Transcript Workshop 2 Presentation – Impact on adolescents

Neglect
The impact on adolescents
Wendy Rydzkowski
Principal Educational and Child Psychologist, Halton
What is adolescence?
• “The awkward period between sexual
maturation and the attainment of adult roles
and responsibilities.” Ronald Dahl.
Cognitive and Emotional
Adolescence is a developmental period when new links
are established in the brain that create connections
between affective and cognitive processes.
• Reasoning
• Logic
• Abstract thinking
• Planning
• Inhibition
Passion, sport, hobby, idealistic causes
Neglect in adolescence
• Neglectful parenting can be seen as being evidenced by a
combination of:
• A low level of parental control of young people (this dimension is
often taken to include parental knowledge and monitoring of young
people’s activities and whereabouts, and establishment of
boundaries)
• A low level of warmth and acceptance (as distinct from disinterest
and rejection) by parents towards young people. For teenagers,
parental monitoring and supervision has to be balanced alongside
factors which assist in a young person’s emerging adulthood, such
as the opportunity to exercise autonomy and independence.
• A young person’s journey to adulthood may also be shaped by
factors including cultural background, levels of impairment,
economic circumstances and contextual changes over time.
Warning signs of neglect
•
•
•
•
•
•
•
•
•
Poor hygiene – smelly, dirty
Dental problems
Poor muscles, joints
Sores, rashes
Burns
Anaemia
Incontinence
Illnesses
Fatigue
Warning signs
•
•
•
•
•
•
Negative self evaluations
Low interoception
Low social support, lack of friends
Dissociative behaviour
Substance abuse
Suicide
Subtle signs
• Eating disorders. Bulimia associated with
indifference and lack of care.
• Binge eating associated with paternal neglect
(Dominy, Johnson, Koch, 2000)
• Anorexia – more severe adverse life events
before the onset of the eating disorder than in
healthy controls.
• Development of OCD.
• Development of aggression.
Subtle signs
• Misinterpret emotional messages
• Denial of negative emotions
• Avoidance of other people’s negative emotions –
can’t offer them support
• Reliance on the self
• Can’t take another person’s perspective
• Paranoia and jealousy
• POSITIVE EMOTIONS ARE ONLY MADE POSSIBLE
BY ADULT ATTUNEMENT
Adult attunement and
Attachment
•
• Bowlby: “Many of the most intense emotions
arise during the formation, maintenance, the
disruption and the renewal of attachment
relationships”
• Happiness, joy excitement
• Sadness, grief, anger, fear.
• IN CASES OF NEGLECT……
What we can do – context to individual
Early recognition of teenage neglect Informal response, for example, meet and discuss with
young person and parents (if appropriate). Seek early resolution to problems
If problems not resolved
Apply Common Assessment Framework – involve young person,
meeting of staff from different agencies, identify lead professional and agree action
If problems persist or more severe
Application of Assessment Framework to understand
impact of neglect on young person’s health and development, decide on course of action,
methods on intervention by which staff from respective agencies
Ecological perspective The research literature supports the use of multi-faceted interventions.
Promoting the resilience of neglected young people by working with young people, parents,
involving schools – and these can be reinforcing of each other
Specific evaluated interventions
These include Cognitive Behavioural Therapy (CBT) and
Multi-systemic Therapy (MST) approaches – but generic programmes will need to be
developed focusing on the specific developmental needs of neglected adolescents
Family and social relationships
Development of empathy and the capacity to place self in someone else’s shoes. Includes a
stable and affectionate relationship with parents or caregivers, good relationships with siblings,
increasing importance of age-appropriate friendships with peers and other significant people in
the child’s life, and response of family to these relationships.
Social presentation
Concerns the child’s growing understanding of the way in which appearance, behaviour and
any impairment are perceived by the outside world and the impression being created. Includes
appropriateness of dress for age, gender, culture and religion; cleanliness and personal
hygiene; and availability of advice from parents or caregivers about presentation in different
settings.
Self care skills
Concerns the acquisition by a child of practical, emotional and communication competencies
required for increasing independence. Includes early practical skills of dressing and feeding,
opportunities to gain confidence and practical skills to undertake activities away from the
family, and independent living skills as older children. Includes encouragement to acquire social
problem-solving approaches. Special attention should be given to the impact of a child’s
impairment and other vulnerabilities, and on social circumstances affecting these in the
development of self care skills.
Providing for the child’s physical needs, and appropriate medical and dental care. Includes
provision of food, drink, warmth, shelter, clean and appropriate clothing and adequate
personal hygiene.
What we can do
Schools and communities
Raising awareness of neglect by inclusion of
neglect/adolescent neglect in PSHE curriculum
Provide opportunities for young people’s involvement and participation in a range
of extra-curricular activities and leisure opportunities
Parenting
The promotion of ‘authoritative parenting’, with a focus on supporting teenage
development, e.g. through local parent groups
What do adults need to do?
Emotional warmth
Ensure the adolescent’s emotional needs are met, giving them a sense of being specially
valued and a positive sense of their own racial and cultural identity. Includes ensuring their
requirements for secure, stable and affectionate relationships with significant adults, with
appropriate sensitivity and responsiveness to the adolescent’s needs.
Give appropriate physical contact, comfort and cuddling sufficient to demonstrate warm
regard, praise and encouragement.
Stimulation
Promote the young person’s learning and intellectual development through encouragement
and cognitive stimulation and promoting social opportunities. Facilitate their cognitive
development and potential through interaction, communication, talking and responding to
their language and questions, and promoting educational opportunities. Enable the young
person to experience success and ensuring school attendance or equivalent opportunity.
Facilitate the young person to meet the challenges of life.
Stability
Providing a sufficiently stable family
environment to enable a child to develop and
maintain a secure attachment to the primary
caregiver(s) in order to ensure optimal
development.
This includes ensuring secure attachments are
not disrupted, providing consistency of
emotional warmth over time and responding
in a similar manner to the same behaviour.
Parental responses change and develop
according to the child’s developmental
progress. In addition, ensuring young people
keep in contact with important family
members and significant others.
Wider family
Who are considered to be members of the
wider family by the child and the parents? This
includes related and nonrelated persons and
absent wider family.
What is their role and importance to the child
and parents, and in precisely what way?
Housing
Does the accommodation have basic amenities
and facilities appropriate to the age and
development of the child and other resident
members? Is the housing accessible and
suitable to the needs of disabled family
members? Includes the interior and exterior of
the accommodation and immediate
surroundings.
Basic amenities include water, heating,
sanitation, cooking facilities, sleeping
arrangements and cleanliness, hygiene and
safety and their impact on the child’s
upbringing.
Employment
Who is working in the household, their pattern
of work and any changes? What impact does
this have on the young person?
How is work or absence of work viewed by
family members?
How does it affect their relationship with the
child? Includes children’s experience of work
and its impact on them.
Family’s social integration
Exploration of the wider context of the local
neighbourhood and community and its impact
on the child and parents. Includes the degree
of the family’s integration or isolation, its peer
groups, friendship and social networks and the
importance attached to them.
Promoting resilience
Promoting the resilience of neglected adolescents
Another approach which practitioners find very helpful arises out
of the research findings on the resilience of young people in the
context of adversity (Gilligan, 2001; Newman, 2004; Masten, 2006;
Stein, 2008).
Resilience appeals in a number of ways: first, in its optimism – the
evidence of young people doing well despite adversity – against all
the odds;
second, in offering a working framework of ‘risk’ and ‘protective’
factors that can provide a clear focus for policy and practice based
interventions;
and third, in giving expression to ‘strengths based’ practice in
children’s services, which also provides the platform for
participatory and rights based approaches.
Coherence
• We need to help them to develop a coherent
narrative.
• “You blamed yourself to give yourself a
coherent narrative about that awful life you
had, because nothing else made sense.”
Giving coherence
•
•
•
•
Do it with drawing
Do it with models/ figures/stones
Ask to speak as the young person
Check out, with empathy drawing… ‘ I wonder if it
felt like this..’
• Understand what they are feeling and help find
the right words for it.
• Recognise what emotion is being evoked in you.
Some words
• Young people experience a far wider range of
painful emotions than scared/angry.
• See the list of feelings on the Margot
Sunderland list (handout).
Further reading
•
Anything by Margot Sunderland
•
Aush,S. Harting, E., Alkon E., Heuser, I. 2013 The Role of Early Emotional Neglect in Alexithymia. Psychological Trauma, Theory, Research
and Practice 5 (3) 225-232.
•
Casey,B.J., Jones, RM., Levita, L., Libby,V., Pattwell,S., Ruberry,E., Soliman,F., Somerville,LH. 2010
•
Storm and Stress of Adolescence: Insights from Human Imaging and Mouse Genetics. Developmental Psychobiology. 52 (3) 225-235.
•
Dahl, R. 2004 Adolescent Brain Development: A Period of Vulnerabilities and Opportunities. Ann.N.Y. Acad.Sciences 1021:1:1-22.
•
DCSF – Adolescent neglect
•
Gardner,R. 2008 Developing an effective response to neglect and emotional harm to children. London: NSPCC Research report.
•
Marshall, N.A. 2012 A clinician’s guide to recognizing and reporting parental psychological maltreatment of children. Professional
Psychology Research and Practice 43 2 73-79.
•
Rees, G and Stein, M . 2011 Adolescent neglect; research, policy and practice. Jessica Kingsley
•
Sroufe, A.L., Egeland, B., Carlson, E.A. & Collins, W.A. 2005 The Development of the Person: The Minnesota study of risk and adaptation
from birth to adulthood. New York: Guildford Press.
•
Tasca,G. Ritchie K., Balflour L. 2011 Implications of Attachment Theory and Research for the Assessment and Treatment of Eating
Disorders. Psychotherapy 3 Sep 2011 249-259.