The ChildTrauma Academy
The ChildTrauma Academy Newsletter
August 2010
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Next week we will see Dr. Perry off on a three-week speaking tour of Australia.  We want to thank Annette Jackson and her colleagues at Take Two and Berry Street for all the work they have put in to organizing these upcoming events, which will span six different cities in Australia.  Upon Dr. Perry's return, we have a very busy fall planned.  We have added several new training events around the country and will begin our Fall NMT 10-week series as well as welcome a second class of Individual Certification Participants and begin making final adjustments to our NMT Online Metric Tool, which has recently entered the Beta Testing Phase.  The season will be busy but also exciting.  Read more about these ventures in this month's newsletter

In his upcoming engagements in Australia, Dr. Bruce D. Perry will explore the negative impact of chaos, threat, traumatic stress, abuse and neglect on children. Hear how these adverse experiences alter the child's brain, and can result in enduring cognitive, behavioural, emotional, social, psychological and physical problems. Concepts of empathy and compassion will also be explored in relation to physical health, mental health and an ability to form and sustain loving and healthy relationships.

Dr. Perry will communicate the key facts, concepts and principles required when working with traumatised children in order to assist in their healing from traumatic life experiences. Interventions will be explored which include the incorporation of current neuroscience, clinical research and traditional knowledge. A discussant will also be invited to engage in a conversation with Dr. Perry regarding the implications for practice.

Theory and research will be interwoven with case examples to assist attendees to further develop their understanding of:
The developing brain
The impact of abuse, neglect and poverty of experience
The fear response
The therapeutic web
The place of hope, empathy and relationships
Neurosequential Model of Therapeutics
This knowledge is key to planning and implementing appropriate interventions when working with those who have experienced significant childhood trauma. This session will be relevant for a range of professionals including those in Child Protection, Family Services, Therapeutic Services, Out-of-Home Care, Schools, Youth Justice, Family Violence Services, Sexual Assault Services, Mental Health Services, Alcohol and Other Drug Services and private practitioners.

Sessions are scheduled for the following dates:
MELBOURNE - 8 September, 9.45am-4pm
CAIRNS - 13 September, 9.45am-4pm
BRISBANE - 15 September, 9.45am-4pm
DARWIN - 17 September, 9.45am-4pm
CANBERRA - 21 September, 9.45am-4pm
SYDNEY - 22 September, 9.45am-4pm


Behavior problems (e.g., noncompliance, aggressive behaviors) or problems with emotion regulation (e.g., tantrums) are arguably the most common reasons parents bring their children to treatment. The severity of these behaviors often results in diagnostic labels such as Oppositional Defiant Disorder (ODD), Intermittent Explosive Disorder, Conduct Disorder, or ADHD. Unfortunately, children with these behaviors also are often labeled as "bad children,"  wearing out even empathic caregivers, teachers and other adults and resulting in more angry, reactive behaviors from the adults.
     The most common empirically supported treatments (ESTs) used to help children with severe behavioral problems are Parent Management treatments (e.g., Parent-Child Interaction Training (PCIT; Sheila Eyberg), Helping the Noncompliant Child (Nicholas Long & Rex Forehand), and Defiant Children (Russell Barkley)). These treatments have shown efficacy in many randomized controlled trials and are hypothesized to work through their use of behavioral principles (e.g., rewards, positive attention, and sometimes punishment). Though these treatments are largely successful, there are still many children who do not respond to Parent Management treatments.
     Over the last ten years, doctors Ross Greene and Stuart Ablon have developed a new approach for treating these children called the Collaborative Problem Solving (CPS) approach (described in their 2006 book Treating Explosive Kids). Greene and Ablon's approach is not based on the assumption that children have "learned" to misbehave or the assumption that they intend to defy adults. Instead, they assume that behavior/emotion regulation problems in children are the result of "lagging cognitive skills" ( or deficits in executive functions. Executive functions are functions modulated primarily by the frontal cortex and they allow people to plan, think critically, solve problems, pay attention, transition between tasks, etc. Thus, the CPS approach assumes that children behave well if they can, and that when behavior problems occur, they occur because the child is frustrated by not being able to complete required tasks...or simply because they don't understand the expectations adults have for them!
     Greene and Ablon stress that we must "rethink children." We need to realize they are unable to meet expected standards rather than assuming they are simply non-compliant. The CPS approach emphasizes showing empathy toward a child when he or she encounters a "trigger" (or events that generally lead to noncompliance/a temper tantrum) and collaborating with the child to resolve problems. Therefore, those who use CPS are encouraged to figure out a child's trigger(s) so they can prevent noncompliance or meltdowns by using problem-solving. While often conceptualized as a cognitive approach, CPS depends upon the capacity to form, manage and maintain well-regulated, empathic relationships. 
     There are three main goals of CPS (Greene, Ablon, & Martin, 2006): first, help adults figure out which cognitive deficiencies are contributing to behavior problems; second, help adults recognize "three common options for handling problems" (pg. 611); and third, help parents and children learn to solve problems collaboratively. Greene et al. suggest that most parents either impose their will ("Plan A") or give in ("Plan C") to solve problems. Greene et al. recognize that Plans A and C sometimes work but suggest that Plan B works best. Plan B involves a parent or caregiver being able to recognize times when a child is prone to be difficult, empathize with the child, and then ask the child for input on how to make difficult situations less problematic.
     CPS is a relatively new approach. However, current research (including a randomized controlled trial; Greene et. al., 2004) suggests that CPS is just as effective as Parent Management techniques, if not more effective in some regards (e.g., long term treatment effects). Based on the current level of research on this approach, CPS can at least be regarded as "possibly" or "probably" efficacious based on Chambless and Hollon's (1998) system of classifying empirically supported treatments. A set of very positive outcomes have resulted in a variety of settings where CPS has been implemented. 
     Check out the Collaborative Problem Solving website, where you can find the articles referenced above plus many more resources:
Chambless, D. L., & Hollon, S. D. (1998). Defining empirically supported therapies. Journal
       of Consulting and Clinical Psychology, 66(1), 7-18.

Greene, R. W., Ablon, J. S., & Martin, A. (2007). Use of collaborative problem solving to
       reduce seclusion and restrain in child and adolescent inpatient units. Psychiatric
       Services, 57(5), 610-612.

Greene et al. (2004). Effectiveness of collaborative problem solving in affectively
       dysregulated children with oppositional-defiant disorder: Initial findings. Journal of
       Consulting and Clinical Psychology, 72(6), 1157-1164.

We are pleased to update you that our much-anticipated online metric tool has now entered the beta-testing phase.  We are currently working with our NMT Partner sites and our Individual Certification participants to gather important feedback about the tool.  We have received very good reviews so far.  We will collect feedback for the next few months and make additional improvements by January, 2010.   Soon after that, we anticipate rolling the web-based version out for use by NMT certified individuals and sites.  Stay tuned for further updates and information on how to gain access to the metric once it's made available to the public. 

There is still time to register for our Fall NMT Case-Based Training Series scheduled to begin on October 1.  This training experience is part of an ongoing clinical care conference series offered by the CTA.  This teaching model has been useful for helping clinicians and front-line staff better understand the neurodevelopmental principles involved in many of the primary symptoms as well as strengths in the children they serve.  This practical teaching model provides an opportunity for ongoing capacity building within an institution or for individuals.
We recommend this series as a complement to any more intensive training/program development projects that our partners have with the CTA. However, individual and institutional participation does not require any other program development activities or projects with the CTA and can serve as a good introduction to viewing maltreated and traumatized children through the "lens" of neurodevelopment.

More information about the Neurosequential Model of Theraputics and the Fall 2010 NMT Case-Based Training Series is available through these links. 

We have added several new training events to our calendar this month.  Learn more about upcoming opportunities on our website:

Bruce D. Perry, M.D., Ph.D.
The ChildTrauma Academy