and structures

38. Case Examples • Joey, 3, screams whenever he sees a woman with red hair

39. Case Examples • Joey, 3, screams whenever he sees a woman with red hair • Sally, 4, runs away whenever her mother approaches her

40. Case Examples • Joey, 3, screams whenever he sees a woman with red hair • Sally, 4, runs away whenever her mother approaches her • Mark, 9, crawls on his hands and knees and barks like a dog

41. Case Examples • Joey, 3, screams whenever he sees a woman with red hair • Sally, 4, runs away whenever her mother approaches her • Mark, 9, crawls on his hands and knees and barks like a dog • Marietta, 7, wets the bed nightly for the first time in four years

42. Implications for Practice • Do not isolate children/adolescents/adults who are re-experiencing trauma • Show up • Provide a safe environment • Work directly with the effects of the traumatic event • Involve children with enjoyable, safe, structured environments

43. Self-Regulation Definition • capacities to manage and make sense of one’s own • thoughts, • emotions, and • behaviors in times of stress • and in the course of everyday life.

44. Emotion Regulation & Trauma • Emotion Regulation: Capacities to modulate emotional responses in a range of situations • Trauma: life events that overwhelm everyday coping capacities

45. Emotion Regulation & Trauma • Emotion Regulation: Capacities to modulate emotional responses in a range of situations • Trauma: life events that overwhelm everyday coping capacities

46. Regulation & Dysregulation • Related to • Styles of attachment • Internalized working models • Self-regulation • neurobiology

48. Copingwith Dysregulation • Re-regulation: To regain a sense of self-efficacy, control, and mastery over self and the environment • Three strategies: • Pro-social • Anti-social • Self-injurious

49. Noxious Events, Dysregulation, Agency, Outcome Noxious Event Dysregulation Search for Coping Strategies Human Agency Outcome Pro-social Anti-Social Self- destructive

50. Implications for Practice • overall goal is to help children re-regulate • Show up • direct work with parents • re-arranging environments