The Healing Power of Touch
Deprivation of sensory stimulation, especially touch, adversely effects the health and CNS development of the child (Bendersky, Ramsay Sc Lewis, 2006, Bendersky, Bennett Sc Lewis, 2006) and can lead to an increase in physical aggression (Bendersky, Ramsay Sc Lewis, 2006) and emotional disturbances (anxiety, depression, ADHD, sensory integration dysfunction, aggression). Touch helps with sensory integration and self-regulation of affect and behavior along with sustained attention (Morrow et al., 2006).
NAS babies need to be held more, have regular skin-to-skin contact, engage regularly in hugging, share close moments, be held close/carried for the first month until the baby “body-molds” to the caregiver, along with use of a rocking chair to rhythmically duplicate the pace of the heartbeat. Touch needs to be gently adjusted, with stroking and kinesthetic stimulation, to the infant’s age and needs (Spielman et al., 2015). Infant massage has been shown to have many benefits for the infant in improving weight gain, sleep/ wake cycle, decreasing pain/stress response, improving neurological, sensorimotor and behavioral development, improving muscle tone, bone density, circulation, immune function and temperature stability, and enhancing feeding outcomes, relieving constipation and gas and reducing length of hospital stay. With slow, rhymical movement the infant is able to have longer periods of quiet sleep, decreased irritability, fewer jittery movements, increased visual and auditory responses, and decreased frequency of apnea, bradycardia and hypoxia (Spielman et al., 2015).
By massaging the infant, it eases parental stress about separation, provides an active parenting role, decreases depression, increases the responsiveness of the infant, optimizes the mother—infant interaction and increases the sense of maternal competence (Renk et al., 2016).
Obtaining Parental Attachment Histories
Not all mothers seeking substance abuse treatment have difficulties parenting. But as a group, they are twice as likely to lose custody of their children because of child neglect. And most parents of NAS babies are at greater risk for maladaptive parenting. Before determining the best treatment approach it is important to obtain a thorough attachment history, as mothers with substance use disorders commonly have developmental histories involving their own insecure attachment (Morrow et al., 2006). Stored memories of psychological “representations” of their early caregiving experiences become the prototype for newly formed relationships. This in turn influences the new mother’s expectations of herself and her child and strongly influences her parenting behavior (Logan, Brown Sc Hayes, 2013). Distortion and denial defenses may prevent the mother from recognizing and responding sensitively to her child’s emotional signals (notably crying, clinging, hitting, running away) and results in parental aggression, neglect and poor limit setting. In addition, continued use of addictive substances drastically reduces dopaminergic responses to stress, leaving the mother vulnerable to negative emotions and absence of pleasure or reward ordinarily associated with caring for young children. Thus, parenting interventions may need to first address personal unmet attachment issues before targeting behavior management skills. Without improving the parent’s capacity to recognize and respond sensitively to their child’s emotional cues, there will be little improvement in the mother-child relationship (Logan, Brown Sc Hayes, 2013).
Symptoms in Preschoolers and School-Age Children and Treatment Options
Treatment options for NAS infants and children include use of the Neurose- quential Model of Therapeutics (Perry, 2009); Developmental Play Therapy (Brody, 1997); Theraplay (Booth Sc Jernberg, 2010); FirstPlay Therapy (Courtney Sc Nolan, 2017; Courtney, Velasquez Sc Bakal Toth, 2017); Filial Therapy (Guerney Sc Ryan, 2013) and Child-Parent Relationship Therapy (Landreth Sc Bratton, 2006), along with use of the therapeutic powers of play therapy and play-based techniques (Schaefer Sc Drewes, 2014) which can enhance parent/ caregiver and infant/child attachment. Toddler/preschool symptoms include mental and motor deficits, cognitive delays, hyperactivity, impulsivity, ADD, behavior disorders, aggressiveness, poor social engagement, and even short stature compared to peers (Behnke et al., 2013; Lester Sc Lagasse, 2010).
Brainstem activities for neuroenhancement include:
- • Pacification: soothing activities in the child’s preferred sensory modality; rocking, massage, brushing hair, painting nails, swinging, cuddling, singing, telling stories, feeding (Brazilay et al., 2018; Courtney, Velasquez Sc Bakal Toth, 2017; Perry, 2009).
- • Sensory stimulation: touching sand and clay, finger painting, shaving cream play; making cookies or banana bread (touch and scent); smelling for fun — household smells (orange, onion, cinnamon, vanilla, lemon, baby lotion, talc, etc.); touching textured items (rough, smooth, silky, hard, etc.); sounds: songs, identification of sounds (natural, household and everyday sounds); and tastes for identification (Perry, 2009).
- • Use of Developmental Play, FirstPlay Therapy or Theraplay is useful for stimulation, achieving mutual attention and a sense of attunement. The interactions should be face-to-face, eye-to-eye, contact with mutual enjoyment, using songs, nursery rhymes, touching games, and nurturing activities (i.e. Slippery Hand Games, Hills and Valleys, The Little Piggy Went to Market).
School age symptoms include impaired verbal, reading, arithmetic skills; poor mental and motor development; memory and perception problems; ADHD with weak executive functioning, problems planning, organizing time and materials, shifting from one situation to another, and learning from past mistakes (Bendersky, Ramsay Sc Lewis, 2(X)6; Brazilay et al., 2018). Additional symptoms include developmental delays, speech problems (producing correct sounds, fluency; voice or resonance), language disorders (understanding others or sharing thoughts, ideas, feelings), and impaired self-regulation (Bada et al., 2007). Furthermore, school absence or failure, behavioral problems, depressed respiration or hypoxia, poor response to stressful situations, poorly developed sense of confidence or efficacy in task performance, depressive disorder and substance use disorder may be evident (Behnke et al., 2013; Bendersky, Bennett &C Lewis, 2006; Lester Sc Lagasse, 2010).
Teachers and therapists need to establish a relationship first, and be spontaneous and in contact with the child when giving instruction or relating. Sensory activities should be used before structured activities, avoiding overstimulation, allowing time to calm down and help self-regulate (Lester 8c Lagasse, 2010). Sensory activities should include play with soaps, lotions, shaving cream on plastic, carrying pots or bags of flour (for weight), and having a quiet place to get away from the environment (Bada et al., 2007; Bendersky, Bennett &C Lewis, 2006; Lester Sc Lagasse, 2010; Kool Sc Lawver, 2010). Midbrain activities that help with limbic system integration should include narrative, movement, social skills, and expressive arts:
- • Narrative activities include dramatic storytelling, books and poems with rhyme and rhythm (Dr. Seuss stories and nursery rhymes).
- • Movement: music, singing, chanting, rhyming, rhythm, marching, complex dance movements, or movement activities (i.e. wave like a tree blown by the wind, pretend you are rain falling down, Ring Around the Rosy); use of jungle gyms, crawling tubes, cardboard box tunnels/ mazes, balance beams, swings, merry-go-rounds, balls, hoops, waving ribbons of various sizes.
- • Social skills games: sharing, cooperative, taking-turn games (Red Rover, Simon Says, Red Light, Green Light).
Animal-assisted therapy with a dog or cat helps the child to learn to touch softly, gently, and empathically. Walks or trips to discover the natural world helps with heightening the child’s senses (Kool Sc Lawver, 2010; Perry, 2009).
Use of opioids and illicit drugs has reached epidemic levels. Consequently, use of illicit drugs by pregnant mothers has put unborn children at risk resulting in addiction in utero and Neonatal Abstinence Syndrome post-partum at unprecedented rates. NAS results in a constellation of signs and symptoms of infant neurobehavioral dysregulation that occurs in the immediate neonatal period, resulting in a central and autonomic nervous system regulatory dysfunction. As a result of these symptoms, NAS babies have a difficult time connecting and attaching, resistance to cuddling or soothing, and decreased ability to respond normally to auditory or visual stimuli. Added complications of attachment result from placement after birth in foster care or orphanages and continued exposure to trauma within the home environment.
A variety of pharmacological and non-pharmacological treatments are available post-partum. Of particular importance is use of attachment-based approaches through massage, physical contact, use of touch, Developmental Play, Theraplay, FirstPlay Therapy and other play-based approaches. NAS babies face long-term difficulties with affect regulation and learning difficulties into preschool and school age which will require developmentally sensitive and sequenced approaches including play therapy.
- 1 Discuss what NAS is and its impact on bonding and attachment with caregivers.
- 2 Discuss what non-pharmacological treatment approaches could be utilized with NAS infants while in the hospital.
- 3 Utilizing an integrative treatment approach, discuss how best to work with school-age children bom opioid-addicted evidencing affect dysregulation.
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