Ronald Federici Replies to Monica Pignotti
April 13, 2010 at 1:39 pm 13 comments
Dr. Monica Pignotti has asked if hospitals use the restraint techniques described in my book (note, however, that these are not “my techniques”). Here is a short list:
- Cook County Hospital, Illinois
- Regional Institute for Children, Maryland
- Jasper Mountain, Oregon
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Entry filed under: ron federici, ron s federici, ronald federici, ronald s federici. Tags: cook county hospital, jasper mountain, monica pignotti, regional institute for children, restraint techniques, ronald federici.
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Dr Ronald Federici | April 13, 2010 at 5:50 pm
This response is for ALL the critical non-professionals and “Ph.D’s ” who have never taken a course on psychological evaluation, diagnostics, treatment, residency, fellowship, board certification or engaged in any formal child-family treatment. These “fringe group” of Pignotti, Rosa, Sarner, Mercer and their friends have never worked in any acute care facility. yet they rely on an alcoholic named Charly Miller who was fired for being intoxicated on the job and has NO license, nor any credibility.. ALL this is fact and well documented in court records in her town. The use of “safety restraints” is reserved for violent and out-of-control children and adults, and you MUST be well trained to do it.
I have been trained by the best professionals, police, FBI and colleagues who actually do the clinical work, where my critics sit and write about garbage and issues they have NO training in.
I urge them to spend ONE (1) day in an acute care facility….they would not make it when struck..and would be screaming for help. Pignotti and Mercer are the biggest hypocrites as they have not treated damaged children. their ” friends” are just plain strange and fabricating.
2. Dr. Federici Responds « Potentially Harmful and Other Questionable Therapies | April 13, 2010 at 9:10 pm
[...] about what hospitals currently use the face-down prone restraint procedure illustrated in his book. He states that the following hospitals use this [...]
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Ron Federici, Psy.D. | April 24, 2010 at 12:39 pm
Neuropsychological Evaluation and Rehabilitation of the Post Institutionalized Child
There is controversy regarding assessment and treatment procedures for the post-institutionalized child
July 18, 2007/ Dr. Ronald S. Federici
International adoptions have become prominent worldwide with the United States receiving the largest amount of immigrant visas issued to orphans. Eastern European countries, particularly the former Soviet Union and Romania, have been attracting families from all over the world due to the high volume of available children with desirable ages, ratio characteristics, and the definitive aspect of parental rights termination which has been a subject of recent controversy in the United States. Recently, there have been landmark cases in the United States overturning long-term custody of the adoptive parents due to the resurgent interest of the biological parents years later. In general, families completing international adoptions find the procedures much more expedient and cost effective as opposed to waiting on a list for infants in the United States which can be years of waiting, or the worrisome possibility of adopting an older child who has a clear documented history of abuse and neglect. Another motivation for families moving towards international adoptions has been media presentations worldwide which have highlighted deprived children residing in Eastern European institutions. Thousands of families have flocked to these countries with the hopes of rescuing a child from life-long institutionalization.
Interest in the post-institutionalized child has gained great attention in all medical and psychological disciplines throughout the United States and in the United Kingdom. International adoption clinics have surfaced throughout the United States following pioneering efforts by Dana Johnson, M.D., Ph.D. of the University of Minnesota, International Adoption Clinic; and Laurie Miller, M.D., Director of the International Adoption Clinic at the Floating Hospital for Children in Boston, Massachusetts. As there has been a significant increase in the amount of internationally adopted children coming to the United States (up nearly 130% since 1990), the need for international adoption medical specialists has surfaced. Specialists from all disciplines of pediatrics and developmental psychology have been on the forefront of evaluating internationally adopted children of all ages. Research has shown the long-term neuropsychological and neurocognitive status of these children can often present a challenge to adoptive families as the “hidden disabilities” of the effects of institutionalization may not surface until the child is of school age.
Post-institutionalized children have been exposed to a volume of high risk pre and post-natal factors such as poor maternal care, malnutrition, fetal alcohol exposure, smoking, neurotoxins, infections, prematurity, low birth weight, and a host of other potential complications. Goldfarb (1943), Bowlby (1951) and Spitz (1945) have clearly defined the effects of institutionalization or “hospitalism” as being strong contributing factors to later neurocognitive and emotional problems, particularly bonding and attachment deficits. Johnson (et.al., 1997) along with numerous medical researchers have intensely researched the health status of children from the former Soviet Union and Eastern Europe and have further documented the high risk factors which may impact later cognitive, learning and emotional performance. Rutter (1998) discusses developmental catch-up and deficits following adoptions after severe global early deprivation and finds a strong tendency towards resilience and short-term catch-up in the younger child group (adoptions completed prior to 25 months). Rutter goes on to explain that global cognitive improvement over the long course of time is still an unknown factor in many of the Romanian adoptees who have been exposed to high risk factors.
There is controversy regarding assessment and treatment procedures for the post-institutionalized child. Many professionals believe that the effects of institutionalization and deprivation will spontaneously abate and a “wait and see” is adopted in addition to the ideology that parents should “give the child time to adjust” as opposed to implementing aggressive assessment or premature diagnoses of handicapping cognitive or emotional conditions. Federici (1998) has emphasized the importance of immediate and aggressive neuropsychological and neurodevelopmental evaluations for all children, particularly the older post-institutionalized child who may present with very prominent behavioral and adjustment difficulties, whereas the child under the age of 24 months requires time to re-stimulate and reattach. Evaluations in the child’s native language are of paramount importance. Many families worldwide are adopting children greater than 4 years of age and often find the child very challenging from the first day of adoption although may have been advised by various professionals or agency personnel that there needs to be this “adjustment period” and a family system emphasizing intensive stimulation, love and bonding in order to promote “developmental catch up” and normal family adjustment.
Given the research and current understanding regarding the damaging effects of institutionalization and the numerous high risk medical factors which may lead to neurocognitive and emotional delays and deficits, the need for aggressive neurodevelopmental and neuropsychological assessment of impairments followed by aggressive neurocognitive and psychological rehabilitation appears to be a necessary inter-vention for children coming from profoundly depriving backgrounds. While long-term follow up regarding the internationally adopted child are still being gathered, early information strongly suggests both neuropsychological and emotional sequalae of institutionalization for a large percentage of children being adopted at an age greater than 4 years. While many children appear to have been unscathed as the result of institutionalization, Johnson (1997) suggests that children who have resided in institutional care become a high risk population. Early intervention programs appear to be a critical factor in promoting optimal development and recovery from institutional damage although many “delays” may be chronic and static in nature.
Presented at the Conference for Children and Residential Care
Stockholm, Sweden
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Ron Federici, Psy.D. | April 24, 2010 at 12:40 pm
Institutional Autism
By Dr. Ronald S. Federici
This article is an excerpt from Dr. Federici’s book, Help For The Hopeless Child: A Guide For Families
Over the past decade there has been a tremendous influx of children coming from post-institutionalized settings in various Easter Bloc, South American and Far Eastern countries. These children have often been placed in hospital-based or classic institutional settings following illnesses or even death of the biological parents or the parents general inability to care for the child’s emotional needs. Children from Eastern Bloc countries in particular have been rapidly placed in institutionalized settings due to the demise of the communist systems which have rendered many people poverty stricken and homeless with a subsequent inability to care for an of the medical, physical or psychological needs of their children.
Children having any type of medical problem (even mild) are often placed in hospital settings or institutional care programs which are state run. For example, children who have been described as being somewhat “slow” or even suspected to have mental retardation (i.e. the Russian word Oligophrenia) are often called morons, imbeciles or some other term pertaining to mental deficiency. These types of children are often placed in neuropsychiatric facilities in great volumes.
Additionally, children with even mild medical problems such as orthopedic damage or some other type of crippling pattern in which they are not able to walk (but could be walking with adequate surgical interventions and physical therapy) are also placed in hospital-based institutions.
Children with somewhat more complicated medical problems such as hepatitis, hemophilia, congenital malformations and deformities, mental retardation or classical autism are often placed institutions for the rest of their lives.
The principal problem with this situation of placing children in hospital-based or institutional settings for a defined “problem” is that many of the diagnoses are typically incorrect or over exaggerated. Once the children are placed in institutional settings, particularly those in the Easter Bloc countries of Romania, Moldovia, and various sections of the former Soviet Union, they are destined to remain there for life without appropriate medical or psychiatric/psychological interventions.
In particular, many of the children who are placed in neuropsychiatric facilities have been termed mentally deficient or Oligophrenic. More often, the child’s mental delays are the direct result of very poor pre and post-natal factors, nutritional and medical neglect, in addition to a child having a situation such as simple speech and language delays in their own native language which have been misconstrued as mental deficiencies.
Once children are placed in these types of institutional settings, they are often moved repetitively. For example, infants are often placed in some type of hospital or nursing setting for the first 1-2 years of their life and then transferred to another setting which can often last from 2-5 years. It should be emphasized that, during these critical years (birth through 4-5 years old) these institutions typically lack any and all type of stimulation, language and intellectual-cognitive development, early school-based programs or even appropriate medical diagnosis are care. So often, children are starved, neglected, and isolated to their cribs.
It has been well documented that many of these children have been found to be tied to their cribs or isolated and sheltered from human contact. Combined with profound medical, nutritional and often physical neglect and abuse, these children regress to very primitive states to where any and all type of sensory-motor, speech and language, and even intellectual abilities have become stagnated and, over the course of time, typically regress and deteriorate to levels where they appear truly mentally deficient when this was not the starting pattern in their lives.
As the institutional child continues to “transfer” from institutional setting to institutional setting, the level of deprivation often increases. Very often, children are “warehoused” in the institutional settings to where there are up to five children in a bed with literally dozens of children per on caretaker who is often completely oblivious to their physical and psychological needs. It has also been documented that there is often a “medical director” assigned to the facility who rarely shows up. The children often receive medical care when they are in an acute or life threatening situation, and the medical care is often very poor and can sometimes cause even more problems in the actual illness of the child (i.e. the treatment can sometimes be worse than the actual illness).
It has been this writer’s experience based on visiting multiple institutions in Easter Bloc settings that the profound levels of neglect intensify with each year the child is alive. Basic physical and nutritional needs are not provided which results in the child’s brain and physical development slowing to where it is almost impossible to actually detect the age of the child. There have been many children observed who have the appearance of a 6 to 7 year old when in fact they are actually in their early or mid-teenage years. Additionally, many children have been literally tied down to their cribs for days, weeks and even months at a time, with even their feedings being given while they are in their cribs. Over the course of time, there is a literally no movement and many of the children lose many and all previously acquired language.
Additionally, many of the children who have some level of physical problem, particularly orthopedic problems in which they are not able to mobilize around the institution, become targets of physical and sexual abuse which further causes post traumatic stress disorder features, profound depression and a “regression” to a stage of early infancy in which they are literally “shutting out” any and all type of environmental and interpersonal contact. More simply, children look for any type of safety and security when they are being totally deprived and neglected.
What tends to emerge in the child who has received multiple institutional placements combined with profound neglect and abuse on a wide scale level is the “regression factor” or the child who “disintegrates” and loses motor, sensory, speech and language, and intellectual skills. Once this regression occurs, it tends to be insidious and progressive.
Emergence of Institutional Autism Syndrome
Previous sections of this book have outlined varying types of childhood pervasive developmental disorders and childhood autism. Reference was briefly made to the “Childhood Disintegrative Disorder” which seems to imply that there is a “loss of acquired skills”.
The child from the post-institutionalized setting does not fall into any of the classic definitions of classical autism, Rhetts disorder or even childhood disintegrative disorder, although there is certainly a “disintegration” once a child has remained in an institutional setting. While there is no actual “equation” as to how long it takes for a child to become damaged while living in an institution, it appears that for every year of life in an institutional setting, there can often be a rapid rate of regression in psychological and cognitive functioning up to 6 months. For example, a child who has been institutionalized for one year most likely is “delayed” six months. A child in a setting for two years is most likely delayed a year and so on and so on. A unique institutionally specific “pattern of behaviors” which constitutes the Institutional Autism Syndrome are the following characteristics:
1. Actual loss of physical height, weight and growth. Many of the children have been described as “not even being on the growth curve”.
2. Inability to physically decided on the actual age of a child. Therefore, many children upon adoption are assigned on age when, in fact their actual age may be much older.
3. Children often are not speaking any language or have language which is so regressive that it is significantly below age and grade level, and almost constitutes the “infant babbling syndrome”. Children may have been speaking in their native language, but have regressed to where there is only a partial ability to receive and express language.
4. Children’s behaviors have rapidly deteriorated to where primitive acting out occurs. While all children in any type of institutional setting typically have behavioral control problems and a lack of social development, the majority of the children tend to be extremely regressed, emotionally and behaviorally out of control to where they present with profound attachment disorder characteristics when, in fact the attachment disorder is one of a “neuropsychologically-based” attachment disorder as cognitive problems are clearly evident.
5. Children in institutions have experienced profound nutritional and medical neglect over the course of (often) years. These factors of profound medical neglect adversely affect the body and brain development to where many of the children clearly develop a brain syndrome which involves language deficits, attentional and concentrational problems, confusional behaviors and clearly deficient memory and learning.
6. If and when major neurocognitive deficits and delays have been evident, children in institutional settings often have very primitive and regressive behaviors. A regression back to enuresis and encopresis (urination on themselves and self-defecation) are very common. Additionally, children can often resort to playing with urine and feces.
7. The ultimate “institutional autistic behaviors” is a complete regression to self-stimulating behaviors as a way of “filling in the gaps” regarding loneliness, deprivation and despair. Combined with profound medical and nutritional neglect, children in institutional settings may have been able to “recall” some pleasurable activities (particularly if they were placed in the institutional setting at an older age). When these minute “recollections” of something positive in their life are gradually and consistently taken away, children tend to resort back to the most infantile stage of development to where they feel safe and secure. This typically means that children will remain very isolated, lost and alone, and resort back to rocking and other self-stimulating behaviors. It is very common for children who have been sensory deprived and socially neglected for years in an institution can find some degree of pleasure in self-stimulating rocking and movement behaviors; hyperactivity and uncontrollable rage and aggressive outbursts; in addition to self-mutilative behaviors such as hair pulling, picking at various parts of their body and, under more severe circumstances, head banging and body thrusting into inanimate objects such as walls and windows. This syndrome implies that the child is both trying to fid a way to maintain internal physical and psychological “movements” which serve as some level of stimulation while at the same time, finding ways to “pass the time” of profound loneliness and despair.
Over the course of time and with continual “practice” of these cognitive and physical behaviors, a child develops a “repetitive pattern” of newly learned movements, mannerisms and speech. Henceforth, the concept of institutionally induced autism has come about based on this author’s many years of experience in visiting institutions and evaluation hundreds of children who have spent many years of their life in a deprived and emotionally damaged setting. Institutional autism will hopefully emerge as a more specialized “subgroup” of pervasive developmental disorder of childhood and reactive attachment disorder as this “syndrome” is specific to the child having been reared (or survived) the profound medical, psychological and environmental neglect often seen in institutional settings and hospitals in the Third World countries. A better understanding of this unique and highly complex syndrome may help families approach the entire concept of international adoptions in a different manner. Examples of improving the entire adoption of the internationally post-institutionalized child may include the following:
1. Adoption agencies having a better awareness of the institutional autistic syndrome and concepts pertaining to post traumatic stress disorder. Setting up a “task force” of trained professionals to work in the institution where children are being adopted out would be beneficial as this may help better “prepare” and “desensitize” the child for a period of time prior to their adoptive families taking charge. Experts should be trained in severe abuse and neglect syndromes, and work with the perspective adoptive child for a minimum of 3-6 months before they are allowed to be placed with their new family.
2. Families having adopted a child from an institutional setting should be required to attend intensive pre and post-adoptive training programs to deal with the post-institutionalized child. The Parent Network for the Post-Institutionalized Child has done an outstanding job of setting up various training programs around the country, in addition to having regular newsletters, mailings and research readily available to families in need.
3. Families need to address specific treatment issues which are highly specialized and germane only to the post-institutionalized child with the possibility of an institutionalized autistic disorder. A unique and innovative family therapy approach should be arranged immediately upon the child’s arrival to their new family in the United States. References regarding innovative treatment are made in the treatment section of this book.
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Ron Federici, Psy.D. | April 25, 2010 at 1:06 pm
The Neuropsychology of Bonding And Attachment Disorders
While abandonment and institutionalization most certainly has a profound impact on a child’s ability to develop trust, bonding and security in newly adoptive relationships
July 18, 2007/ Dr. Ronald S. Federici
While the role of the Developmental Neuropsychologist is to evaluate intellectual-cognitive, memory processing, learning aptitude, and problem-solving strategies, a critical duty may actually be in the evaluation of a child’s emotional integrity and perception of relationships. The interplay between neurocognitive development and emotions encompasses basic neurobiology which suggests that human emotions, reactions, interactions and attachments may be strongly mediated by a combination of genetic, neurochemical, neurocognitive and environmental factors. As there has been a tremendous amount of discussion regarding “attachment disorders” in the post-institutionalized child, the current psychological research focuses almost solely on the effects of deprivation and abandonment and the creation of an “attachment disorder” without a more detailed understanding of the role of innate neurocognitive functioning.
While abandonment and institutionalization most certainly has a profound impact on a child’s ability to develop trust, bonding and security in newly adoptive relationships, an emphasis needs to be placed on the integrity of the post-institutionalized child’s higher-level neurocognitive abilities with a comprehensive assessment regarding the availability of “innate skills” needed for bonding, attachment and the development of appropriate social-interactional and reciprocal behaviors. While many children with post-institutionalized attachment disorders may display a combination of unattached or even indiscriminant behaviors (Ames, 1997), many post-institutionalized children display a very intense pattern of behavioral dyscontrol; aggression and violence; destructiveness to self and others; a lack of cause-and-effect thinking; indiscriminant affections to strangers as evidenced by being inappropriately demanding and clingy; or a pattern of social withdrawal, isolation and maintaining a self-stimulating posture. A principle complaint from parents adopting an older child is that the child may be out of synchrony with their environment resulting in difficulties in providing management, structure and organization.
The concept of a “neuropsychologically-based attachment disorder” seems most appropriate for many post-institutionalized children, particularly the child who shows a history of high risk pre and post-natal factors which may have influenced neurocognitive development. For example, there is a documented interaction between growth parameters and neurologic competence in profoundly deprived institutional children assessed in Romanian institutions (Johnson and Federici et.al., 1999). Children who have shown documented medical and neurological impairments along with extended time in institutional settings typically display very pronounced impairments in the development of appropriate social-interactional skills. Combined with suspected impairments in neuropsychological abilities, behavioral patterns can often be quite aberrant and intense in nature, often overwhelming the newly adoptive family.
Therefore, it seems only appropriate to broaden the horizon when assessing children for bonding, attachment or general psychological dysfunction by including a comprehensive assessment of neurocognitive abilities or deficit patterns. As children from institutional settings are at highest risk for medical, neuropsychological and emotional problems, an assessment of only the psychological or behavioral manifestations provides only a partial understanding of the adjustment issues which often produce tremendous stress on the newly adoptive families and treatment providers attempting to intervene and provide services (Johnson, 1997; Federici, 1999).
Careful differential diagnosis regarding neuropsychological versus psychosocially-based attachment disorder can help provide newly adoptive families with better parameters of understanding the post institutionalized child. Additionally, neuropsychological and neurocognitive rehabilitation approaches should typically supersede solely psychological or psychiatric/pharmacological therapies as providing direct interventions and increasing speech and language, sensory-motor, abstractive logic and reasoning and, of greatest significance, visual-perceptual analytic abilities. These brain behavior interventions strengthen the post-institutionalized child’s ability to adequately “perceive” and process human relationships, emotions, facial expressions, social cues, and the necessary sequential “steps” needed to move towards a more healthy level of bonding and attachment. Too often, children from institutional settings are quickly categorized as having either a “reactive attachment disorder” or modicum of psychiatric syndromes ranging from Attention Deficit Hyperactivity Disorder, Bipolar Disorder, Post Traumatic Stress Disorder, varying types of depression and anxiety conditions or, very commonly, oppositional and conduct disorders or even autism/pervasive developmental disorders. While many of these psychiatric patterns may be co-morbid conditions, there needs to be a very aggressive but yet conservative approach in assessing the post-institutionalized child. Rank ordering developmental disabilities of the child as opposed to relying solely on the assessment of families or treatment providers may avoid misleading diagnoses and nonproductive therapeutic interventions.
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Dr Ron Federici | May 2, 2010 at 1:47 pm
NEW YORK TIMES
Lawsuit over adoption raises disclosure issues
By Pam Belluck
New York Times
POSTED: 01:30 a.m. HST, Apr 28, 2010
ShareScores of complaints have been made in recent years against adoption agencies by people claiming they were inadequately informed or ill-prepared for problems their children turned out to have.
Many state laws and the Hague Convention now require agencies to disclose “reasonably available” records. But it can be unclear, especially in international cases, how assertive they are expected to be in getting such information.
The case of Chip and Julie Harshaw of Virginia Beach is, in some ways, the reverse of the now-familiar story of a Tennessee mother who put her Russian-born child on a plane home: The Harshaws are committed to raising their Russian son, even though they say they would not have adopted him had they known how severely impaired he was. But when they decided to adopt, the Harshaws told their agency they could care only for a child with minimal health problems and “a good prognosis for normal development,” according to notes in the adoption agency’s paperwork.
They rejected one child because he had abuse-inflicted burns. But when a toddler in a Siberian orphanage appeared to fit their criteria, they brought the boy, Roman, home. ” ‘A beautiful, healthy, on-target, blond-haired boy’ was what they had quoted to us,” Julie Harshaw said.
After the adoption in 2004, Roman began showing “uncontrollable hyperactivity” and aggression, Julie Harshaw said. He has threatened their 5-year-old biological daughter with a steak knife and a two-by-four, and held her underwater in a pool. Their 13-year-old biological son has felt so much stress that he has required therapy.
Therapeutic programs have ejected Roman for kicking, biting, hitting and, most recently, on his 8th birthday, pulling out three of his teeth using a pen cap, fork or spoon.
Doctors finally diagnosed fetal alcohol spectrum disorder, brain damage and neuropsychiatric problems in Roman, whose IQ is 53. He was recently placed in an institution and is not expected to ever live independently, one of his doctors said.
The Harshaws are suing the agency, Bethany Christian Services, seeking compensation for the care Roman will need.
After Roman’s problems were diagnosed, the agency offered to end the adoption, to try placing Roman with another family. The Harshaws refused. “He’s not a dog; you don’t take him to a pound,” Julie Harshaw said.
The family claims that Bethany indicated, inaccurately, that a Russian doctor working for the agency had examined Roman, and that Bethany gave them incomplete medical information when more detailed records were available. (Such records were produced by Bethany more than two years later.)
Bethany, which calls itself “the nation’s largest adoption agency,” disputes most of the claims.
“Bethany is a highly respected adoption agency that provided all the appropriate information for consideration by the Harshaws,” said Mark Zausmer, a lawyer for Bethany, based in Michigan. “Bethany provided this family counseling, extensive documentation, opportunities to consult with physicians, medical records and other materials from which they could fully evaluate how to proceed.”
No organization tracks the number of cases against adoption agencies, and academics and industry officials say many are settled out of court and sealed, so the outcomes are unknown.
But these days, “a far greater percentage of these wrongful adoption suits relate to international adoptions,” said Marianne Blair, a University of Tulsa law professor.
Chuck Johnson, acting chief executive of the National Council for Adoption, an advocacy group, said, “There have been a growing number of families that have sued when they adopted a child from another country.”
Some lawsuits, Johnson said, come from families “expecting you to do the impossible when you did all you could,” but he said there had also been “agencies that have purposely concealed information.”
Issues of disclosure have drawn increasing attention in recent years. Lawsuits erupted in the 1980s over domestic adoptions in which histories of abuse and other problems were kept from adoptive parents.
“The philosophy was the blank slate, that adoption is a new start,” Blair said. Now, she said, experts believe that “disclosure of health information is vital.”
As a result, many states enacted disclosure laws, followed by similar requirements in the Hague Convention, which apply to countries that ratify the treaty, as the United States did in 2008. Russia has signed the agreement but has not yet ratified it.
Those regulations were developing as the Harshaws’ adoption was proceeding, and at most agencies, “the atmosphere was definitely an emphasis in getting what could be obtained and making sure that they disclose that,” said Joan H. Hollinger, a law professor at the University of California, Berkeley, who is serving as an expert witness for the Harshaws. Agencies were also focused on “preparation of adoptive families for what they might encounter,” Hollinger said.
Bethany says it clearly advised the family that children from Russia could have problems, including serious ones, and that records might be inaccurate.
While the Harshaws’ pediatrician raised overall risks after reviewing a video of Roman and a two-page medical summary, observing that some of the notations could indicate learning disabilities, she saw no specific indications of severe problems on the pre-adoption records provided. She noted a lack of detailed, up-to-date information and said she could not see Roman’s face clearly. (Facial characteristics may provide clues to health deficiencies.)
“They were warned about generalities,” said their lawyer, Samuel C. Totaro Jr., but the agency caseworker told them a Russian-trained doctor based in New York had “gone over there and seen him, and you have a healthy, on-target child, and the family took great reassurance from that.”
In a deposition, the caseworker acknowledged she had said that the doctor, Michael Dubrovsky, visited the orphanages to “see the children” and review pictures, videos and medical information. The agency says the Harshaws misinterpreted that to mean Dubrovsky had examined Roman.
In a deposition, Dubrovsky said he had never seen Roman, had not practiced medicine for years and was a facilitator for Bethany, not a medical screener.
The agency also suggests that the fetal alcohol syndrome was unlikely to have been detected before the adoption, noting that the Harshaws did not receive that diagnosis until two years later.
Zausmer said the agency did not conceal information and provided a translated synopsis of the Russian medical records that was standard at the time.
“We don’t believe that there was anything in the Russian records that would have materially affected any adoption decision,” Zausmer said.
But Dr. Ronald S. Federici, a neuropsychologist who diagnosed Roman’s illness, said the full 10-page medical record the agency produced after the adoption, at the parents’ urging, would have shown that “the boy had fetal alcohol syndrome.”
The Harshaws hope the institution can stabilize Roman enough to send him home; either way, he will need extensive lifetime care.
“What we’ve been through and what we’ve lost,” Chip Harshaw said. “Every day is ‘Groundhog Day,’ a repeat of the stress and anger and frustration.”
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Dr Ron Federici | May 2, 2010 at 6:05 pm
The Therapeutic Value of Using Physical Interventions to Address Violent Behavior in Children
A quick review of the published information on physical interventions over the last three years would seem to indicate that a fundamental and universal shift has occurred, away from the use of therapeutic restraint, as well as the use of seclusion, to address violent behavior in children. However, this is somewhat deceptive. Treatment environments have been faced with increasingly violent and assaultive children in a continuing trend that was identified a decade ago (Bath, 1992; Crespi, 1990). This challenge must be considered along with the fact that young children most often present violent behavior in treatment settings (Miller, Walker & Friedman, 1989). Unlike the impression given by recent media, the reality is that most treatment centers for young children use physical interventions to address violent behavior in a safe and effective manner. It is true that physical interventions have been the subject of substantial training to insure they are done according to national crisis management guidelines, but it is not true that the mental health community has abandoned physical interventions for violence.
It is important to clarify the interchangeable terms therapeutic holding and physical restraint. This physical intervention is when a trained adult stops a child from hurting self or others by using approved crisis intervention holds to protect the child until the child is no longer a danger. There are a variety of approved holds but all of them restrain the child from being violent and causing damage to self or others. A distinction must be made between the type of holding discussed in this article and “holding therapy,” which is a physically intrusive method to produce a crisis in a child and force the child to experience physical or psychological pain. Holding therapy and other similar intrusive techniques are not sanctioned by any legitimate professional organization and in the opinion of the authors are not therapeutic and are not valid psychological treatment.
There is increasing pressure on these programs to become restraint and seclusion free, but is this direction in the best interests of the children? The answer will emerge only after a dialogue of the valid points on both sides of this issue, but to date only one point of view has been advanced. The purpose of this article is to provide another perspective on this issue, one that has not been previously put forward.
A variety of interventions have been used over the years to address violent behavior among children and adolescents (Troutman, Myers, Borchardt, Kowalski & Burbrick, 1998). In settings such as psychiatric hospitals and treatment programs, two of the most frequently used interventions are therapeutic holds (also called therapeutic restraint) and giving the individual a chance to regain self-control in a seclusion or quiet room. Interventions less often used to address violent behavior are mechanical restraints and using medications for chemical restraint (Measham, 1995). Over the last ten years the latter two interventions, mechanical and chemical restraint, have been criticized as excessive and too restrictive. Mechanical and chemical restraints have declined in some programs and have been eliminated in others, particularly in non-hospital settings.
More recently, in the last three years, restraint and seclusion have been the subject of considerable controversy. A host of arguments have been presented against the use of restraint and seclusion to address violent behavior in children (Wong, 1990). Most notable was an investigative series in a Connecticut newspaper, the Hartford Courant (Altimari, Weiss, Blint, Pointras, & Megan, 1998). This expose of injuries and deaths reportedly caused by the use of restraint and seclusion is often credited with starting the current wave of criticism for the use of restraint and seclusion. This controversy has run the gambit from media coverage to policy change and new federal legislation.
The array of criticism directed at the use of restraint and seclusion has one glaring absence, a review of the therapeutic benefits of physical holds to address violence among children. Although seclusion is often used interchangeably for therapeutic restraint, the two are very different interventions bringing up very different issues. The focus of this article will not be seclusion, but rather a review of the therapeutic components of physical restraint.
Before addressing the potential therapeutic components of physical restraint, it is important to briefly consider the most frequent criticisms of using this intervention. A recent nationally published article is a good example of the criticism being directed at the use of physical restraint (Kirkwood, 2003). The article calls restraint violent, dangerous, and even potentially deadly to children. The point is made that this intervention can actually cause further trauma due to concerns such as counter-aggression by adults and repeating abuse the child has experienced in the past. Restraint is called a violent means to maintain control and “rule over” children. Rather than use physical restraint, the article recommends negotiating with the child, understanding the reasons behind the behavior and giving the child choices. Some critics have gone so far as to say a physical restraint should be avoided at all costs and any use of physical restraint is a treatment failure.
In the face of such harsh criticism, is there any defense for physical interventions such as restraining violent children? The authors believe there is, but the starting point of discussing the therapeutic components of physical restraint must begin with an acknowledgement that even good interventions when done poorly, or at the wrong time, lose some or all of their therapeutic value. Rather than an indictment of all physical interventions, the criticisms outlined in the article mentioned above can serve to improve the quality of physical restraint and, for that matter, all other behavior management.
All behavior management can become ineffective, demeaning and even psychologically damaging if done poorly. It is safe to say that using a violence intervention to “rule over” children is poor behavior management. Like other types of behavior management, if physical restraint is done in a violent and dangerous way, it may be possible to replicate the past abuse of the child, at least in the child’s mind. However, physical restraint is not step one of any intervention with a child. Physical restraint should not be a shortcut to taking the time to understand the child and the reasons behind the child’s behavior. Restraint is also not the opposite end of the continuum from appropriate negotiations and setting out clear and meaningful choices. Physical restraint is properly used only when the adult is trying to understand the child and other limit setting techniques have failed to safely address the violent behavior of the child. Interventions are also not therapeutic when they are based on a power struggle or when the adult is out of control. Any behavior management approach loses its therapeutic value if used to merely control the child without supporting and understanding the child’s thoughts, feelings and goals for the behavior. This is true for all behavior management interventions such as: time outs, logical consequences, giving choices, negotiating as well as physical restraint. It is not necessarily the technique that makes an intervention therapeutic, it is more often the when, how, why and by whom the technique is employed that makes the difference.
If physical restraint is a legitimate part of any behavior management plan, it must have the potential of therapeutic value when used appropriately. Among nationally recognized crisis behavior management systems there are clear guidelines as to the appropriate use of physical restraint. Behavior management systems such as Crisis Prevention Institute (CPI) and Professional Assault Response Training (PART) are two well known examples. Both outline the safe and effective use of physical interventions after crisis de-escalation techniques have been used to address the situation.
National accreditation organizations such as the Council on Accreditation (COA) and the Joint Commission on Accreditation of Health Care Organizations (JCAHO) sanction the appropriate use of physical restraint. If any legitimate organization were to declare physical restraint a “treatment failure,” an expression currently being used by opponents of physical interventions (National Technical Assistance Center for Mental Health Planning, 2002), one would expect it to come from entities that hold organizations to the highest standards of the industry, and yet all major national accrediting bodies sanction the use of physical interventions. It is difficult to find any national professional organization, such as the American Academy of Pediatrics, that does not agree with the general statement, “Restraint and seclusion, when used properly, can be life-saving and injury sparing interventions” (American Hospital Association and National Association of Psychiatric Health Systems).
Here are some of the reasons why physical restraint, when done well, can be an important, effective and therapeutic intervention to address the violent behavior of children.
• Physical touch can be very therapeutic to children, particularly in a crisis. Long before a child learns English, Spanish or Swahili, the first language a child learns is the language of touch. Touch is considered a basic need for all children. When a young child is frightened, the first instinct is to hold on to a trusted adult. Children who demonstrate serious acting out often do not know how to ask for what they need, yet supportive, firm, and safe physical touch can give a child a message of reassurance. If touch is poorly used, such as slapping or striking a child, the message of such a touch can be very frightening. When a young child is in a crisis situation, touch can be one of the most reassuring interventions when the touch lets the child know that the adult will insure the situation will be managed safely for everyone.
• Emotionally defended children can become psychologically more real and available after an emotional release during a physical restraint. This dynamic is not restricted to children. It is often when our emotions overwhelm us that we open to learning something new that we have defended ourselves from. There is a parallel in psychotherapy to this dynamic when a client has a difficult but insightful experience that usually includes being catapulted beyond the individual’s ability to keep out important information. For some children it is difficult to get to this place without some form of emotional meltdown that often accompanies a physical intervention.
• Children need to know the adult will insure everyone’s safety. The adult is responsible to insure the child cannot hurt him or herself or others, if other management methods fail, physical interventions are important. The adult cannot put the responsibility on a child to regain inner control once it has been lost. The amount of time it takes for any crisis situation to be under control, during which time chaos reigns, is the amount of inner fear the child has. Children can regain their footing, but the assistance from a supportive adult can be critical.
• Young children with emotional disturbances need and often seek closeness with adults and violence is less threatening than other forms of intimacy. Behavior cannot always be taken at face value with children who experience violent rages. In fact, these children can often act counter-intuitively. They can push you away when they want closeness, they can strike at you when they are beginning to care about you, and they can act in ways to receive reassuring touch by becoming aggressive and violent to self or others. It is important to understand why a child is acting the way they are. At times, a frightened child seeks and needs the reassurance of physical touch when they can’t allow themselves to ask for physical comfort. It is often trusted adults that young children become violent with, because they know they are safe and they will get the reassurance they need. If they do not find the physical reassurance they need and seek, they will often raise the level of acting out until they get it.
• Physical restraint is the surest and most direct way to prevent injury and significant property damage when the child loses control. The above referenced article in Children’s Voice (Kirkwood, 2003) begins with a description of a child doing significant damage to a car with a rock. In this example the adults stood by and did not stop the child and the author called this a better, however more costly, intervention. This seems to defy common sense. Would any parent stand by as a child does thousands of dollars in damage to the family car? Recently, a child in our program picked up a rock, ran around a new car and heavily scratched it to the amount of $2,650 damage. Afterward the child felt badly for such out of control behavior and said good kids do not do such bad things. It is important to understand that kids, as well as adults, view themselves in relation to their own behavior. It only makes sense from a practical and therapeutic perspective to stop children from hurting others and doing damage they will use to feel worse about themselves. Physical interventions may be the best way to insure this.
• Traumatized children must learn that emotionally charged situations and all physical touch does not end in being used or abused. The human being has several types of memory, including factual (explicit), subjective (implicit), emotional, experiential and body memories (Ziegler, 2002). Early experiences of touch can establish a lifelong trajectory of meaning attributed to physical touch. It is common that children with emotional disturbances have difficulty with caring touch. Body memories need to be addressed while the child is still young or the child can avoid the very closeness they need. Abused children learn that when someone gets angry someone else gets hurt. Supportive physical restraint retrains the body not to fear touch from others.
• An intervention considered to be good parenting is likely to be good psychological treatment. Psychologists, family therapists and parent trainers would all call stopping a child from running into a busy street good supervision and effective parenting. They would also recommend a parent prevent an older and much larger sibling from physically harming a younger sibling. It is not hard to imagine the same parenting consultants suggesting that when an angry child is heading for the family car with a baseball bat, that the bat be taken away before the damage occurs. If these parenting interventions would be basic common sense to most everyone, why would some call these same interventions unhelpful and non-therapeutic to children with serious anger problems?
• Children with emotional disturbances need the assurance that adults are safely and appropriately in control of the environment. Serious acting out such as violence is often seeking this assurance. Most emotional problems in children have their source in chaotic, abusive and/or neglectful home environments at some point in the child’s life. To be in a home where the adults are not in control of themselves or the environment is like going down the road in the back seat of a car with no one driving, it is terrifying to a child who has been there. These children often push a new environment to the point that the child finds if the adults can safely and appropriately manage the challenges. Often when the child has such reassurance and can rely on others for basic needs, he or she can once again get back to the task of being a child.
• Treatment programs are responsible for directly addressing violent behavior and not just skillfully preventing the behavior from presenting itself during treatment only to reappear in the home or community after treatment. The argument that all physical restraints can and should be avoided at all cost may address the principle of prevention, but misses the point of treatment. In the extreme, all physical restraints could be avoided, this simply requires an adult to passively stand by and allow a child in a rage to do whatever he or she wants to do. One may call this “preventing” a restraint, but how did it address the responsibility of a treatment program to treat and extinguish serious violent and antisocial behavior? The role of prevention and treatment are quite different. Not intervening when a therapeutic response is called for is not so much prevention as it is abdicating adult responsibility. If someone needed treatment for a debilitating phobia of spiders, the symptoms could be prevented by having an insect free environment, but this would not be treating the phobia. Programs charged with treating violent behavior cannot simply insure that the symptoms never come up in the treatment environment because they will surely resurface once the child leaves that setting. In psychological terms, treatment often requires steps such as re-exposure to stimuli, cognitive reprocessing, skill development, practice and mastery, none of which have an opportunity to happen if preventing symptoms or preventing a particular intervention at all cost is the goal.
Are therapeutic benefits guaranteed by the appropriate use of physical interventions? No intervention comes with a guarantee. However, as one side of this debate offers sensational media stories and points to abuses of physical interventions (and there have been abuses), there exists research and professional literature that has found therapeutic value in physical restraint when used properly. Restraint has been found to shorten the crisis over other interventions (Miller et al., 1989). Research studies have found physical restraint effective in reducing severely aggressive behavior, self-injurious behavior and self-stimulatory behaviors (Lamberti & Cummings, 1992; Measham, 1995; Miller et al. 1989; Rolider, Williams, Cummings & Van Houten, 1991). Physical restraint has been found helpful in treating aggression with dissociative children (Lamberti & Cummings, 1992). Physical interventions have also been recognized in the role of re-parenting children who have not been taught limit setting due to absent parenting (Fahlberg, 1991). Physical restraint has been called an effective intervention to protect the child and others from harm and prevent serious destruction of property (Stirling & HcHugh, 1998).
A frequently cited criticism of restraint is that it takes away the ability of the child to learn and internalize self-control. However, research studies have found the opposite. In two studies nearly a decade apart, physical holding produced rapid gain in internal behavioral control (Miller, Walker & Friedman, 1989; Sourander, Aurela & Piha, 1997). Physical restraint has been called ethically sound (Sugar, 1994) and recognized for significant therapeutic benefits (Bath, 1994).
The arguments for and against the use of various interventions such as medications, institutionalization, physically intrusive therapies, seclusion, and physical restraint are important discussions. However, children are not served when only one point of view is expressed. Many interventions, including physical restraint, can have damaging consequences when improperly used, however, at times the consequences of not using serious interventions can be even more damaging to a child. A five-point evaluation of interventions for violent behavior has previously been recommended (Ziegler, 2001), 1. Was safety insured? 2. Was self control internalized? 3. Was the intervention individualized and based on understanding the child? 4. Was the intervention therapeutically driven? and 5. Was the intervention effective in producing the desired result?
If we are to meet the challenge of increasing numbers of violent children in our system of care, we must carefully consider how we can best meet the short and long term needs of these children, while insuring the safety of other children, their parents, and the community at large. A reasoned approach to this question would be careful consideration of all the issues and not a singular movement to reduce or eliminate physical interventions, which have been found to be safe, ethical, effective and therapeutic.
References
Altimari, D., Weiss, E.M., Blint, D.F., Poitras, C. & Megan, K. (1998). Deadly Restraint: Killed by a system intended for care. Hartford Courant, Hartford Connecticut (8/16/98).
American Academy of Pediatrics—Committee on Pediatric Emergency Medicine (1997). Pediatric, 99 (3), 497-498.
American Psychiatric Association, Arlington, VA.
Bath, H. (1994). The physical restraint of children: Is it therapeutic? American Journal of Orthopsychiatry, 64 (11), 40-48.
Council on Accreditation for Children and Family Services (2002). Accreditation Standards 7th Edition. New York, NY.
Crespi, T.D. (1990). Restraint and Seclusion with Institutionalized Adolescents. Adolescence, 25, (100), 825-828.
Crisis Prevention Institute, Inc. (2001). Nonviolent crisis intervention Training Manual. Brookfield, Wisconsin.
Fahlberg, V.I. (1991) A child’s journey through placement. Indianapolis: Perspective Press.
Joint Commission On Accreditation of Health Care Organizations (1996). Accreditation Manual for Hospitals: Volume 1 – Standards. Oakbrook Terrace, Il.
Kirkwood, S. (2003). Practicing Restraint. Children’s Voice, 12 (5), pp. 14-19.
Lamberti, J.S. & Cummings, S. (1992). Hands-on restraint in the treatment of multiple personality disorder. Hospital and Community Psychiatry, 43 (3), 283-284.
Measham, T.J. (1995). The acute management of aggressive behaviors in hospitalized children and adolescents. Canadian Journal of Psychiatry, 40 (6), 330-336.
Miller D., Walker, M.C. & Friedman D. (1989). Use of a holding technique to control the violent behavior of seriously disturbed adolescents. Hospital and Community Psychiatry, 40 (5), 520-524.
National Association of Psychiatric Health Systems, Washington, D.C.
National Technical Assistance Center for State Mental Health Planning (2002). Networks , Alexandria, VA.
Rolider, A., Williams, L., Cummings, A. & Van Houten, R. (1991). The use of a brief movement restriction procedure to eliminate severe inappropriate behavior. Journal of Behavioral Therapy and Experimental Psychiatry, 22 (1), 23-30.
Smith, P.A. (1993). Training Manual for Professional Assault Response Training Revised.
Stirling, C. & McHugh, A. (1998). Developing a non-aversive intervention strategy in the management of aggression and violence for people with learning disabilities using natural therapeutic holding. Journal of Advanced Nursing, 27 (3), 503-509.
Troutman, B., Myers, K., Borchardt, C., Kowalski, R. & Burbrick, J. (1998). Case study: When restraints are the least restrictive alternative for managing aggression. Journal of the American Academy of Child and Adolescent Psychiatry, 37 (5), 554-555.
Wong, S.E. (1990). How therapeutic is therapeutic holding? Journal of Psychiatric Nursing & Mental Health, 28 (11), 24-28.
Ziegler, D. (2001). To Hold, or Not to Hold…Is That the Right Question? Residential Treatment for Children & Youth, 18 (4), 33-45.
Ziegler, D. (2002). Traumatic Experience and the Brain, A handbook for understanding and treating those traumatized as children. Phoenix: Acacia Press.
8.
Ron Federici,Psy.D. | May 16, 2010 at 8:15 pm
The risks of adopting from Russia
Russia and the US are negotiating changes to overseas adoption procedures after a controversy last month sparked by an American adoptive mother who sent her son back to Moscow alone. The BBC’s Kim Ghattas met a Pennsylvania family with a unique perspective on US-Russia adoptions.
In a leafy town in Pennsylvania, four children and their parents are reunited after a day at school and work. Abby, 14, is showing off her purple nail polish, Lydia, nine, wants to rehearse on her cello.
Trevor, seven, and Hayden, 11, are wolfing down snacks prepared by their mother Julie, while father Mike asks about homework.
They appear the all-American family, but the children were all adopted in Russia and the transition has been a sometimes arduous journey for the Jones clan.
“It just seemed that the need was so great, that it really just pulled at our heartstrings, that it was the right place for us to be,” says Julie Jones, describing the decision to adopt the children from their homeland.
“ If we had seen the videos, in all honesty, we probably would have inquired about some other children ”
Mike Jones
Abby and Hayden were adopted first, in 1999. Six years later, Julie and Mike and the two children went back to the same orphanage in Russia to adopt Trevor and Lydia.
Russian orphans, especially when they are adopted as older children, are often damaged, mentally and physically, by life in orphanages and by the drinking and smoking of birth mothers.
In the first videos her future parents saw, Abby looked like a sweet timid child. The couple expected some challenges but didn’t realise how much Abby suffered from attachment disorder.
After the adoption was completed, the orphanage gave the couple more videos showing a very different child – much angrier, almost menacing.
“If we had seen the videos, in all honesty, we probably would have inquired about some other children,” Mike Jones says.
“It’s a challenge for the adoption agency because they want to get as many children adopted as they can. But at the same time, there probably are some instances where they’re putting the children in a little better light than they are.”
‘Failing system’
Mike and Julie are very happy Abby is in their life and, overall, satisfied with the US adoption agency they used. But they count themselves lucky that the problems the children had were not more serious, and that with the support of friends and family they were able to provide the right environment for the children.
But not all adoptive parents are able to cope and that’s where the system starts failing. Even young Abby knows it.
“Because I was raised in such a good family, it’s better here than it was in Russia,” she says, sitting on a swing in her parents’ garden.
“There’s a lot of kids who should be [allowed] to come, but I just think that [both] governments should just look at the families more closely.”
The case of seven-year-old Artyom Savelyev – sent back to Russia alone by his adoptive mother with a note saying she no longer wished to parent the child – sparked anger in Russia at the US.
There were calls for a total moratorium on adoptions with the US because this was not the first incident involving Russian orphans. Since the early 1990s, the Russian authorities say 18 orphans adopted internationally have died in their adoptive families, 17 of them in the US.
Just over two thirds of Russian orphans adopted abroad end up in the US. But 15 children also die every year under domestic Russian adoption, according to Russia’s children rights ombudsman Pavel Astakhov.
The Russian Duma eventually rejected the motion calling for a freeze on adoption in the US while the two countries negotiate a bilateral agreement to improve the process.
The failings are on both sides. Russia is one of only three countries that has yet to ratify the 1993 Hague adoption convention which regulates international adoptions.
US officials want the Russian side to give more information about children, and sooner, so parents can make an informed decision.
“The parents don’t see the complete medical status of the child until they show up to court for the final adoption,” said one US senior official who spoke on condition of anonymity because the negotiations with Russia are ongoing.
“In some cases that may be a little later than the parents would have wanted to see it depending on what it says.”
Dr Ronald Federici, a clinical neuropsychologist in Virginia, who has worked with adoptive families, tells a similar story.
He says the information is often only one or two pages of redacted information badly translated, given to the parents when they are in court, the child already in their arms.
Some parents, albeit overwhelmed by their new knowledge, feel obligated to bring the child home and then problems start. Others simply leave the children behind, according to Dr Federici.
That’s why the issue of matching children with the right family is so important.
“ We’re not getting a fifth – but we have no regrets ”
Adopting parents Mike and Julie
Some families are able and willing to deal with problem children, others are not and US adoption agencies are being urged to put in place a better vetting system. Many observers said Artyom should never have been adopted by the single mother he was matched with.
There are also concerns that families are not getting appropriate post-adoption support, after the adopted child arrives in the US.
This support is currently not mandated or enforced and because Russia is not part of the Hague process, the US state department cannot bar agencies that fail to provide it.
If things break down, there is little recourse for the families. So the sad, little known fact is that Russian adoptees are often simply sent back to Russia.
Not all of them make it into the news like Artyom. In the last 10 years, Dr Fedirici alone has seen 39 children sent back to Russia.
“[These children] have foetal alcohol syndrome, trauma, deprivation, neglect, abuse, malnutrition and illness. These things can be overcome, but it’s a very arduous process,” said Dr Federici.
But for the Jones family, back in Pennsylvania, it is a happy ending.
“We’re not getting a fifth,” said Julie, laughing, “but no, we have no regrets.”
The key now, for both the US and the Russian governments is to make sure other families too have no regrets about adopting from Russia.
Story from BBC NEWS:
http://news.bbc.co.uk/go/pr/fr/-/2/hi/americas/8684093.stm
Published: 2010/05/16 11:40:22 GMT
© BBC MMX
9.
Dr Ronald S. Federici | May 19, 2010 at 11:11 am
Handle With Care Behavior Management System®
Bringing Crisis Into BalanceTM
Legislative Alert
A bill has been introduced requiring all school staff
that use restraint be trained in restraint
H.R. 4247 and S. 2860
The documents below are in Microsoft Office 2007 and Microsoft Office 2003: Power Point and Word. If you have trouble viewing contact us.
FREE power point on the laws governing restraint use in schools.
Restraint Law v. 2007. Call us for MS Office 2003 version.
FREE white paper submitted to States on the therapeutic use of physical intervention.
White Paper v. 2007; White Paper v. 2003
FREE talking points HWC submitted to Congress on February 12, 2010 regarding proposed bills H.R. 4247 and S. 2860.
Talking Points v. 2007; Talking Points v. 2003
Feel free to distribute the above documents freely. We just ask that you keep the document intact under HWC’s cover page.
Established in 1984, Handle With Care® (“HWC”) has created safer human service environments in over 1000 organizations and schools in all 50 states and internationally.
Welcome to our website:
Handle With Care has been providing crisis intervention, behavior management and restraint training services and resources to schools, special education classrooms, human services staff, healthcare providers, community and juvenile programs, families and educators for almost 30 years. Established in 1984, HWC is committed to helping schools and organizations create and maintain safer and more caring environments. We are dedicated to the reduction of workplace and school violence through the use of preventative actions that result in a decrease in the need for the use of physical restraint. Our core philosophy is premised upon the belief that the least restrictive intervention should be used and there is no dignity in allowing a child or adult to hurt himself or someone else.
Handle With Care’s program is used by schools, ADA/504 and IDEA classrooms, JCAHO accredited and Medicare/Medicaid participating facilities. HWC complies with JCAHO policies, CMS regulations and HHS rulings and the Children’s Healthcare Act regarding safety and restraint. HWC’s founder, Bruce Chapman regularly provides consultations, answers and advice on the entire spectrum of behavior management, crisis intervention and restraint. Bruce is qualified as an expert on such topics as the proper and improper use of physical and therapeutic (mechanical) restraint and self-defense. We appreciate you visiting our site and look forward to helping your family, organization or school create and maintain a safe, therapeutic and caring environment.
HWC teaches a full spectrum of interventions including the best and most effective standing, seated and floor restraint along with a verbal de-escalation program. Handle With Care’s program and physical intervention techniques are appropriate for and very effective with autistic and DD children/clients.
HWC’s program is fully documented in a Participant’s Manual, Instructor’s Manual, Power Point and Video.
Handle With Care’s training program consists of verbal de-escalation (including theoretical models and role plays) and nonviolent physical intervention.
Training
For additional information, call or email us at:
Tel: 845-255-4031 ; Email: Info@handlewithcare.com
10.
Ron Federici,Psy.D. | July 4, 2010 at 1:20 pm
Hi, Dr. Federici! It’s hard to believe that it was a year ago I first sent you an email regarding a family consult. I hope you and all of your family are doing well. From some of the listserves, it sounded like you went ahead and moved your office? If so, I hope that all went well for you too. I’m in the middle of opening a larger ABA center here in Southern Indiana, so I can appreciate the challenges!
Your help has proven invaluable with the children. While we continue to work through some issues with several of them as would be expected, they’ve all made huge strides forward this past year, in a large part because of your guidance and direction. Here’s a quick update on each child, plus a request below:
Kris is like a completely new person. He seems like a weight has been lifted and he’s doing extremely well. We’ve not seen the dark days for a long time from him and he’s worked through a lot of stuff with us. He just returned from his first mission trip (Jamaica) and that also has had a very positive impact, it seems.
Will’s change is incredible. We were able to explain to the school that we all had been operating under a misdiagnosis and convinced them to build him, Cary and Adam a language-based program within their existing school, customized in many ways for their specific needs based on your recommendations. Will went from starting the year reading at pre-K levels and nearly zero math ability to now reading at 80% proficiency on 3rd grade sight words, and large improvements in occupational math capability. Cary and Adam both had their best years ever, though both have a long way to go. Cary’s just so extremely hyper, it still it drives folks around him batty, plus he has a hair-trigger temper and has gotten a lot more mouthy. But it happens less frequently and in between, he’s actively trying to do things to improve his behavior and relationships. Thankfully, the darkness has abated quite albeit though it still shows up periodically. Adam still struggles, but the med trials on the Abilify didn’t go well, though the Welbutrin seems to help some. The local doc is trying him on a low dose of Risperdal, but we’re being very cautious given his earlier unusual reactions. It seems like his development – physically, mentally and emotionally has just stopped for the most part. It’s worrisome, as he seems totally out of touch with other people and is adamant his view of the world is accurate.
Ava is a pretty moody 13-year-old, but seems to be doing well most of the time. We try to get her out and involved in other things so she gets a break from the stress around here, but she still prefers to be a homebody, so we’ll keep working on that.
Kristie’s anxiety continues to be a major source of issues for her, but that seems to be improving some. She deals with some paranoia now too and the morning mania continues to be a major issue, but I’m doing some behavioral interventions with her that she finally seems to be responding to most days. We’re also seeing a lot more smiles, conversation and interest in what other people are doing, so that’s positive.
So that is the update. Again, I can’t really adequately express how much I appreciate all you’ve done for our family. You gave us the window we needed into our children so we could help them more appropriately and for most of them, it seems to be working. You also helped Jim and I take a very hard look at what was going on with us and that situation has improved dramatically over the past year also.
Thank you again for everything and may God bless you and your family…
With appreciation,
Kim Derk
“Dr. F: I had another thought about topic to include in Anna’s ‘needs/problems’ section of report: “She may reach puberty by ___ years of age, and will need direct teaching and hands-on assistance to manage self-care during menstrual periods, and cannot reliably relay menstrual pain due to high pain tolerance/thalamic pathway-sensory nerve involvement, which may create unpredictable moods and behavior”, or something akin to this. Hope it’s not too late. Off to take in sights with lots of layers to keep us Southerners warm. Everytime we leave hotel or restaurant or Metro stop, Anna announces “Dr ‘Rici is CLOSED, Mommy”. When we ask if she likes you, she says “Ye. . . . NOOOOOO!”. Guess that sums it up. Who really LIKED their drill sergeant, but am sure she has a love spot in her heart for you.
Thank you for everything. You met and exceeeded our every expectation, and we thank God for you. May you have blessed holiday season. Sincerely”
Lyn
“Dr. Federici. Thank you for everything. You met and exceeeded our every expectation, and we thank God for you. We have been to so many “experts” over the years, and you nailed it in two days, and have helped us see hope and a light at the end. We have learned more from you in these past days, than from years of ‘therapy”.
May you have blessed holiday season. Sincerely”
Jeri H. , Houston, Texas
“You are a life-saver, Dr. Federici! Your quality evaluation and comprehensive parent training has saved our family! We went through so many people, and you are the ONLY one who gets it with post-institutionalized kids. We owe you so much…thanks for helping all the families out there. God Bless!”
Will/Mary V., PA
“Hi. Just want to thank you for finding the time to meet with the Boyle child and the state department family/parents (from Africa). I read the report of your eval and just get blown away. This was the BEST evaluation and treatment plan we have ever seen for one of our state Department kids adopted from Ukraine. Actually, it was the best Neuropsychological Evlautaion we have seen altogether. This is a life long challenge for these parents. Your eval/recommendations was certainly something deeply needed and appreciated by them. Thanks for all the great support to our families serving abroad Thanks again”
D. Supervisor, Exceptional Programs, US Department of State
“May I ask what Dr. Federici does for….assessment?”
“Federici conducted 34 tests, held a diagnostic clinical interview and reviewed seven years worth of reports for my chld. I doubt that most other clinical psychologists are as thoroughly versed in the pre and postnatal challenges that confront Romanian children at least. In my experience, they don’t conduct as many tests.
My child was in his office from 8 in the morning until 6 p.m. Some children will receive additional testing; in our case, quite a bit had already been done, so Federici looked those results over and made sure to widen the testing to not duplicate (and/or to corroborate) what had been done before. Federici likes to do a great deal of testing by way of simulating a school day. He discovers what the mentally fatigued child does, what the low frustration child does, etc., what the “give up” child does, what the “dependent” child does…my child found it challenging, just like learning in school…
Within three weeks of our visit, Federici compiled and sent me a highly useful 37-page report. He also revised the few inaccuracies immedaitely when I made the request. Not only did his assessment provide the interconnected aspects of my child’s learning, pulled together to show how, for example, short term memory and attention were involved. He made sense of a complicated history, noting subtle and obvious issues in a way that made the report’s findings difficult to ignore in public school. Furthermore, because Dr. Federici has the credentials in psychopharmacology, he indicated which medications might help my child. I felt that I had received a thorough, competent evaluation.
I went to Federici because I was frustrated with the ignorance or “sluff off” factor I was encountering locally. …. I chose to go to Federici because of his knowledge base and the awareness that he could deliver a report (and revise it!) much more quickly than a hospital center.”
Hi Dr. Federici, sorry it has taken me so long to write back. You may recall I was struggling a couple of months ago with the Adults Only program. I reread your book, watched the tape (Saving Dane), and reread Wendy’s program. We got over the bumpy spots and things went relatively well.
Katie is able to be redirected verbally when she engages in body movements or “silly talk.” She returned to school in late August and has made a smooth transition to a new school, new teacher, and new classmates. Staff there is also finding her easy to redirect and Katie is now being mainstreamed again in the 3rd grade for math and some of the other subjects.
Katie has also transitioned to a new daycare setting (she is taken by bus to a different school) and has handled the change well. I am very pleased with the results I’ve seen as a result of implementing your program. I wish I could clone you and move you closer. Once I enjoy the fruits of our labors, I’ll be ready for the next steps! Thanks for providing such a wonderful service!”
Pat M.
“My daughter and I would not be where we are with peace in our home, and secure signs of attachment without the intervention and support of this team. My message to anyone adopting an older child is early intervention and consultation with this team of professionals.”
P.R., Indianapolis
“A great expert in the field of Child Psychology. We need him here in the U.K and Ireland”
J.R., England
” Extremely talented and skilled Clinician, Presentor and Parent!”
Mental Health Staff and Parents, Iceland
” Always a Professional we welcome here to lecture and train”.
Adoption Society, Australia
“Dr. Federici is the only neuropsychologist qualified enough to evaluate and treat the most complex children, especially post-institutionalized children”.
T.T., Founder, PNPIC
“Ron Federici and his group were the only ones that could handle my out of control child who had failed multiple treatments. His group has the best treatment team for the family in need”.
B.C., California
“This group of professionals evaluated and treated our situation, pro bono, because we were in dire need. The evaluation and program for my son helped immensely.”
K.C., New York
“If it weren’t for the most professional evaluation and intensive treatment program given our family with our adopted child, we would have been destroyed.”
K.J., Fort Worth, TX
“NBC-Dateline “Saving Dane–Saving a Family” which highlighted Dr. Federici’s expertise with the most disturbed children was an inspirational show of recovery.” Professional review, NBC Dateline June 2003.
“Dr. Ron Federici and his staff are an unmatched resource for families experiencing the challenges of parenting children with complex behavioral and learning problems. As an adoptive parent of a number of post-institutionalized children, Dr. Federici understands the emotional as well as the clinical issues facing each family. His superb diagnostic acumen is paired with an excellent track record of effective interventions.”
Dana E. Johnson, M.D., Ph.D., Professor of Pediatrics, University of Minnesota
“Given his extensive professional and personal experience with children of international adoption, Dr.Federici provides families with a uniquely informed and invaluable assessment of each child’s cognitive, academic and emotional strengths and weaknesses as impacting children’s functioning in home, school and other settings. His comprehensive neuropsychological assessments and expertise with post-institutionalized children, offered in conjunction with practical strategies, provides parents with tools and a much needed and individualized road map to identify the critical educational, medical and behavioral supports known to be essential for the promoting the wellbeing of these often misunderstood children and their families.”
Lisa M.H. Albers, MD, MPH, Director, Adoption Program, Children’s Hospital/Harvard Medical School
“I have worked with Dr. Federici for 10 years and have traveled with him to Romania on many medical missions. I learned about the plight of orphans from Dr. Federici and he inspires me daily. I send families to him because he knows the intricacies of the mind of an orphan mentally maimed by the harsh and unimaginable conditions of orphanages all over the world. He saves the souls of children. He is a creative and daring psychologist who drains his soul to help the hopeless!”
Dr. Jane Aronson, International Pediatric Health Services, PLLC
“Hello Dr. Federici and Leslie: I just wanted you to know that we have turned a HUGE corner! I called in desperate need 2 weeks ago and only 1 1/2 days later Michael decided to begin to comply.
I did have an emergency visit with his Psychiatrist, but we only decided to increase his Tenex to 1 mg b.i.d. I am very glad that is the only change we made because the difference in Michael and his behaviors is like nothing I have ever seen!
I have a new analogy for you to use. When I was pregnant people would tell me about their labor and delivery pains, but because I have never been through this I could only imagine. And, of course, my own labor and delivery would be my own personal experience. This is how I perceive explaining “extinction burst”. If you have never been through it, or seen it, you can only imagine what it will be like. And, of course, it is different for every child. I now understand that what Michael was doing on that Wednesday (hurting himself and me) was a true “extinction burst” (UGLY) (and perhaps a little something else). He was fighting for his life to try to get his old behaviors to work!
Well, I am happy to say that his old behaviors did not work
We are committed to the program and now even more so. The changes are so unbelievable!
Thank you, thank you. The work that Dr. Federici and you do is invaluable to families like ours.
Will keep you posted, and I’m sure have additional questions along the way. We just wanted you to hear some GOOD NEWS!”
Kelly F. (Rick, John and Michael too)
“did they determine over the phone before you traveled which of your children would need the extensive evaluation ?”
We knew that Kat was either on the way out or we needed to do something “really different”. When we made an appointment for Kat, we were willing to pay what ever was needed for peace (what price do I put on that).
We sent (our other children) to stay with my brother for the 4 days we were in DC with Federici. When we came home and started to work the Federici program with Kat, our youngest son’s Autistic behaviors were amplified. He displayed very stereotypical behaviors. We decided to take him to Federici for a full evaluation. After it was all said and done; the biggest suggestion was to try and reduce stress in his life and redirect him whenever he displayed stereotypical behaviors and get him around better role models (Kat was not a good role model for him). Our son was diagnosed as above average intelligence and many other positive dx’s.
“I’m also wondering if there is any testing that can be done locally through the child’s pediatrician that can help to minimize Federici’s cost.”
We could not face another person that was not willing to believe us. We were not willing to waste another nickel on “She’s Cute, She’s Adorable”.
We had tried local stuff only to be told that “everything was fine” and “she’s cute and getting better”. This was not the case at home. I video taped what was going on in our home and the therapist was beside herself stating “I had no idea it was like this”. We gave up on local’s and decided to try something extreme.
The result has been extraordinary. Kat is not a perfect, normal 4 year old however, she is nowhere near the behavior monster she was last year. She can sit and eat dinner, she can play with her brother, she will use the toilet for its intended purpose. This is priceless! We had lost all hope for Kat until we saw Federici.
Many may disagree with his tactics and call it barbaric or something along those lines. They may say that I have violated my child’s rights. I can tell you that my child has a right to life. The path she was on was a suicidal path, self mutilation, running into traffic, throwing herself into moving cars, the fireplace, the wall, the doors. We have done all we could do to save her from herself.
She is a different person today. I know this helps. I think very Highly of Dr Federici and his staff because “it worked for us” and “saved our family” on many fronts.”
B.D., New Jersey
“Hi Dr. Federici, We thought we would touch base with you and give you an update as to how things are going with W and D since our visit with you two years ago.
We still speak and enforce your level program EVERYDAY. Of course, we have made revisions from time to time to keep up with development, responsibilities and privileges, but the basics are the same. The kids are very used to this in their lives by now. Tracking their token count is a daily part of their lives, much like brushing their teeth! They have had their ups and downs, mostly due to lying – but we seem to have gotten a better grip on that lately.
W has come a long way. He thrives on his schedule and is quite self-directed. He doesn’t like bumps in his road or unexpected transitions, but he’s doing better at accepting them when they happen.
D struggles with many thinking errors as well, especially when it comes to relationships. She will continue to be a handful, for us and for whoever else in her future!
Overall they (we) are doing wonderful compared to where we were two years ago. On your 50-80% improvement scale, we give W a 75% and D a 60%. We expect more…still lots of room for improvement.
They even get themselves up with their own alarm clocks, get dressed, make their beds, feed our pets, get their own breakfast all on their own! Sounds a tad different from their experience in your waiting room two years ago!
Thank you again for all you did for us. We still hope to come back some day so you can see the progress for yourself. I’m sure you could put W’s anger control skills to a mighty test, but hopefully he would show improved survival skills! Sincerely,”
TJ & K., Boise, Idaho
“When we brought home our daughter Grace from Ukraine in March of 2004, we wondered if we would be able to parent her. She was 17 months old, 13 pounds and one big bundle of nerves. Grace has fetal alcohol syndrome, a disorder prevalent in the Eastern European orphan population. We are so grateful to have had that diagnosis which is necessary to getting her the proper help. Giving her love and time was not going to unwind the condition she was in.
It wasn’t just FAS that brought Grace to this level of stress, but a combination of unfortunate life stunting scenes. She was the 6th child born to a 26yr old alcoholic in Crimea. Born full term she weighed 4 pounds and micro cephalic. At three days she was taken from the hospital to the orphanage where she lay wrapped tightly swaddled in a blanket. Over the course of the following year and a half she would experience a constant set of illnesses including acute bronchitis, pneumonia, chicken pox, measles, salmonella poisoning as well as malnourishment that kept her too ill to be kept with the healthy orphans. Her main stay would be in the infirmary, a small dim room with a few cribs, no toys, and no stimulation day after day.
When we met Grace for that very first time we could hardly hold her because her body literally didn’t want to bend. It’s like picking up a wet, mad cat out of the bath tub- legs stick out everywhere. While she didn’t scream at us, she didn’t really look at us either. She had been deprived of so much that she couldn’t understand people. And deprived as she was, she was most content to be left in her crib where she could rock and bang her head and flick her fingers on metal screws. That was how she knew the world. So imagine her reaction when we took her away from that existence.
R and I were sure that she would thrive and be excited at discovering her new world. We couldn’t have been more wrong. Her behavior deteriorated more so upon our arrival home. She wanted to be able to continue what R and I termed “zoning out.” If she could sit and gaze or stick her finger in a hole and stare at it all day, she would have. We tried everything you could imagine. We left her alone to do it; in the case she might feel comfortable enough to enter our world. That didn’t work. We put socks over her hands so she couldn’t cram them up her nose anymore but then she’d only gaze or enter into another activity with her feet. Pretty soon, we realized there was no chance at bonding because we were so focused on how to get her into our world.
Looking back we were beyond clueless. While we had the diagnosis of fetal alcohol syndrome, there was nobody in our community to train us in how to parent her. And even if we found someone who understood FAS, we needed someone who would also understand the type of conditions she existed under in the orphanage. Love alone would not heal this little girl. As the first months passed, R and I were becoming the bundle of nerves that Grace was. Admittedly, I wondered if I could do this parenting thing with Grace and more selfishly, I was exhausted.
A friend of ours gave us some information about Dr. Federici and his practice in Alexandria, VA and we contacted them. By then I had been on all of the adoption forums on the internet and was convinced Grace had reactive attachment disorder as well as a host of other disorders. I had contacted a few different therapists through email explaining our situation only to be encouraged to disrupt the adoption. We felt at the end of our rope. What Dr. Federici and our occupational therapist, Wendy Schmidt were able to explain to us is why Grace was this way and what we needed to do to help her.
The severe lack of stimulation and neglect from her stay in the infirmary in addition to her malnourishment caused her to enter into a pseudo autistic state; a dissociative state where she used these maladaptive self soothing coping behaviors to exist. Dr. Federici has written on the subject calling it institutional autism. In order to bring her out of these “basement” behaviors, it would take minute to minute daily structure with me, her mom by her side. We needed to recreate a new world and in order to do that she needed consistency and repetition. And further, I would have to stop her “zoning.” Life in our home for those months was a bit like the movie Groundhog Day. Each day was a replicate of the day before. For a few weeks I think I must have cursed Dr. Federici and our therapist a few times a day. Each time she withdrew into her “zone,” I held her in my arms in what is called a “settle hold.” This is not to be confused with holding therapy techniques. I simply held her in a cradle like you would a small baby so that she couldn’t continue the maladaptive behaviors. She screamed and screamed. Days went by like this. I seriously questioned if any of this was working. Slowly she stopped the screaming and then began to look around, still refusing to look at me. Eye contact was particularly difficult. I wanted to put her down on the floor so many times and to be able to go on with my life.
I admit that I became so frustrated, I wondered if this was going to be what life would be like forever. If only I could set her down on the floor. She would have been happy to have been left alone to continue her “zone” and I could be sure of some quiet time. Isolation was setting in for me. Not only was I staying home everyday with a screaming child in my arms, but most of my community didn’t understand what it was I was doing or why I was doing it. I was tired of the explanations and the strange looks. I know they meant well but the best thing friends and family can do is be a support and not offer advice based on the normal healthy child they are raising at home.
Ever so slowly, as we inched ahead day by day, we began to see the unraveling of this tightly wound bundle of nerves we met that first day. She began to look at my face, only to glance away if our eyes met. And then she began touching my face while I held her. I began to add something new to our schedule as she was ready for it. Nearly three months passed before I left the house to take her out to public places. I realize now how vital that time was for her to be able to feel safe. She began to giggle and understand “silliness.” She no longer reached for strangers as if they were equal to me.
We even had to teach Grace what it meant to feel pain. For all of the times she felt pain and cried as an infant and nobody came to soothe her, she ceased “feeling” the pain. Crying and acknowledging hurt for her was useless. We taught her this by each time she fell we ran and scooped her up and made a big deal about what happened and told Grace she was hurt and cried with her. Basically the exact opposite of what we did with our two biological boys. But it worked! She needed to have her feelings validated and to be able to once again connect her physical pain and appropriate emotional response. This was key to helping cure the “zone out” periods. Grace learned that Mommy and Daddy fixed pain not gazing, hair pulling, eye poking or any one of her other coping mechanisms.
Today Grace is three years old and we have had her with us for 18 months. In that period of time she has truly blossomed reaching more goals than we ever imagined for this short period of time. For a child that had to learn to suck from a bottle when we brought her home, she is now learning to chew solid foods. A child that couldn’t walk until 21 months is now running and jumping a year later. A girl that didn’t understand what a Mommy and Daddy was, now calls out to them for hugs and kisses. A babe that didn’t know what smiling was for, now laughs heartily at a tickle or the cat’s tail brushing across her skin.
There is no greater joy than watching the emergence of life in a child that was in many ways lifeless. She only existed and now she is exuberantly alive! And you know what, I wouldn’t change a thing. It’s easy to say now of course, but in many ways her special needs humbled me, carving in me, a new patience and a whole new compassion for what many children experience in the orphanage setting.
Grace will never be cured of fetal alcohol syndrome and the secondary effects of it. She is frustrated easily with not being able to talk and to communicate her needs and wants. She will slowly achieve more goals as the time passes but she will forever have to live with the brain damage that cannot be reversed and we her family will need to adjust with her. R and I never set out to adopt a child with special needs, we only trusted that God would take us to the child He wanted us to have. And in doing so, we have received His grace and our Grace.”
T&R, Arkansas
Hi Dr Federici:
Just a quick update on Kristina: Heavy metals (blood and urine) were negative. Risperidol is GREAT! We now have a child psychiatrist managing the meds and doing fine at 0.25 BID. Her voice is not as loud, less rocking, crashing, banging, less agitation, staying on task/focused, especially at school. Unfortunately last weekend, we had 4 days of hell (she acted like she did pre-risperidol). I called child psych and she upped the dose to 0.25 TID (8 am- 4 pm/ after school- and bedtime). Things are better now.
Child psych ordered a fasting lipid panel which was abnormal. Note it was ordered/drawn 3 weeks after starting drug. Kristina must have crappy genes as she is not diabetic or obese. Her cholesterol is 197. Her HDL is 38 (low) and LDL is 145 (high). As you know, the HDL should be high and the LDL low. Hers are reverse and indicative of “moderate CHD risk”. Child psych doubts it is from the risperidol as she has not been on it long enough. We are redrawing labs in 6-8 weeks, if lipids are higher, she will pull her off resperidol and try another drug. Any thoughts on abnormal labs and/or drug effect?
Peds endo at Childrens Mem’l Hosp won’t see Kristina unless she is off the growth chart. She is at 10% now.
Peds neuro at Childrens is admitting her next week for a 24 hour EEG and comprehensive neuro exam, per your recommendations. Do u want results?
By the way, liked your commentary in PEOPLE mag last week. Both Kristina’s teacher and principal stopped to tell me they recognized your name in the magazine.
IEP implementation meeting is Monday with the whole team. School district has ABA trainer that will work with Kristina’s school and us to put behavioral program in place (finally). They are following your recommendations and for that we are eternally grateful to you. Feel free to use us a a reference for other families. We think you are terrific! Regards,
Karen J.
Hello Dr. Federici,
I just wanted to say thanks again a million times for your help with Irina. We took your advice on the Risperdal and kept her on it. It has been 2 weeks now on the medication and 1 month out of school and she is like a different child. She is so much better. She is sleeping good and her mood swings, hyperness and anger have greatly improved. We can see some hope now! Just wanted to share with you the good news about her and say thank you so very much for doing what you are doing for the kids.
Lori and Mike, VA Beach, VA
Hello Dr. Federici!
I am writing you to share good news about a former patient — D.S.. We visited you in August of 1999 from Cleveland, Ohio … and have corresponded several times since them. D. was selected to be the valedictorian of his confirmation class at our synagogue. Today he delivered his speech in front of the congregation. It was a moving and meaningful experience. The entire congregation was crying …the cantor said it was the most powerful confirmation speech she had heard in her 25 years at the synagogue. We thought you might enjoy reading it. And … you should know … that you were included in his first version of the speech as one of the reasons why he has reached the point he has. (the first version of the speech was more like a book … and needed editing). Thank you again for your guidance and expertise.
H.S., Ohio
Dr. Federici,
I was very moved by the Episode of Dateline “Saving Dane” I think your program is wonderful, and I can’t tell you how wonderful I think Dane’s parents are. I can only hope that all parents would be so patient with there children. They were amazing. Please if you are still in contact with them. They did a wonderful job on Dane. I couldn’t get over what a happy little boy he was towards the end of the show. I’m just hoping that his road has gotten easier and that he is just as happy if not happier these day . . . . My name is Allison, i’m from Tracy, California and I was very moved by this story.
Dr. Federici:
On behalf of Debbie and myself and especially little Miss Kelly, thank you not only for attending today’s meeting but for using your expertise to make the meeting a done deal in our favor before it even started. Today was the polar opposite of the meeting 3 months ago, which was a done deal against us before it even started, and the chair of the meeting was even condescending and rude, refusing to even consider your test results. But when the meeting started today I sensed a change in attitude within the first five minutes. The “educational establishment” was in our corner after looking at the data and wanted to work with us “in good faith,” as they put it. As I told Debbie after today’s meeting, when the odds are stacked against you, it is time to bring in superior firepower: Dr. Ronald Federici. Cordially,
Stuart
Just a note to say that Mihaela is doing really well since we started Sensory Processing Therapy and implemented all your recommendations. We have been in therapy for almost a year and the change in her is unbelievable. Can you tell me is Sensory Processing something that needs to be continued for a long time with children from Romania? I am sure that it depends on the child. What books can you recommend on the treatment at home for SPI? We have also seen an endocrinologist for her as well. I don’t know what we would have done without your help with Mihaela. You have been a life saver to us Dr. Federici and I just want to tell you THANKS!
Mihaela’s Mom
Dr. Ron:
We want to tell you that Dane continues to excel all around since we completed the “program” featured on “DateLine NBC” over 4 years now. NO MORE rages and uncontrollable episodes! Never a dull moment at our house! On a happy note, the kids are doing great!!! Megan is making A’s in her honors college program and enjoying her new apartment and roommates nearby. Dane is a speedy cross country runner (carrying the team’s first place trophy) on the JV team at his new high school. Both love us at this point in time, Praise God!!! Our family is blessed and has been restored thru so much.
Dear Dr. Federici,
Four years ago I contacted you about my then 9 year old son, Joshua. Although I had to modify your program due to Josh being my foster son at that time, your program still worked. Josh is now happy & healthy and learning to enjoy life after being abused and neglected for the first 8 1/2 years before he came ‘home’ to us. He still suffers permanent brain damage (FAS/E) but he is completely mainstreamed now and last quarter he made the honor roll! And today Josh won three out of his four of his wrestling matches and won 2nd place in his division! Not bad for a kid I was told may never heal who used to bite me, kick me, spit on me and try to kick the windows out of the van. THANK YOU, THANK YOU, THANK YOU!
Again, I can’t thank you enough for helping us save Josh. I need another miracle now to save Justin. Thank you so much for helping our family, again.
Carol
HI DR FEDERICI
DAVID IS DOING GREAT. HE HAS HIS MOMENTS BUT HE IS LISTENING AND FOCUSING BETTER. ON MONDAY I AM MEETING WITH THE SPECIAL NEEDS SCHOOL TO SEE IF WE CAN BYPASS THE WAITING LIST. AS WELL I AM SPEAKING WITH POTENTIAL ABA THERAPIST RECOMMENDED BY THE SCHOOL BOARD. DO YOU WANT TO SEE US IN MARCH. IF SO, DAVID HAS SCHOOL BREAK THE WEEK OF MARCH 5. LETS US KNOW. DR FFEDERICI IT IS GREAT HAVING A SON NOW INSTEAD OF AN ANIMAL.
STANLEY
Dear Dr. Federici,
We really enjoyed the opportunity to work with you and we both sensed a genuine desire on your part to help children. What you do for children and their families is amazing and your strength of character and knowledge was truly apparent throughout our visit. Your perspectives on parenting Andrew were insightful and we can clearly see benefits in the short period of time we have tried to implement the techniques. In a sense, the methods you taught are liberating in that we now understand that it is not necessary to constantly cater to Andrew’s wants and needs. Best Regards,
J & D from Connecticut
Hi Dr. Federici and Nadya,
We wanted to follow up with you and inform you on how our son, Sam , is doing. We had met with both of you back around May 2007.
Dr. Federici, after all your testing, your conclusion was that Sam had depression and you recommended that we put him a low dosage of an anti-depressant. Well we finally found a child psychiatrist in New Jersey which was no easy task. We showed her your report and she acceded to prescribe a very low dosage of Prozac, which she recommended.
Well we are so happy to tell you that is exactly what Sam needed. He is a completely different boy now. He’s generally happy and acts like a normal boy. His self esteem has markedly increased and it has had an incredibly positive impact on the whole family!
We are still working on bonding issues, but after dealing with four years of his depression, we feel the bonding will come in time. We are trying to incorporate some of Nadya’s recommendations regarding this issue.
We do thank the Lord that he is doing so much better now.
Thank you and may you continue to assist so many families that are in such difficult situations.
God Bless,
Paul and Vicky B
11.
Ron Federici,Psy.D. | July 4, 2010 at 1:21 pm
COMPREHENSIVE IN-HOME EVALUATIONS AND
INTENSIVE FAMILY INTERVENTIONS FOR CRISIS OR EMERGENCY CASES
PLEASE E-MAIL FOR DETAILS!
COMPREHENSIVE PSYCHOLOGICAL AND NEUROPSYCHOLOGICAL EVALUATIONS FOR CHILDREN/ADOLESCENTS AND ADULTS EXPERIENCING COGNITIVE OR EMOTIONAL DISORDERS
INTERNATIONAL RECOGNOGNIZED EXPERTS IN THE NEURODEVELOPMENTAL ASSESSMENT AND
FAMILY TREATMENT OF BOTH DOMESTICALLY AND INTERNATIONALLY ADOPTED CHILDREN
Comprehensive Psychological and Neuropsychological/Neurodevelopmental Assessments:
Cognitive-Intellectual Evaluations ( from Infancy to Adults )
Dual-Language Assessments (Russian, Romanian, Italian and German Languages , Culture-Free and Non-Verbal Intellectual Testing)
Academic Achievement Testing (ALL AREAS)
Attention Deficit Hyperactivity Disorder Evaluations and co-existing conditions
Non -Verbal Learning Disabilities and Visual-Perceptual Impairments affecting learning
Comprehensive Speech and Language Evaluations/Auditory Processing Testing
Learning Disabilities/Dyslexia/Multiple Handicapping Conditions
Autistic Spectrum Disorders
Testing for school and standardized testing accommodations (ADHD,GT,SAT,LSAT,MCAT,GRE,etc)
IEP Reviews and Consultations
Assessment of Organic Brain Syndromes/Traumatic Brain Injury and Trauma-Developmental Disorders:
Fetal Alcohol/Drug Related Birth Defect Syndromes (FAS/ARND)
Assessment of “Developmental Failures/Traumas” affecting brain growth and development (pre-post natal factors, malnutrition, neglect, heavy metal exposure, delayed growth, institutionalization and trauma)
“Second opinions” for complex diagnostic cases
Cases previously unresponsive to treatment
Neuropsychological evaluations of Post-Institutionalized Children (Developmental Disabilities; Post Traumatic Stress Disorders; Institutional Autism; and the Neuropsychology of Bonding/Attachment Disorders)
Organic Mood Disorders
Executive Dysfunction
Pre and Post Adoption Consultations
Coordination with agencies and therapeutic treatment centers
Cognitive Rehabilitation to improve behaviors
Clinical Interventions For Individuals and Families:
Family Cognitive-Behavioral-Reality Therapy Strategies for Acting-Out and Behaviorally Challenging Children
Structural and Strategic Parenting Training to gain rapid control over unmanageable children (NO HOLDING THERAPY TECHNIQUES USED-ONLY SAFETY TRAINING FOR FAMILIES)
Assertiveness Training for Parents and Anger Reduction Techniques for children
Psychotherapeutic approaches emphasizing social skills, relationship building, and teaching respect / responsibility and self-control
Trauma Therapy for Post-Abuse Syndromes/Post Traumatic Stress Disorder
Family Therapy emphasizing bonding / attachment and family structuring and preservation
Highly Specialized and Intensive Treatment Services:
Comprehensive Neuropsychological and Neurodevelopmental Evaluation of all Autistic-Spectrum Disorders (ASD/Aspergers Syndrome/PDD)
Assessment of atypical “Institutional Autism” following adoption/trauma/institutionalization
Intensive evaluation and interventions for cases previously described as ‘non-responsive to treatment’
Second opinion evaluation and treatment of “resistant” children–especially post-institutionalized cases
Application of intensive ‘Applied Behavioral Analysis’ and ‘Verbal Behavior Therapy’ for all autistic-spectrum disorders and children with severe neurodevelopmental and behavior al disorders
Intensive In-Home, crisis management and reconstructive therapy. Highly experienced therapists will travel to your home to do crisis assessment, therapy and long-term family programming in-home. Our highly specialized service has been featured on ‘Dateline NBC’ and is available for families who are at the point of crisis and/or disruption in their adopted or biological child. This is an outstanding alternative to hospitalization or residential care.
12.
Ron Federici,Psy.D. | July 4, 2010 at 1:21 pm
Neuropsychological and Family Therapy Associates, under the Directorship of Board Certified Dr. Ronald Federici (father to seven internationally adopted children), maintains an international reputation in the assessment and treatment of the most complicated neuropsychological, developmental and brain traumatic disorders.
Neuropsychological and Family Therapy Associates is committed to providing the most comprehensive evaluation and state-of-the-art treatment services for children having the “full range” of Developmental and Psychiatric Disorders. Conditions such as autistic spectrum disorders; complex learning and attentional disorders; minimal brain dysfunction conditions; severe disruptive and behavioral disorders; chronic psychiatric disorders ; attachment-related disorders; post-traumatic stress disorders (following abuse and neglect from early childhood experiences); and chronic stress affecting family functioning.
Individuals and families from across the United States and abroad come to our specialty clinic for first, second and third opinions for answers and treatment recommendations no one else has been able to provide. Virtually all of our children and families have felt overwhelmed and unable to understand the special needs of their children or their own diagnoses. All of us in the practice are experts with decades of experience in complex neurodevelopmental evaluations and comprehensive family treatment. Our work has been featured on national television (Dateline NBC: Saving Dane, Saving a Family”), with our clinicians forming a “multi-discipline treatment team”.
We are proud of our reputation and take on the most difficult cases, particularly internationally adopted children. We also have a division in our clinic which handles domestic adoptions, abuse and neglect, and general child developmental psychology.
13.
Jon Goodman | September 25, 2010 at 3:18 pm
Author: Jon Goodman, AdvocateForTherapy@blogspot.com
September 5, 2010
HEADLINE on GOOGLE: ACT, also known as Advocates for Children in Therapy, a for-profit organization, has recently made a rather large public statement saying they can prove that Attachment Therapy, Holding Therapy and Therapeutic restraints always hurt kids and always are lethal. Nothing could be further from the truth! I disagree with this statement on many levels, and find it incredulous that ACT is willing to make this statement and yet gives NO acceptable alternatives for adoptive parents and adoptees that has the power to replace the aspect of touch therapies and properly applied attachment therapies for severely affected victims of childhood abuse and neglect. In addition, ACT has no creditials for making such an assertion and has made a smear campaign against professionals who are aiding adoptive families in working with their severly unattachment children on bonding issues that are life-threatening if left untreated. Whomever authorized such statements within the ACT community has not done their homework and must have a personal vendetta against an individual in the attachment community. But why put out such statements that may prevent many victimized children a chance at a cure? I believe more attention needs to be paid to the false blanket statements of such organizations as ACT that proclaim to be reaching for an audience of adoptive parents who have children with attachment disordered children.
For children with severe reactive attachment disorder due to post traumatic stress disorder, the power of touch is the only modality of therapy that can reach these children’s psych where abuse and neglect is often stored in the preverbal mind, which is the deepest and hardest to reach place later on in life. Does ACT not know that Traditional talk-therapy does not begin to address in a 3-5 year old the level of hurt that the child has experienced? Does ACT propose that parents do nothing? or use therapies that are known NOT to be effective? ACT seems to be putting adoptive parents in a catch-22. And after reading the ACT website, I am serioulsy wondering if any of the author’s have ever actually seen attachment therapy in action or if any authors have even stopped to consider their actions on the children that will be denied help or treatment due to their negative and unthinkable words of ignorance.
There are no words to heal this predicament called attachment disorder. Only touch. There were no words for the 3 month old in a Romainian orphanage of understaffed and untrained poverty-ridden staff when no one came when he cried in hunger or pain. There were no words for the 6 month old girl a a Russian babyhouse for orphans who itched from scabies so deep in her skin that only unconsciousness was relief and even though it went on for months. There were also no words for the infant who was left in a dark closet full of nibbling rats while the birth parents were passed out drunk in the backyard of their summer shack in Ethiopia. Words don’t heal attachment disorders. The pain is stored deeply within the child’s most primitive bodily memories-which are 100 % sensory, and 100% unreachable without touch. Memories of the smell in that dark rat infested closet or the freezing temperature the child experienced are all stored in a cluster along with the misery. Once one preverbal memory is activated it lets loose the whole chain reaction-even though this happened long before the adoption into a new family. Muliply these traumatic episodes over any period of time, and you have the basis for a few early traumatic memories. Muliply these instances over periods of years-and you have severe post traumatic stress disorder that effects the mind of a child and causes reactive attachment disorder in full swing. It is no wonder.
Attachment therapy requires getting inside the hard shell of these kids’ outer attitudes and emotions, getting to a vulnerable space where new memories of safety and security can begin crowding out the old, traumatic ones. There is no complete cure, only increments of recovery and better quality of life. In most cases, families have seen at least five professionals to help their child with his/her strange behaviors and attachment problems before they find out about or stumble upon a reference for a psychologist, counselor or social worker who has any experience in working with adopted children exclusively or with any expertise. Through trial and error, and usually desperation, a family will be relieved to find out:
A: the right diagnosis
B: that they aren’t the only ones with this situation
C: there is documented evidence that shows the number of recoveries from RAD and PTSD
D: that their child has hope of not ending up in prison, dead or on drugs
It’s also worth noting that ACT does not exclusively state in their literature that RAD is a problem only for adopted children. Rather, it states no knowledge of the special needs of children that have lived in institutions and what the post orphanage behaviors have done to them. although they are the largest group of children with known attachment disorders. Therefore, by saying ACT advocates for children in therapy, they are actually doing the opposite. It condemns the very type of therapies that specifically has been known by adoptive parents and professional attachment therapists to do wonders in healing. It is as if ACT has picked a cause to advocate for just because deaths and sensationalism has occurred in the misuse of attachment therapies used by unqualified individuals. It is a case of “contempt prior to investigation.”
In all fields of medicine there are truly horrible situations that arise from extreme use of any method-including medications, surgeries, psychological therapies and even using “NO therapies.” By using the extreme negativism of a handful of fatal cases of so-called rebirthing therapies, ACT stands that ALL therapies that include attachment therapies and the professionals that work with them are bad. ACT is fine with NO therapies or therapies that don’t work, such as traditional talk-therapy.
Orphans who are adopted that were exposed to alcohol and/or drugs or other lethal toxins during pregnancy are more prone to be severely traumatized by orphanage living due to their lack of appropriate or available coping mechanisms. These children can develop a hard, aggressive stance toward anyone who might hurt them—even if that means love and protect them. The severe form of personality disorder that develop out of this state is called borderline or antisocial personality disorder. Once into later teens and adulthood, the prognosis for adoptees with this label, personality disorder, is practically bleak. Prisons and insane asylums are full of personality disordered adults. These people often lead extremely lonely and isolated existences (and even committ suicide) because of a lack of early intervention strong enough to change the course of the reactive attachment disorder. Yet some type of attachment therapy gives an extremely good prognosis when intervention happens early in life.
Do parents want to do nothing as ACT suggests? Or are they willing to try what has worked for many other RAD and PTSD adpted children? In our case, we opted for hope. My wife and I became attachment therapy adocates ourselves as we watched and learned while our children grew beyond their pasts. Not only did I, personally, sit in on every single session with the attachmenent therapist, I was always asked to hold my child in a loving, gentle and safe way at all times even when I was being punched in the face repeatedly by my 5 year old son. Did I have to be strong enough to watch my child struggle when his comfort level was getting busted? Of course. Was it easy to see my son cry out in rage that he hated me for no reason? Yes. Did I look him in the eye and tell him over and over that I loved him and needed to keep him safe no matter what? I had to. When my son spit in my face and told me he wanted to go back to Russia (even though they’d abused him) because I was worse, did it shock me? No. He would say anything to keep intimacy out of his heart and mind. Truly, it is fear that held my son captive, not the work of attachment therapy. Intense feelings of fear of loving, being loved, trusting, caring, and needing another human being were paramount and highly subconscious in my son. Once those feelings were activated by any number of triggers known and unknown he would run or fight even if it meant self-sabotaging himself over and over. It was a no-win situation that held him prisoner and us, as parents, the wardens. Neither my son nor I could have told you any of this before we went through a year of attachment therapy with a qualified attachment therapist. Fast forward seven years ahead and you will see a boy who DOES NOT have these issues! He is still overly sensitive and sometimes jealous if he thinks we love the cat more than him, but there is no overt symptoms of a child who we were once told had brain damage, RAD, PTSD, Conduct Disorder, ADHD, Pervasive Developmental Delay and Fetal Alcohol Syndrome. The attachment factor is key!
The good news I want adoptive parents and adoptees to know is this. Once the attachment issue was resolved, everything else got better. That’s the testimony of a parent who’s been in the trenches, but this was an area I knew nothing about when we adopted our son. What would we have done without a qualified attachment therapist, like Dr. Ronald Federici, to take our case? Who would we have turned to if it weren’t for the work of Dr. Bryan Post and the Post Institute, or Heather Forbes? What if Bowlby had never written about the controversial attachment theory due to fear of whether groups like ACT would end his career by ruining his reputation? Where would we be now? Would our son be in a group home or juivenile delinquint facility? Yes, left to his own devices, we believe he would have had to be locked up and supervised carefully around the clock to keep from hurting himself or others when he was “activated” with PTSD triggers, which was constant and growing when we started attachment therapy with him.
Without being taught and actively working with our son by using behavioral and attachment therapy and therapeutic restraints that were age appropriate to limit his aggression, would we have eventually just let him run away or beat us up? He was trying his utmost at the time to get away and torment us. Should we have just let nature take it’s course? Hell no! My son was worth saving, and so is every other kid out there who suffers. We must do whatever it takes, while thoroughly doing our homework, to make sure we are using the utmost safety and latest standards of proven therapy modalities and qualified experts to give our children what they never had-ADVOCACY. I would advocate to the very end for my children and so would Dr. Federici, Bowlby, Forbes and Post! I pray these professionals don’t take an ounce of flack from organizations that promote NOT curing our kids. I pray adoptive parents will not delay early intervention using attachament therapy by a qualified attachment or behavioral specialist to get into the solution NOW before it’s too late. As for ACT, I wish they could have walked a mile in our shoes for just one day before they made such liable comments about attachment and holding therapy and the pros who helped us. Its a personal insult.
So why any organization or group would advocate against the work of a type of therapy that changes so many lives for the better, that enables so many severely disturbed children to recover over time, or that lends itself to the quality of persons teaching and delivering the therapy, I don’t understand. Why throw out the baby with the bathwater, so to speak? Show me some other equally effective treatment for RAD and PTSD in adopted children that works and I will certainly eat my words. Until then I pray ACT will rethink their wrongful propositions about what kids need in attachment therapy—especially if you haven’t had a child with RAD, aka. the raddishes.
Jon Goodman, Adoptive Dad