Saturday, March 10, 2018

Six Thoughts as Oprah Tackles Childhood Trauma

Learning about developmental trauma has changed the way I see most people. At one point I thought of the relationship that’s most stressful for me and I decided to measure that person’s Adverse Childhood Experiences (ACE) score and I wasn’t surprised that her score (from what I knew of her experiences) was unusually high.

No wonder she treated me so poorly!

For the first time since I’d known this person I began to look at her with compassion rather than being angered by her unfair treatment of me.

Parenting children from hard places, I have to understand how trauma impacts development, and, the more I learn, the more I realize childhood trauma is a pervasive problem that needs to be better addressed in our society.

Like many of you, I’m looking forward to hearing the conversation between Oprah and Dr. Bruce Perry tomorrow on 60 Minutes and I’m thankful Oprah is using her platform to join and initiate such a crucial discussion.

In preparation for tomorrow’s segment, I began gathering some of my often-too-scattered-to-share thoughts regarding developmental trauma, and they are summarized in the following six ways.

1. Language Matters

For the past twenty years I’ve worked with children in residential care and the diagnosis for those struggling the most from their early life experiences has always been “Reactive Attachment Disorder,” often shortened to “RAD.” The label is still used, although it seems many professionals are beginning to question the diagnosis. There’s been a movement to change the diagnosis to “Developmental Trauma.”

When a child has suffered from trauma that has interrupted his development, the ability to attach with a caregiver is impacted. However, “attachment” is a two-way street. If all a child knows from primary caregivers is neglect and/or abuse, he has to do what he needs to do to survive.

Labeling him with an attachment disorder insinuates that he must change when he does not have that ability. The only way for his attachment experience to change is for a loving caregiver to monitor his relational tolerance and consistently nurture him in ways he can handle until he can handle more. Then, his caregiver has to adjust nurture to match the child’s increased tolerance for nurture.

A friend of mine used to say that “Reactive Attachment Disorder” was a natural response to a very unnatural problem. When we label the child as “disordered,” it’s easy to forget that the caregivers must do whatever is in their power to create both real and felt safety so they can build their mutual attachment.

Once I made the shift away from using the term “Reactive Attachment Disorder,” to speaking more generally of trauma, it was easier to see that the behaviors I was so frightened by were survival strategies. It didn’t take long for me to drop the words “manipulation” and “control” once I realized these were tools my child used to survive and they weren’t premeditated. Again, it was all he knew to do to survive.

Once I began seeing my child as a survivor who was constantly in a battle, I began to have compassion on him rather than fearing him. Once my compassion grew, I had more clarity on how to specifically support my child.

2. The Behaviors often Associated with those Labeled with RAD are Real

As I’ve mentioned before, the behaviors of children who don’t feel safe and can’t regulate their emotions can be terrifying and, for years, I remember reading information that labeled these children with RAD and said there was little possibility of them ever developing a conscience.

The fear I had as a result of my reading led me to believe our children were doomed. Our family was doomed. When I first heard Bruce Perry MD speak about trauma and how children can make progress, I began to make a shift. Eventually, rather than being scared of my children, I began to notice their fears. Once I began to see their fears more clearly, I had the ability to begin protecting them from those fears. Once our children were less scared, their behaviors became a ton less scary.

I finally realized that the place I needed to begin was to be safe and create safety and routine for my children. After time, my children were calm enough around me to hear some of my words. It seemed to take forever before I could begin helping them problem solve verbally, but, in a way that seemed to make our relationship more natural. The parents of a newborn are constantly watching for signs and patterns so they know how to provide for their child’s needs. I had the opportunity to mirror this process with my adopted children until they felt safe and confident enough to verbally process with me.

3. Parents often Feel Isolated, Judged, and Hopeless

Our families need help that is rarely available to us. Before our children feel safe with their primary caregivers, they often need frequent, long, and predictable breaks from their caregivers because, for many of them, primary caregivers are their number one fear- for good reason. Their caregivers also need predictable breaks from their lovely children.

Getting these breaks is nearly impossible though. Even school rarely seems like a break. In fact, until babysitters, camps, and schools understand some trauma basics, the time our children spend with them does more harm than good- leaving the entire family feeling overwhelmed and hopeless.

Those supporting our family need to know that it isn’t cute when a child they’ve never met jumps into their arms and starts kissing them on the cheek- it’s survival. They need to know how to respond kindly to that survival. [For example:  Hi. What’s your name? We don’t know each other yet, but I hope you’ll still like me on Friday. If so, maybe you can give me a hug then. It’s not safe to hug strangers.]

When our friends see our families, our children often present their best behavior. Our friends see this behavior and don’t understand that being around strangers brings our children’s stress levels down and they are able to function higher as a result. They also don’t understand that our children have often depended on strangers to safely meet their needs when the adults in their lives have been untrustworthy or that they’ve often learned to charm strangers as a defense mechanism.

As a result of friends seeing only charming behavior from our hurting children, the parents in our families are often dismissed as having gone crazy post adoption and the result is often painful isolation from healthy community.

4. The Support our Families Need

I’m going to limit this bullet to education, childcare, and therapy for brevity.

The first years our children were home it seemed their education was nearly impossible. Their schools weren’t trauma informed. The information we shared with schools was rarely considered. Our children suffered. Our family suffered.

Even when children who have experienced developmental trauma seem to function high, there are often gaps in their education, sensory needs, language, and social skills that need more attention than I had ever imagined. Our children had to spend so much of their effort surviving the way they knew how that they often missed opportunities to develop skills necessary to thrive in a healthy environment.

Our children need years to work on those skills in a setting that is low stress. Most of the children in care I’ve worked with over the years would have benefited greatly if they’d been provided with tutoring, speech therapy, occupational therapy, in a low stress environment- rather than in a traditional classroom- to develop skills they are lacking. The classroom is swarming with relationships that are often overwhelming for our children during the years they are building their general relational tolerance.

As I mentioned, school was an unhealthy place for our children during their first years at home. During that time, we only saw our children thrive in one setting: nature camp.They loved the wide open space. The nature was calming to them. Their sensory needs were met as they explored. The only problem we ever had was one of my children refusing to return to the building for lunch!

If I could develop a program to help families heal and build healthy attachments, it would begin with nature. There would be a wide open natural space to explore, clean portable restrooms, outdoor sinks, and picnic tables. Children would not need to go through any unnecessary transitions as transitions are often felt as threats/losses. The staff would be trauma informed and would work closely with families to be sure they were encouraging rather than hindering healthy attachments.

Beyond what our children need, their parents need excellent, trauma-informed coaching. In my experience, during our earliest days, this was far more valuable than sending our children to therapy. We’ve had great experiences with a trauma-informed therapist, but excellent therapists who understand our children are challenging to find. Our experience is that any therapy that isn’t helping is hurting. Finding parent coaches can be far less stressful. Parents can choose coaches from all over the world and meet with them via Skype when their children are sleeping. Our family needed coaching to know how to help our children feel safe and how to lower their stress so we could eventually build trust and enjoy being in a trusting relationship.

5. There is Hope

Seven years ago, I imagined by this time our family would have at least one child living in a residential treatment center. While it’s possible that’s still in our future and we do not see residential treatment as a failure, we’re in a much brighter place than we ever imagined. One of our children wants to go to a small, private school so he can develop and nurture closer friendships. Another child spent a couple of unexpected months home from school this year and he jumped right into the homeschool community without reservation. He knew it was a safe community because I brought him there and because I was present.

6. Our Families Need to be Heard

While those of us parenting children who have a history of trauma need to be heard and understood, even greater is the need for our children to be heard and understood. Like Oprah said, “The question that we should be asking is not ‘What’s wrong with that child,’ it’s ‘What happened to that child?’”

Our children speak loudly through their behavior before they feel safe enough in a trusting relationship to communicate using their voices.

They don’t need to be judged. They need to be heard.

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