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Disinhibited social engagement disorder DFS Training
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Disinhibited social engagement disorder DFS Training



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  • 1.  Question:  How old is Dare Family Services?
  • 2. Answer: Fifty years old
  • 3.   Question What country has a psychologist appreciation day?
  • 4.  Answer:  China
  • 5.  Question: What do Wire Monkey Moms and Terry Cloth Moms have to do with love?
  • 6.     Answer: Love of a caregiver is more important than food and other rewards. Another Answer That early love makes people stronger and more resilient.
  • 7.  Question  Imprinting is against the law in 3 states?
  • 8.  Answer:  No  Why?
  • 9.  Like the chick and Tom, Imprinting happens to all humans, is biological and very powerful. When disrupted, it can lead to serious attachment problems.
  • 10.  Question:  What is Child Directed Play?
  • 11. Question: Can you “do” Child Directed Play with Teens and Adults?
  • 12.  Answer:  Yes  How?
  • 13.   Question: Why do humans (beginning as babies) seek proximity?
  • 14.  Answer:  Security, affection, comfort and ………..
  • 15.  Question? Are babies and toddlers who cry when their moms’ leave them and then fail to be comforted by strangers in a Strange Situation securely attached?
  • 16.  Answer:  Yes
  • 17.   Question: What are three behaviors that babies with secure attachments display that make their current and future lives happier?
  • 18.     Answer: 1. Seek to be physically close to a loved one 2. Seek comfort from a loved one when distressed 3. Accept comfort from a loved one when distressed
  • 19.   Question What symptoms do you see in an infant, toddler, child or adolescent who suffers from Reactive Attachment Disorder?
  • 20.    A. A consistent pattern of inhibited, emotionally withdrawn behavior toward adult caregivers, manifested by both of the following: 1. The child rarely or minimally seeks comfort when distressed. 2. The child rarely or minimally responds to comfort when distressed.
  • 21.   Question: A child with no emotional problems, who has been trained in the basics of Stranger Danger, and who has stable and loving parents, is at low risk of being abducted from a playground?
  • 22.   The Stranger approached the child! Now the reverse. The child approaches strangers:
  • 23.  A pattern of behaviors that involve culturally inappropriate, overly familiar behavior with strangers. The overly familiar behavior violates the social boundaries of the culture. The diagnosis cannot be made before age 9 months.
  • 24.  A pattern of behavior in which a child actively approaches and interacts with unfamiliar adults and exhibits at least two of the following:
  • 25.   1. Reduced or absent reticence in approaching and interacting with unfamiliar adults. 2. Overly familiar verbal or physical behavior (that is not consistent with culturally sanctioned and with age-appropriate social boundaries).
  • 26.   3. Diminished or absent checking back with adult caregiver after venturing away, even in unfamiliar settings. 4. Willingness to go off with an unfamiliar adult with minimal or no hesitation.
  • 27.      Co-occurs with other developmental delays: Cognitive Language Stereotypies Malnutrition
  • 28.  Most of the treatment disinhibited social engagement disorder (DSED) is provided by primary caregivers (e.g., parents or substitute parents) in their everyday interactions with the child (Mayo Clinic)
  • 29.     Several therapeutic ingredients seem to be important in the treatment of RAD and DSED. When caregivers provide these ingredients, the child may experience healthy dependency, come to rely on someone, and begin trust a new person. In other words, the child may become attached. These therapeutic ingredients include the following: Security Stability Sensitivity
  • 30.   Security, or a sense of psychological safety, helps promote the development of a new attachment relationship. Constant or intense stress and anxiety do not facilitate a sense of security; rather, they promote guarding behavior. To correct the scars of attachment disruption, the clinician, parent, or caregiver must have time and be ready to listen to the child without judging. Limits must be set for the child, but these should be set in the context of empathy and compassion. Only when verbal children feel emotionally secure will they begin talking about what has happened to them (and, probably, to their siblings) and gradually develop trust in the new caregiver.
  • 31.   Stability refers to the permanence of the attachment figure. It takes time for a child to develop trust in a new primary caregiver. After experiencing disruption, children need to learn to recognize their needs and to understand that these needs can be met repeatedly by the same person. It is common for these children to fear that the caregiver will disappear, die, or go away, thus giving rise to another disruption. Some children take a long time (>1 y) to trust a caregiver again; others trust a caregiver after receiving just a few months of sensitive care. This may be a temperamental feature (eg, orientation toward others versus inwardness) or a reflection of the quality of the match between the child and the new caregiver. Separations and disruptions may reactivate a defensive isolation on the part of the child.
  • 32.  Sensitivity, or emotional availability, refers to attentiveness to the child’s needs. Substitute caregivers should be informed that although the child may or may not be mature cognitively, his or her emotional development is frequently delayed in areas such as emotional expression, attachment, and ageappropriate independence. This delayed development makes emotional availability on the part of the caregiver especially important.
  • 33.  Ideally, over the course of treatment, the child will gradually begin to develop feelings of dependency toward the primary caregiver once he or she learns to expect that the caregiver will be physically and emotionally available at times of crisis. During this process, parents should be cautioned to expect and tolerate occasional regressive behaviors and to view them as signs that the child is psychologically working through earlier phases in development.
  • 34.   It is helpful to encourage parents to think of the child, for the time being, as emotionally younger and as having legitimate emotional needs appropriate for his or her emotional age. In a sensitive way, allow the child to express and to experience dependency.
  • 35.  Some children are almost frozen emotionally and expressing age-appropriate emotions has not been safe for them. At first, these children might appear to be obedient because they do not express anger and are not prone to emotional outbursts. As time goes by. children may start to feel that they can safely express emotions such as anger, jealousy, and neediness, and they may begin to direct temper outbursts, jealousy, and anger toward caregivers upon separation. This is good!
  • 36.  In this scenario, things that previously seemed not to matter to the child (e.g., whether the caregiver comes or goes) may suddenly become highly upsetting. For example, a child who never seemed to mind separations may strongly protest the parent’s leaving by clinging or going to the parent for comfort. Caregivers should see these behaviors as positive signs that a new attachment and a deeper level of trust have formed because the child now feels safe enough to be able to express his or her developmentally appropriate dependency needs.
  • 37.  No specific pharmacologic treatment exists for DSED. However, psychopharmacologic agents may be used to address associated problems such as explosive anger, hyperactivity, and difficulty in focusing or sleeping. These agents are used at similar doses and with the same objectives as in other psychological disorders
  • 38.      Consultations Specialists should be consulted about particular problems that may be associated with experiences of detachment and neglect (e.g., excessive eating and drinking), as follows: Endocrinologist or nutritionist for short stature and malnourishment Pediatric gastroenterologist to rule out gastroenterologic problems
  • 39.  A psychotherapist, particularly in the presence of the primary caregivers, may help the child express emotional needs, fears, and anxieties.. Caregivers may become more sensitive to the issues faced by their child (e.g., anger about having been abandoned, maltreated, left alone, or locked up). Also, children and teens may be able to express their dependency needs in the therapy setting quicker and more effectively than without therapy.
  • 40.  No specific diet is indicated; however, many children who have experienced disruptions and early neglect also have feeding disorders and may require treatment. Also, some children may have excessive appetite and thirst.
  • 41.  Question: A 10 minute daily Non Directive, joyful interactions between a youth and a caregiver can change biological markers associated with stress and mature the emotional part of the brain in emotionally neglected children and teens.
  • 42.  Answer:  Yes
  • 43.  Any other questions or answers?