Concerned About Unconventional Mental Health Interventions?

Concerned About Unconventional Mental Health Interventions?
Alternative Psychotherapies: Evaluating Unconventional Mental Health Treatments

Thursday, June 19, 2014

What Is Childhood Trauma About, and What Can Be Done to Lessen Its Effects?

A reader kindly commented on yet another Tina Traster claim—that adopted children in general have suffered from the trauma of a “broken maternal bond” or “primal wound”. Traster is apparently under the much mistaken impression that a child’s emotional attachment to the mother occurs before birth, and that therefore all adopted children have experienced a distressing separation from an attachment figure. These ideas are authority-based, not evidence-based; someone told Traster these things, and now she is taking her chance as a temporarily famous person to pass them on to others. She is unconcerned with the fact that easily observable evidence shows us her claims are incorrect.

Is it possible that an adopted child can have experienced trauma? Yes, most certainly! Some adopted children did experience trauma as a result of separation from the birthmother or other familiar caregivers, if that separation occurred between about 8 months and about three years of age, if the separation was abrupt and permanent, and if new caregivers treated the child insensitively and unresponsively. Please note that I say “or other familiar caregivers”, because there are many cases where a child who is to be adopted is separated very young from the birthmother, placed with foster parents for many months, and then abruptly separated from the foster parents. Children with these latter experiences are not traumatized by the separation from the birthmother, but may have experienced the separation from the foster family as traumatic.

Other adopted children may have experienced separations at younger or older ages and not found these traumatic as might have been the case for separation during the most vulnerable period. It’s possible that a baby can go from hospital to adoptive parents without experiencing any traumatic events. However, many cases of adoption occur in the wake of trauma of all kinds. Debilitating illness and death of a parent may leave the child parentless, or one parent may kill the other in front of the child and go to prison as a result. Vicarious traumas like these may occur singly, or may be combined with  direct traumatic experiences like car wrecks, physical attacks and injuries, sexual penetration, or uncontrolled and threatening adult rage. When children are adopted later than the first few weeks of life, the chances are that neglect, abuse, or exposure to others’ trauma have been experienced by the child; if nothing had happened, the child would not have been placed for adoption, unless he or she has handicapping conditions that the first caregivers found they could not manage.

In addition to these problems, it is possible that both adopted and nonadopted children may also react negatively to the later experience of coming to understand past events. Perhaps a child did not really know that his father killed his mother; now he finds out and grows mature enough to try to make sense of this. Perhaps a child adopted from China learns that her birthparents may have abandoned her because they wanted to have a son. Perhaps a nonadopted child comes to understand that his parents “had to get married” and may resent his existence because of this. One father of my acquaintance jocularly described to his teenage son all the efforts to abort that the parents had made without successfully ending the pregnancy. All of these later experiences can compound early traumas if such occurred, or can have powerful distressing effects on their own.  

One of the major effects of  traumatic experiences is the tendency for the individual to become emotionally dysregulated in the presence of “triggers”--  events that are not in themselves harmful but are reminiscent of or associated with the original experience. (“Triggers” are much in the news lately, as instructors are being asked to give warnings about reading or classroom material to students who may have experienced related trauma in the past.) Although children in general become dysregulated more often than adults do, they can usually be helped to calm and regulate themselves by familiar people—but when a child’s dysregulation is set off by the effects of past trauma, even familiar caregivers may not be able to help control a tantrum, rage, “meltdown”, or panic. The effect on the family, on the child’s relationships with siblings and friends, and on the child’s education may be devastating.

What can be done to help these difficult family situations? There are presently no treatments that are strongly supported by research evidence. However, there have been some attempts to create  multimodal treatments for these problems. One of these, Trauma Systems Therapy (TST) was described by Richard M. Smith in the Brown University Child and Adolescent Behavior Letter for June, 2014 (p. 1, pp. 6-7). Smith described TST as “the disciplined use of the whole range of tools targeting all levels of the system”. Careful assessment of problems includes understanding of child symptoms, family stressors like unemployment or caring for many or special needs children, school history, and financial pressure. Eventually, Smith says, “the work centers on analyzing what triggers and follows from the child’s dysregulated behavior, and then on how to prevent the triggers… It’s like looking at a football game in super slo-mo, only maybe the players don’t even know what game they’re playing or how. Families often start out reporting that there are no triggers whatsoever—‘he just blows up, it’s random’, they may say. Only after a lot of work can they be coaxed to see that it’s much more complicated, and also less, because the triggers are knowable, predictable, and often preventable. Getting people to accept their own role in the triggering can be harder still.”

There has been some work on the outcome of TST, but high levels of evidence are not yet in place. But even in the absence of such support, it’s clear that TST is a highly plausible approach. Unlike the assumptions made by Tina Traster, it is congruent with other things we know about children and families. It does not commit the fundamental attribution error by claiming that any problem is caused by a characteristic of the child, but instead works with a range of child and parent characteristics, temporary and permanent stressors, and long-term strengths and weaknesses of family and community. Whether TST will turn out to be the primary evidence-based treatment for traumatized children is unpredictable,  but it is clear that its approach to problems following trauma is free from the neurobabble and the superstition about early development that dominate Traster’s remarks.    



12 comments:

  1. Yes, trauma changes a kid (or adult) -- permanently. But it does appear that rather a lot of kids thrive despite the most horrific traumas imaginable.

    Behold the Polish Pahiua children -- a group of kids who watched their parents starve to death / be murdered by Nazis, shipped to what amounted to a concentration camp in Siberia for several years, put on a boat to New Zealand and then raised in a big orphanage in a small town. Amazingly, those turned out fine (finished school, got jobs, married, had kids, didn't end up in jail). Really:



    http://www.slate.com/articles/life/the_hive/2013/05/pahiatua_s_polish_world_war_ii_refugees_a_group_of_young_poles_made_a_new.html

    And if those 700+ Polish kids can somehow manage to survive the loss of their family, country, language, culture AND growing up in an orphanage to become functional adults, well, clearly anything is possible.

    What helped those kids succeed? Are there lessons to be learned? What makes some kids resilient?

    I was amazed at the resilience of so many of my daughter's high school classmates -- about a quarter of whom are Haitian, having arrived in Montreal following the 2010 earthquake (taken in by extended family they'd never or only briefly met before). These are kids who didn't speak French or English, many of whom had barely attended school at all, lost their families, crash landed in a city that was about as familiar to them as the Moon... and in 3-4 years, learned two new languages, caught up kids like mine (upper middle class, college educated parents, no/minimal trauma, etc) and in some cases surpassed them!

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    1. Dear Jules--

      Your points are well taken-- many people manage well following what would appear to be very distressing events. These good outcomes are aided by positive temperamental qualities and certainly helped along if the child has been able to establish a secure attachment before the difficulties occur. These factors may help a child manage not to be "traumatized" by events that might have that effect on those with less resilience.

      There are a lot of examples of the kind you give. The "Bulldogs Bank" children were a small group of preschoolers rescued from the Theresienstadt concentration camp at the end of World War II and cared for at an English country house under the supervision of Anna Freud. The children's mothers were unknown and probably long dead, and the children had been kept alive secretly by camp inmates who smuggled food to them from their meager rations. They had only each other as consistent companions. The children developed normally-- some of them are still alive, and one had a blog, but I can't seem to find it right now.

      The real concern about traumatic experiences for children is not that their entire lives will be ruined in a direct way, but that their dysregulated behavior in response to reminders of the trauma will interfere badly with family and friend relationships and with both school and play. When such problems occur, there can be a cascade of ill effects (including the parents' belief that the child is just bad) that end by closing off many good developmental options.

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    2. My daughter's Haitian classmates were (overwhelmingly) very poor kids who'd lost most/all their family in Cite Soleil* who were shipped off to a relative aborad they didn't/barely knew as there was no other option. Kids with boatload of trauma even before the earthquake and an, umm, inconsistent education (at best).And *these* kids caught up -- within a few years. And (there's really no tactful way to say this) *these* kids started from SO far behind a kid like mine. Which is mind-blowing.

      How did they catch up? why did they catch up? What can be done to replicate the successful catching-up-ness?

      It's *unsuprizing* that, say, a not-too-traumatized middle class Haitian kid would catch up academically to my middle class untraumatized Canadian girl -- the Haitian kid wasn't really behind.

      I
      * upper/middle class Haitian families, well, the ones I'm friendly with, tend to have dual citizenship and a house here.They and their kids are trilingual and "escaped" as an entire family, mostly by driving themselves to the DR border, showing their Canadian passport and buying a commercial plane ticket. Seems like much less trauma (the whole family is safe and together, kids/parents already fluent in French/English, no worries about where their next meal is coming from, etc). Again, there's no tactful way to say this, but this group of upper/middle families/kids didn't really need to catch up, because they weren't "behind".

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    3. I think there are two separate questions here (not that I can give a good answer to either one). The first is, how do kids catch up when they've been left so far behind but finally get a break? Maybe the answer to this is that our whole elaborate school system and careful education from preschool onward actually doesn't do much good-- maybe waiting until the kids are older and then schooling them would be just as effective-- I speculate of course! Other than that, maybe the poor Haitian kids had always heard about how education was the key to everything,so when they got a chance, they went for it?

      The other issue is about the role of trauma. However bad someone's experiences may appear to observers, if there are no ill effects, we can't really say that trauma has occurred. It may be that horrible things cause trauma only to certain individuals under certain circumstances. We can't just assume that because people go through experiences that we would not wish on our worst enemies, that they are therefore traumatized-- and even if they are, the impact may show only in certain areas of their lives.

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  2. TST sounds like an interesting approach, one that doesn't put the "blame" onto the child.

    Did you know today is NATA Day? I just discovered this:
    http://www.attachu.org/events/nata-day/


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    1. I did not know that! When I tried to look it up on Google I only found things like an association of Telugu people, so I gather that this is a recent PR invention.

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  3. As always Jean, your words ring true to me.

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  4. Tina Traister's at it again... a horrific, inaccurate article full of INCORRECT INFORMATION regarding RAD:

    http://www.adoption.net/adoptive-parents/blog/rescuing-julia-twice-conversation-with-the-author-adoption-groups-can-t-stop-talking-about?vnc=H_OO-Fn4f-vdKZsuUlU4XYhotlatJq9YTOs1jJ2NpjI&vnp=0

    Plus, a blog post by a self-procl;aimed trauma mama, begging her kid's teacher to try to parent her kid (vs teach him and hold him responsible for his actions):

    http://www.thisradmom.com/2014/08/dear-teacher-my-child-needs-us-to-be.html

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    1. Thank you-- I hope to comment on these in the next few days, and on an attempt to use the PW argument in court.

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    2. Consider writing about this adoptive mom too -- she adopted a tween from foster care who isn't cuddly. The girl has PTSD, has told amom and adad that she doesn't like to be hugged/touched, that it makes her feel unsafe and, specifically, does not feel safe when (appropriately) touched by adad.

      Reasonable request, yes? The girl's body is her own, she's entitled to dictate who can or cannot touch it, yes?

      Not according to amom. She's lobbying to have the kid hug her adad, telling her daughter's best friend to tell the girl to hug her dad, etc.

      Some kids aren't tactile. For the love of god, why why why are adoptive parents unable or unwilling to accept this?

      (It's my pet peeve because I was the least tactile kid ever. I'm not adopted, my parents are lovely and I just did not and do not like to be touched).

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