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.