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ATTACh Conference: Building Attachment Across States: Healing the Spectrum of Dissociative Symptoms in Children and Adolescents

Joyanna Silberg's  Powerpoint Presentation can be found here.


I have to say ATTACh did a great job of finding speakers who catch your attention and keep it.  With humor and references to previous speakers it makes it seem like they are all a great big family wanting to help you with each of their specialties.


Joyanna Silberg kept me interested even though I was already suffering from jet lag as I am a west coast girl getting up early on the east coast.


I highly urge you to look through the Powerpoint Presentation linked above but here are my notes and important thoughts I took away from her presentation.


Disassociation is defined as disruption in the usual integrated functions of consciousness, memory, identity or perception - but really it is too adult centric.


When your inner life is a place you have to stay out of, having an identity is impossible.  Remembering not to remember such as "I try to forget to remember." or "It hurts to remember." or "I have nightmares".  Funy though how much energy it takes in the present to avoid making sense of the past.


"It's like a brain seizure"

"My face was smiling but my brain was crying"

are how some people feel about being disassociated.


What neurophysioloigcal affects of trauma lead to disassociation?

Excessive activation of amygdala

Suppression of activity in left prefrontal cortex

observing ego

underdevelopment of right orbitofrontal cortex, ability to self-regulate

decreased hippocampal volume: putting experiences into chronology

Underdeveloped corups collosum: disintegration of left and reight

Decreased serotonin: Mood is dysregulated.


At each moment the state is self is constructed from the ground up... so continuously and consistently reconstructed that the owner never knows the it is being remade unless something goes wrong.


States become increasingly flexible through development.

Fear based states are rigid and resistant

loving caregiver helps regulate those states.


Interest  to Excitement

Enjoyment to Joy

Suprise to Startle

Fear to Terror

Distress to Anguish

Anger to Rage

Same to Humilation

Smell to Dissmell

Taste to Disguste


Affect is an amplifier.  It either makes good things better or bad things worse.  Affect is the psychic glue of consciousness and identity.

So complex and pervasive are habits of script formation that we live more within these personal scripts for the modulation and detoxification of affect than in the world of innate behavior.


Key insights from Interpersonal Neurobiology:

The mind is a regulator

Transitions between states are key moments when the self is built

Interpersonal processes shape the mind (Daniel Siegel - the developing mind)


The brilliance of the mind lay in what is discarded not what is retained.


Dissociative shifts in a child create reciprocal states in caregivers and therapists.

Children encode contradictory parental behaviors and messages and realities and represent environmental dissociation within.


Healthy attachment promotes integrated functioning by allowing the child to grow with freedom and trust emotional information.

A healthy mind effectively selects the information that will allow seamlessly managing the transitions between states, between affects, between contents and between developmental challenges in a way that is adaptive to each shifting environmental demand.


In the normal brain affect is a signal for memory retrieval, approach or avoidance, action plans, assessment or reorganization. 


The New Definition of Disassociation: The automatic activation of patterns, action, thought, perceptions, identity or affect which are overlearned and conditioned avoidance responses to traumatic cues and emotions.


Her book The Child Survivor will be out shortly.


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2012 ATTACh Conference: The Complexity of Adoption in Trauma: Understanding the Impact of Trauma Through a Developmental Lens

I was very lucky to go to the ATTACh Conference this year.  I will share notes and information from each of the sessions I attended along with any helpful documentation.

Bessel van Der Kolk, MD is an amazing speaker.  Holding my attention for 7 hours is nearly impossible but he did.  I have learned a lot.
His Powerpoint Slide Handouts are located here.
Understanding Interpersonal Trauma in Children: Why We Need a Developmentally Appropriate Trauma Diagnosis is located here.
Understanding Interpersonal Trauma in Children: What We've Learned Since the DSM-IV, and Why a Developmentally-Appropriate Trauma Diagnosis is Needed in Future DSMs is located here.
Clinical Implications of Neuroscience Research in PTSD is located here.
A paper on Developmental Trauma Disorder is located here.


I have taken notes and I will be putting them down here along with anything it brought up in me personally or based on my personal or limited professional experience.

When doing assessment tests which involved having a picture of a family shown working on a car the healthy children found the picture pleasant and told a story when prompted about the car being fixed and the family driving off and doing something positive.  Older traumatized children did not find the picture pleasant and told stories of murder and mayhem.  Younger traumatized children may not have verbalized anything about the picture but become agitated, hyperactive and acted out upon seeing the picture.

Traumatized children have changed perceptions and very few neuro pathways between true and violent perceptions.

I look no further than my own daughter and know this is true.  I can say 1 million positive things about her but when she is asked to repeat back or tell me what I said, her words are mixed or she claims that my expression or tone showed how much I hate her.  Everyone she meets she complains they are fake or bad or stupid.  I would be very interested in seeing what story she would tell based on the picture.

We watched a video of how a child reacted when a mother who was interacting and playing nicely with her son went stone faced and didn't respond to him.  It was heartbreaking how he tried and tried to get his mom to interact and how anxious and upset he was getting for the 2 minutes the mom did not interact with him.  She then started playing with him again.  6 months later when they measured levels as the child went back into the room they saw he immediately became anxious even though the incident was never repeated.  It shows how intensely neglect can affect a child and how later even if the child doesn't remember the incident how they will have an emotional memory of the incident.

He talked about rhythms and movement and how children will try to be in sync even a 3 hour old infant will try to mimic the parent sticking their tongue out.

One of the common issues with traumatized children is that they get stuck in hyper arousal.  Normal development teaches children to become aroused and then go to calm - to engage and then disengage.  Nothing lasts forever that this arousal will pass or the anxiousness will pass.  Children learn this using mirror neurons.  Games like peek a boo show a child that you will come back so their anxiousness and fear is quickly relieved and they learn to trust that the parent will come back.

Traumatized children often do not learn these techniques and are constantly in a state of hyper arousal.  I find this very true with my daughter.  She never seems to be calm - always hyper aroused and always reacting over the top because she never learns that it will end and therefore it doesn't end.

We need to hold our own state instead of mirroring someone else's negative state.  If you can get others to mirror your positive state you can share the joy.  Traumatized children who had limited connections may not have an active mirror neuron system and no one has learned how to "activate" it if they don't seem to have one.

Major parts of the brain and what they do are:

Primary Motor Cortex - Motor Execution

Sensory Cortex - Self Location

Parietal Cortex - Object Person Location

SJS - Biological posture, motion and orientation

Premotor Cortex - Motor Preparation and goal representation.

Beatrice Beebe Found that we follow each other's moves as we look and then look away.

We follow each other's faces up and down as we become more and less positive.

We go up and down together.

We each can anticipate how each other's gaze, face & engagement will go.

Infants detect regularities in events.

Rhythmical, predictable, interactions with infants form the basis of prediction and causality;

temporal relations between own sensations and behaviors and enviornment.

What is likely to happen next generates the capacity to plan appropriate actions.


Babies cannot escape the emotion on mother's face.

Acting lessons can get faces of parent and child who were not in tune with each other to become in tune with each other.

PCIT (Parent Child Interaction Therapy) is also very helpful to create these the above.


John Bowlby was part of the British upper class - many researchers are and felt disconnected with nannies and boarding schools.  He found what cannot be communicated to (m)other cannot be communicated to the self (1991).


Bruce Perry Stimulation of reward system in human brain: decreasing distress.

 When we are missing positive human interactions we are not able to calm ourselves or decreasing distress and allowing sensations of pleasure, calm and safety and release of hormones we turn to alcohol, sweet, salty, fatty & drugs of abuse.


High Danger situations can cause addiction to trauma after an extended length of time and can make you feel good because of the rush of chemicals.  This in turn can make time feeling quiet make the person not feel anything at all.


Pleasure of pain and the pain of pleasure.

 This is shown in The Hurt Locker. 

Which shows the problem with trauma and that it is hard to live when not exposed to danger.  How to enjoy things that are not high danger.

March and sing in unison keeps everyone together.  Move together with pleasure can be good in therapeutic groups.

You can learn to be in charge of your own physiology.


In 1975 Freedman, Kaplan and Sadoc's Comprehensive text book of psychiatry actually said that incest is rare and not bad.  It has taken a lot of work just to show how serious and destructive sexual abuse and neglect are.  A study found that autoimmune disorders with patients who were victims of incest occur more often then patients who were not victims of incest. (Van der Kolk, wilson, Burbridge & Kradin)


Trauma is a response to the entire organism.

ACE study about turning gold into lead - ie How does one turn a happy baby into a homeless man.


The effects of child maltreatment on health - through a Kaiser study - those who were maltreated had a lot of health risks.  So for example we really have to understand that with these people obesity cannot simply be cured by diet alone.  There is definitely a relationship between childhood abuse and common health risks.  We have to understand how far reaching abuse and trauma really is.


EMDR was compared to Prosac for PTSD.  EMDR showed to be more effective.  Yet drug companies continue to push drugs and since everything is driven by money and the medical community, prosac is still pushed.


Child abuse and neglect are more expensive than anything else added together - it affects mental health, drug abuse, crive, victim loss of motivation and pleasure.


Increased Threat Detection:

1.  Orbitofrontal cortex.  Inhibit inappropriate action: helps postpone reward seeking.

2.  Dorsolateral prefrontal cortex.  Here things are "held in the ind" and manipulated to form plans & concepts.  Helps set priorities.

3.  Ventromedial prefrontal cortex.  Here emotions are registered and meaning bestowed on perceptions.

4.  Anterior cingulate.  Helps focus attention.  Integrates cognition and affect.  Tunes into thoughts; awareness of self.

Traumatized children have no concept of time only now - no past or future.

From the Emotional Expression of Animals and Men by Charles Darwin  - Man and animals... all have the same senses, intuition, sensation, passions, affections and emotions; behaviors to avoid or escape from danger have clearly evolved to render each organism competitive in terms of survival.  But inappropriately prolonged escape or avoidance behavior would put the animal at a disadvantage in that successful species preservation demands reproduction which in turn depends on feeding, shelter and mating activities all which are reciprocals of avoidance and escape.

The purpose of emotion is to move (if you are scared you run or fight - if you are in love you move closer.)

Nina Bull wrote in Attitude and theory of emotions:

The goal of emotion... is to effect physical movement and regain a state of physical equilibrium.  the liberated nerve force produces in us the state we call feeling which must expend and liberate itself in intense sensations, active thought, violent movement.

Heart Math and freeze framer are helpful to see in real time how thoughts and emotions affect your heart rate.

Yoga works for PTSD - often as effective as ay drug.

Kids brains are made to play and imagine.

They tried to get Developmental Trauma Disorder into the DSM V but it was turned down.

Abused girls tend to start puberty 1 year earlier and sex hormones are higher.

Trauma and early attachment patterns DETERMINE brain development.

You can change the size of your brain by practicing and using the areas that were not active much.

Brain activation during emotional regulation.

The default state for traumatized people lose the "I am" sense of self.

He suggests EMDR for specific triggers and Neurofeedback for long term trauma.

(I know that was long and disjointed but I wanted to get it all down while I could still read my notes.)

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email lists and facebook pages created

Today I created email lists and a facebook page for RIverside Support.
I also started adding in content.  I hope this helps people as much as I believe it would have helped me when I started on this journey!

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A New Beginning

Today I started updating this website.  This is a new beginning and a chance to bring what I have learned from the IT world to my new psychology world.

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