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Inability to Regulate Emotional States
A common denominator for all children referred to Sandhill, regardless of diagnosis, is an inability to regulate their emotional states. This can be displayed as temper tantrums, verbal aggression, or even mild to moderate physical aggression towards others, self, or property. Because of this, most of our children have experienced rejection and failure in settings like school and social situations. Sadly, the general public may view these children and just spoiled, or willfully misbehaving, not grasping the fact that they truly do not have the same capacity as other kids to manage big feelings. Additionally, they often misperceive the intentions of others and this misinterpretation leads to reactions or interactions that may be inappropriate, thus setting them up for additional rejection and failure. At Sandhill Center we focus on a neuroregulatory approach with one of our main objectives to help develop the capacity to regulate and manage big feelings, thus leading to improved relationships and feelings of acceptance and worth.
Autism Spectrum Disorder
The neuroregulatory approach is very effective with children diagnosed on the Autism Spectrum. Understanding that these children do not respond to traditional behavior modification approaches, we incorporate a variety of strategies and interventions, to address social skill deficits, sensory integration issues, rigidity, and many other hallmarks of ASD. Use of a squeeze machine developed by Temple Grandin or a sensory deprivation floatation tank, can improve a child’s capacity to self-regulate. Our small, home-like environment provides nurturing individualized attention without over stimulating and overwhelming a child.
Family relationships may be strained prior to placement, making relationship repair a crucial goal of our treatment program. We encourage family contact by telephone and visit, with phone calls beginning immediately after admission.
Parenting children with affect regulation difficulties is often a counter-intuitive process. Our staff help parents become attune to their child’s needs and respond in a manner that is productive and therapeutic, in order to help build healthy and durable relationships between children and families. Parents are seen as active participants in the treatment team and participate in treatment plan and brain metric reviews.
Unsafe or Reckless Behavior
Children may display unsafe or reckless behavior such as self –harm (head banging, scratching), running off without awareness of the surroundings, or lashing out at others without regard to consequence. Usually this is a result of impulsivity and dysregulation, not willful behavior. Young children are naturally less aware of risks or consequences than adolescents or adults. They have yet to have the life experience to understand that reckless and unsafe behaviors may have permanent or dire consequences. For children at Sandhill Center, that lack of understanding is 10 times that of the average child, as is their impulsivity. It is often these unsafe behaviors that finally bring a family to make the decision to pursue residential treatment.
Resistance to Adult Care and Guidance
While it is not uncommon for children to give some “push back” with parents and begin to explore being more autonomous, many of the children that come to Sandhill Center exhibit this in an extreme fashion. People may view this as oppositional behavior or resistance to relationship, but for some children it is an attempt to control their environment or prevent themselves from becoming too connected to others thus risking failure and rejection. For other children, they may have been exposed to environments early on that did not provide for their needs, thus requiring an excessive level of autonomy for survival. Closeness and dependency on others can also be a big trigger, and a child may do everything in his or her ability to avoid this. This may look like an explosive tantrum when told “no”, or perhaps acting impulsively without regard for permission. Parents can often feel rejected and struggle not to take the child’s resistance as a personal affront. Our task is to develop or restore the child’s trust in adult care and guidance by sending the child the consistent message that adults are their to provide care and safety.
Adoption or Attachment Issues
Approximately fifty percent of the children at Sandhill Center are adopted. While some of these children struggle with developing relationships with others (attachment), some do not. Conversely not all children that struggle with developing relationships are adopted. However, regardless of the reason or whether or not the child is adopted, it is important to note that the core of the program at Sandhill Center is relational, and interventions and strategies designed to target problems must always be done in the context of relationship.
Refusal to Attend School
Most all children at Sandhill Center have had significant struggles in the academic environment. Some get to the point that they absolutely refuse to attend school and will do anything and everything to prevent attending school. For many of our children, school has not been a positive experience. They may have been seen as behavior problems, labeled lazy for not completing work, or feel like failures for not being able to keep up with other children. Del Rio Academy, the onsite school for Sandhill, provides a warm, non-threatening environment. The close coordination with the residential environment allows the treatment to seamlessly translate to the school day as well. Additionally, each child’s academic program is individualized, enabling remediation and support where necessary while building on strengths.
Lying, Manipulating, Controlling Behaviors
By the time parents decide that residential treatment is necessary for their child, they will have faced some significant challenges in the form of what we call “control strategies” These are maladaptive behaviors that children often develop to maintain control of their world. They can be in the form of lying, manipulation, stealing, tantrums, or any of a number of actions to attempt to get what they want or attempt to avoid consequences for their actions. To an extent, these control strategies have worked in the past, and so they persist in employing these negative behaviors. Challenging these control strategies, and helping children develop healthy behaviors to manage their world is an important part of the treatment at Sandhill Center.
Depression, Anxiety, Bipolar Disorder
Children at Sandhill Center may have a diagnosis of a mood disorder. It is not uncommon for them to have a number of diagnoses on admission, and while medication is effective and important, Sandhill addresses the mood disorders in the milieu and in therapy. Healthy habits like a brain friendly diet, plenty of rest, and ample exercise are all part of our program. Parents usually notice an improvement in mood within the first few months. It is not unusual for children to decrease medication over time as they develop capacity for regulation and healthier coping strategies.
Failure to Take Personal Responsibility
Failure to take responsibility for one’s actions or inactions is another common concern parents have about their child. This is usually the result of feeling shame and not wanting to be seen as “bad”. The shame can be so damaging, that the child will do almost anything to try to avoid it. However, usually the avoidance of personal responsibility just makes the problem worse. It can feel like an endless cycle of frustration for everyone. Working with the child to accept and understand that personal responsibility is key for healthy functioning in relationships. By identifying and managing the underlying shame this cycle can be broken.
Failure to Recognize Actions Affect Others
As a child grows up, the ability to see his or herself in the context of the greater world increases. There develops an ability to understand that actions have consequences and impact on other people. Children at Sandhill Center sometimes seem to have not developed this awareness, and may be seen as lacking empathy towards others. This can be immensely frustrating to a family, hurtful, or even dangerous. Engaging them in relationships and identifying the impact of their actions on others helps them to start to develop this awareness and begin repair work with the family.
Projection of Blame on Others
Much like the failure to take personal responsibility for their actions, parents may see their child blaming others for his or her actions. This is a common control strategy for children at Sandhill Center, and is usually connected to avoiding shame and embarrassment by making a problem someone else’s fault. Working with the child to accept and understand that personal responsibility is key for healthy functioning in relationships. By identifying and managing the underlying shame this cycle can be broken.
Failure in Traditional Treatment Programs
All parents who choose Sandhill Center for their children have tried other forms of treatment. Most children have been in outpatient treatment for years, and parents may have tried every form of behavior modification they could. One parent stated to us, “I could have bought a sticker store!” Some children have even been hospitalized or attended another residential treatment program. For a child at Sandhill Center, traditional behavioral models and cognitive talk therapy have been ineffective because they don’t focus on the child’s main problem, dysregulation. Treating dysregulation requires neuroregulatory strategies and interventions that organize the lower areas of the brain, while traditional modalities target the upper area of the brain. At Sandhill we work from the bottom up, understanding that the key to changing is developing a solid foundation first. We find that once the foundation is solid, children can be open and more responsive to traditional therapy and improve their ability to work in individual and family therapy.