Related Articles

Beyond Point and Level Systems

Wanda K. Mohr, PhD, APRN, FAAN, University of Medicine and Dentistry, New Jersey; Andres Martin, MD, Yale University; James N. Olson, PhD. University of Texas–Permian Basin; Andres J. Pumariega, MD, Temple University, Nicole Branca, MSN, APRN; University of Medicine and Dentistry, New Jersey

Many residential treatment facilities and child inpatient units in the United States have been structured by way of motivational programming such as the point and/or level systems. On the surface, they appear to be a straightforward contingency management tool that is based on social learning theory and operant principles. In this article, the authors argue that the assumptions upon which point and level systems are based do not hold up to close empirical scrutiny or theoretical validity, and that point and level system programming is actually counterproductive with some children, and at times can precipitate dangerous clinical situations, such as seclusion and restraint. In this article, the authors critique point and level system programming and assert that continuing such programming is antithetical to individualized, culturally, and developmentally appropriate treatment, and the authors explore the resistance and barriers to changing traditional ways of “doing things.” Finally, the authors describe a different approach to providing treatment that is based on a collaborative problem-solving approach and upon which other successful models of treatment have been based.

Shame and Attachment


Understanding Shame and How to Help from The Attachment Disorder Site.

Clinical Implications of Neuroscience

Clinical Implications of Neuroscience

Research in PTSD


Boston University School of Medicine, The Trauma Center, 1269 Beacon Street,

Brookline, Massachusetts, USA Q1

ABSTRACT: The research showing how exposure to extreme stress affects brain function is making important contributions to understanding the nature of traumatic stress. This includes the notion that traumatized individuals are vulnerable to react to sensory information with subcortically initiated responses that are irrelevant, and often harmful, in the present. Reminders of traumatic experiences activate brain regions that support intense emotions, and decrease activation in the central nervous system (CNS) regions involved in (a) the integration of sensory input with motor output, (b) the modulation of physiological arousal, and (c) the capacity to communicate experience in words. Failures of attention and memory in posttraumatic stress disorder (PTSD) interfere with the capacity to engage in the present: traumatized individuals “lose their way in the world.” This article discusses the implications of this research by suggesting that effective treatment needs to involve (1) learning to tolerate feelings and sensations by increasing the capacity for interoception, (2) learning to modulate arousal, and (3) learning that after confrontation with physical helplessness it is essential to engage in taking effective action.

Developmental Trauma Disorder

Developmental Trauma Disorder

A new, rational diagnosis for children with complex trauma histories.

Bessel A. van der Kolk, MD

Research has shown that traumatic childhood experiences not only are extremely common but also

have a profound impact on many different areas of functioning. The Complex Trauma taskforce of the National Child Traumatic Stress Network has been concerned about the need for a more precise diagnosis for children with complex histories. In an attempt to more clearly delineate what these children suffer from and to serve as a guide for rational therapeutics this taskforce has started to conceptualize a new diagnosis provisionally called developmental trauma disorder. This proposed diagnosis is organized around the issue of triggered dysregulation in response to traumatic reminders, stimulus generalization, and the anticipatory organization of behavior to prevent the recurrence of the trauma effects.

Children’s Voice Article

“A Restorative Approach to Residential Treatment”, an article written by Patricia Wilcox, LCSW, and published in Children’s Voice, the magazine of the Child Welfare League of America, in May/June 2008.

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