Wednesday, 23 April 2014

Child Development & Trauma

Canst thou not minister to a mind diseased?
Pluck from the memory a rooted sorrow
Raze out the written troubles of the brain
And with some sweet oblivious antidote
Cleanse the stuffed bosom of that perilous stuff
Which weighs upon the heart
  William Shakespeare, Macbeth, Act V Scene iii

Children can appear traumatised for many reasons including being gifted and talented. For some children and young people the stress of being highly able can be a lot to deal with especially on top of other difficulties and trauma in their lives. Take the following as a scenario:
               What we may know:

A young child in primary school has an EP assessment and has been identified with a full-scale IQ of 140 and is high ability in literacy. The child is in the top set in class. Not particularly high ability in any other area. Is bored in school and under challenged coasts and is extremely disruptive in class. Can be difficult, arrogant and indifferent to staff. Has social and emotional difficulties with their peers; find playtimes particularly challenging. Can discuss on a very adult level, asks difficult questions and is bossy and opinionated.

What we may not know:

The child is from a poor socio-economic background, was premature at birth and the mother is an alcoholic and the father has passed away. The family live and depend on benefits. The child is the middle child of seven children and has to help with taking care of their brothers and sisters. Prior to going to school the child has to deliver his two younger brothers to school (which is two bus rides away) and then get him to school. The child’s support systems at home are poor and the child is left to his own devices more often than not. After school this child picks up the two younger children, goes home and helps to make dinner and get the children to bed, then endeavours to do his homework and get himself to bed and so the scenario begins again at 6am the next morning.

If you add all this together and then consider anything else that we may not know, you may begin to see how a child maybe suffering from the symptoms of trauma and how this will impact on their behaviour. If you then add to this the characteristics, traits and behaviours associated with high ability you may then begin to see how the behaviours can be heightened.

Behaviours we may see as a result of ability and trauma:
Selective Mute                          

When children are traumatised from a young age they can develop Acquired Brain Injury (injury to brain function). Children who are traumatised may find school difficult to manage and the trauma may lead to some of the following impairments and distortions:

  • Speech, language and processing disorders
  • Learning difficulties
  • Distorted education narrative
  • Emotional and behavioural difficulties
  • Difficulties with social connectedness and integration
Research tells us that adversity prior to birth can lead to lasting developmental impairment and impaired brain function. Such adversity can also have an impact on the capacity of the child to benefit from the attachment process. Impairment can be caused by some of the following:

            Adverse genetic inheritance                                       Maternal exposure to illness

            Extreme deprivation                                                    Trauma

            Toxic substances, e.g. alcohol, drugs, radiation     Head injuries at birth

            Lack of oxygen at birth                                                Complications of prematurity

            Low birth weight

Alcohol is a neuro-toxin which adult brains can tolerate – baby brains cannot. Certain traumatised individuals have the capacity to turn off the pleasure parts of their brain and start to crave mind altering substances, e.g. alcohol, sugar, caffeine and nicotine – to name but a few. Some traumatised individuals show signs of other illnesses, e.g. migraines and headaches, breathing problems, aches and pains and avoidance techniques, e.g. not wanting to go to school.

Human brain development (the useful brain) develops after birth. Very few neuro-connections are there at birth but during the first year of life the brain mass doubles and the foundations are laid in the brainstem to begin to regulate our emotional life. In year one of the development of the baby brain, social interaction is the main influence. In year two those neuro-connections that have not been used and developed in babies first year of life “drop away” and the one that are left become coated in myelin, stay and become physical structures, e.g. fixed and firm in year two and we begin to integrate all the mass of sensory information our presents to us. From years one to four the foundations are laid to regulate our emotional life and from years two to six we begin to establish the foundations for the thinking cortex. It is now that we begin to be capable of abstract thought, cognition, meta-cognition, learning and learning how to learn.

If all goes well we have laid the foundations for development capacity of integrating our physical, emotional, intellectual, social and spiritual development. Personality is not a given from birth. If all does not go well…… our brains can be depleted, damaged or injured so that the developing personality can be harmed. With help and support all is not lost and we are never beyond the reach of healing. Primitive patterning can be changed with time and patience of the caregiver, e.g. parent/carer, teacher, foster parent.

If a baby’s attachment needs are not met at birth and soon after, this can affect the structure of the developing brain. Symptoms for a child can be lack of self-regulation, e.g. temperature, intake of food, stress and processing disorders. Many high ability children have great difficulties with the processing of information, e.g. reading, writing, visual and auditory processing; some children with VPD/APD may have poor filters in areas like noise, light, crowds.

Babies are born completely helpless and to survive they must develop a bond between themselves and their main carer/s through scent, taste, touch, sound and the parental gaze checked constantly by the baby. To feel safe the baby must develop a deep sense of safety with their parent/carer in order to become less controlling and develop a healthy dependency.

Older children and young people with unmet needs may seek the attention of their parent/carers and be very controlling and/or very dependent. Children with unmet attachment needs may:

  • Be unable to form core identity
  • Be profoundly puzzled by relationships of every kind
  • Lack any fundamental sense of safety
  • Be very demanding of attention
  • Be very controlling
  • Be very dependent
Children with behaviour difficulties may be suffering from trauma driven by unmet primitive needs at birth – they are NOT naughty children.

Babies and young children require physical attunement with their parent/carer; babies and children need a network of main carer's and bonders in order to survive and develop into balanced adult individuals. They engage in an intimate dance of conversation from birth where their bodies and brains, feelings and thoughts begin to work in tune; this attunement patterns within the baby brain. Attunement provides the blueprint for all human interaction and stress regulation is the first pattern. Young babies cannot regulate stress and unregulated stress injures the brain. When a mother or carer is soothing a stressed baby as the carer’s heart rate, blood pressure and muscles calm, so the baby’s calm. Self-regulation of stress at birth is nil and children who do not have these needs met as babies may be unable to regulate stress. It is important to help children self-regulate.

Children suffering from trauma can be:

             Hyper-aroused                               OR                    Dissociative                  
             (Gifted/Over-excitable/ADHD)                                            (Gifted/hypersensitive/solitary/isolated)

Dissociation reduces pain and creates a coping mechanism for the survival of acutely traumatic situations.

Dissociation – a defense against overwhelming stress where the individual cuts themselves off from conscious awareness of their senses that makes use of the human capacity to split awareness.
Hyper-arousal – a disorder involving persistent deregulated stress.
Attunement – the process through which the infants carer, by mirroring and then leading change in the vitality and effect of the infant, enables the young child to develop regulation of stress, affect and impulse.

Extreme stress causes loss of blood to the brain and this incites rages. Traumatised children often find it difficult to self-regulate mood. Young children are subject to limbic storm rages when their brains are at an unstable point of development consequently they need their attuned carer to keep them safe, contain the rage and reintegrate them. When this happens the adults are role modelling self-regulation patterns and the young child learns:

  • To manage aggression
  • To manage destructiveness
  • To manage anger
Limbic System – A group of linked structures in the brain centrally involved in emotion, memory and the processing of complex social and emotional information.

When children do not develop these skills they may find it hard to manage such behaviours. Add to this the stress and misunderstanding of being gifted and having to manage the traits, characteristics and behaviours associated with high ability and you can then, perhaps, understand the impact of trauma on a gifted and/or high ability child. Many of the processes for speaking our feelings can be knocked out of us by trauma. The child that stands blank when asked why they did or said something often really cannot remember why or what they said due to trauma and dissociation.

Children with positive attachment will generally respond: 
impulse – thought – action

Traumatised children will often respond:                             
impulse – ACTION – thought
This may account in many cases why gifted children tend to display what some professionals may consider negatives behaviours. When working with children how do we know what traumas they may have dealt with in their short personal lives (and may still be ongoing)? Add to this the traits and characteristics of giftedness (which many professionals do not recognise or understand) and it may begin to come clearer as to the levels of trauma in some children within our schools.

Being gifted, or having gifted characteristics that are not understood, can, and will, cause trauma in children which can lead to (or exacerbate) unwanted behaviours. Children who have unmet attachment needs from birth and who are gifted will have double the dose of difficulties. When working with children we need to be aware of these concerns and difficulties in order to have empathy, compassion and understanding of what is required to endeavour to support, help and heal and traumatised child.

Recovery is not quick, but traumatised children can learn to think differently and have healthy happy lives. The traumatised child will need to be surrounded by a secure team of adults who understand and are able to work with the child; a multi-disciplinary team. Trauma disrupts cognitive functioning and some children can think it is their fault, they can try to stop themselves recovering because we do not know how or who we will be once we recover and this can be extremely scary. Trauma can take over our identity and being gifted may be one of the triggers for trauma. Trauma can stop articulation as it turns off the part of the brain that enables us to articulate our feelings. Intelligent individuals can’t articulate under severe trauma or stress.

You will find that traumatised children/individuals tend to stick together because their internal physiology matches and mirrors each other – like minded. Just like gifted individuals understand each other and stick together so do traumatised.

Carers, teachers and professionals living and working with traumatised children are likely to suffer from Secondary Trauma which is where it becomes very stressful for the caregiver or teacher to be in the company or around the traumatised child; they may be unable to continue to enter the emotional space of the traumatised child and begin to share the child’s avoidance. They too will begin to show the following symptoms:

Changes in health
Eating disorders            
Excessive drinking
Substance abuse         
Change in sleep patterns

Those working with traumatised children are the ones most likely to suffer from Secondary Traumatic Stress Disorder (STSD). The three key preventative factors are training, support and regular supervision.

Traumatised children need:

1.             Help to develop trust - Affective attunement – soothing, stimulation, trust
      2.             Responsibility - Re-integrative shame – impulse, choice, responsibility
      3.             Self-control - Sociability – self-control, reflection, reciprocity

Appropriate treatment for trauma:

1.             stabilization – safety, explanations, words for feelings
      2.             Integration – physiological, emotional, cognitive
      3.             Adaptation – social connectedness, self-esteem, joy

 Working with traumatised children:

1.                Safety  – soothing hyper-aroused children
      2.             Engaging – stimulating interest and teaching about trauma
      3.             Trust & feelings – learning connectedness
      4.             Managing self – regulating impulse and the body
      5.             Managing feelings – choices and emotional processing
      6.             Taking responsibility – making sense of the world we share
      7.             Developing social awareness – learning self-control
      8.             Developing reflectivity – promoting self esteem
      9.             Developing reciprocity – learning that life can be joyful

You have brains in your head
You have feet in your shoes
You can steer yourself in any direction you choose
You're on your own
And you know what you know
And you are the child who will decide where to go
Dr Seuss

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