Trauma and Attachment
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As the adoption of special needs children rises in this country, so does the need for adequate post adoption services. The current condition of post adoption services in most states still reflects the old adage of "just give them enough love and they'll be fine." This was probably true during the last era of special needs adoptions, which was before World War II. Before that war, the average age of children being placed for adoption in the U.S. was 4 years old. Most of the children being placed then were available because their families were not able to financially care for them or because a single parent could not provide adequate resources. After World War II, the world of adoption changed with the dramatic increase in infants available for adoption.
This trend lasted into the 1960's when adoption again began to change with the advent of birth control. Once again, older children came to dominate the landscape of adoption. Our current dilemma in older child adoption, now called special needs adoption, is the level of trauma children have experienced prior to placement. While prenatal exposure to alcohol was a possibility before World War II, prenatal exposure to drugs was virtually non-existent. In addition, current special needs children, if not prenatally exposed, typically have lived in their original family where drugs and alcohol are the driving force behind the chaos, abuse and neglect these children suffer. The availability of relevant post-adoption services has not kept pace with the need to help families raising traumatized children. I have worked in social services and mental health for over 22 years and I cannot remember a child I have met who has not been exposed to a family setting that included drugs and alcohol. This may be due to the fact that I have worked in community mental health, domestic violence, foster care and post adoption, all areas in which children who have experienced trauma are likely to be seen. Parents who have adopted children with special needs know that a child who has previously experienced trauma from having lived in chaos, abuse and neglect is affected in all of the child's functioning systems. The child's cognitive emotional, behavioral and physical systems have all been impacted by early trauma.
Consider how many of the following traumatic experiences your child has endured:
- Parental Alcoholism
- Parental Substance Abuse
- Group Care/Out of Home Care
- Mental Illness in Parent(s)
- Sexual Abuse
- Emotional Abuse
- Physical Abuse
- Neglect
- Poverty
- Abandonment
- Divorce
- Loss of Family
- Malnutrition
- Physical Illness
Our kids have suffered much trauma. My foster son experienced 11 things on this list before age eight. Traditionally, mental health practitioners have diagnosed children with behavioral symptoms subsequent to trauma with diagnoses such as Reactive Attachment Disorder, Attention Deficit Disorder, Oppositional Defiant Disorder, Conduct Disorder, etc. These symptoms could also be called Post Traumatic Stress Disorder (PTSD.) This is not to say that those first disorders do not exist-obviously they do. However, my question is, to what degree are the behavioral symptoms presented by a child symptoms of traumatic stress? If so, we then have a basis for understanding the symptom rather then simply the behavioral description the other diagnoses provide. For instance, is it possible that what has traditionally been called Attachment Disorder is more effectively called Post Traumatic Stress Disorder? A child experiences disorders in their ability to successfully attach because the trauma symptoms the child presents in the new family are based on the child's previous traumatic experiences and are not useful. I came to this way of thinking by many routes, one being through the research on adults with Post Traumatic Stress Disorder, primarily Vietnam War Veterans. This research describes how difficult it is for the family of the veteran with PTSD to live with the behavioral symptoms of the vet re-experiencing the trauma of the war on a daily basis. This does not necessarily mean flashbacks. It can mean mood swings, hypervigilance, unpredictable anger, despair and a strong need to control every situation.
Another way I understand the correlation of behavioral disorders to PTSD is the way in which trauma is stored in the brain. For instance, memories are encoded in the brain in different ways. Declarative memory contains facts-explicit details about events that can be verbalized. Non-declarative memory, or implicit memory, is experienced viscerally and is not immediately available for verbalization. Recent experiments with adult victims of trauma have shown that when an event is perceived to be traumatic, i.e. life threatening, that part of the brain that gives language to the experience stops working. Instead, the traumatic event gets stored in the sensorymotor domain of the brain. Another way to think about this is to understand that each of our brains has an extensive filing and storage system for details and experiences. Like all memory, traumatic memory gets stored too. This is useful for us when we can make use of memory as a way to protect us from further trauma. It is helpful to be able to call out of memory that a particular situation is potentially threatening and our response needs to be protective. However, for those of us who have not experienced trauma as a daily event, we are selective in our understanding of what is threatening because we believe we are generally safe.
Our children with special needs do not have that advantage. Their experience has been that the world is a dangerous, threatening, hostile and uncaring place and that potential danger is always present. That means that the filing system in their brain is stored with memories that indicate that even seemingly benign situations can carry some hidden threat. When a person is responding to their environment out of fear of a potential threat, they become hypervigilant, their heart rate is often higher than normal, even at rest, and their adrenalin system is always pumped up ready for "fight or flight." This "fight or flight" phenomenon is evident in children who are often defensive, or ready to blame others, are in need of controlling each situation they encounter, are usually ready to fight back when there is nothing to fight about, or seem to "check out" and become non-responsive to any requests. Children who are suffering from some form of PTSD or traumatic stress are both emotionally and neurophysiologically "alert" to potential danger. What is very hard for both parents and professionals to understand is that simply telling the traumatized child that this new family will not hurt them in the ways they have been hurt before is not enough to change the filing system in the brain. The way the filing system got filled up was by experience with trauma and highly emotional situations. Once way to change what the filing system has assigned to a particular situation is to re-do the situation emotionally.
There are many ways to re-do the emotional experience. But because traumatized children operate at a higher level of adrenalin functioning, the new emotional experience is going to have to be highly charged. Some of the ways to evoke new emotions therapeutically is through movement, art, music, drama and through holding therapy. This last intervention is the most controversial for many people. I use many different interventions in my work with children but the one that appears to make the most difference for the most shut down, controlling and angry kid I know is holding therapy.
There is much misunderstanding in the general population and in the professional world about what holding therapy is or isn't. In my practice with colleagues at the Attachment Center Northwest outside Seattle, what holding therapy isn't is violent or abusive. When seen on TV, the part of the therapy that is shown is the catharsis. It is dramatic. That is just a segment of what really goes on. Holding therapy is nudging, cajoling, challenging and for the most part nurturing. Holding therapy allows for re-experiencing of a traumatic event, within an emotionally charged situation; but this time the outcome of the trauma is different. The child gets taken care of rather than neglected; comforted rather than abandoned. The child shares his rage; fear and grief with nurturing adults who are in control and keeping the child safe. Parents who are safe, trustworthy and predictable are the most significant part of the therapy because they comfort the child at a time when the child is most vulnerable. For the traumatized and neglected child, this comfort is a new experience because most children from chaotic backgrounds have learned to take care of themselves. They have not allowed themselves to be comforted or nurtured because they don't know how. Finding a therapist who understands trauma is critical when seeking services for a child with a traumatic past. The family needs to be an integral part of the therapy. The resolution of trauma, decrease in trauma-based behavior and increase in ability to be vulnerable and nurtured is what will lead the attachment disordered child to risk attachment. There are two national organizations that are available to help families find therapists in their communities who understand trauma and/or attachment. Those organizations are: ATTACh and The International Society for Traumatic Stress Studies 60 Revere Drive, Ste. 500 Northbrook, IL 60062 PH: 847-480-9028
Taking care of our traumatized children requires that we take good care of ourselves. Finding the right help is the first step.
info@attach.org© Rebecca Perbix Mallos, MSW
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ATTACh
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