Rebuilding Attachments with Traumatized Children

Healing from Losses, Violence, Abuse, and Neglect

Richard Kagan

• Publisher: Routledge
• Year: 2014
• eBook ISBN: 9781136399794
• Topic: Psychology
• Subtopic: Mental Health in Psychology
• Index: Psychology

Learn to build the trust you need to help children in crisis!

Rebuilding Attachments with Traumatized Children: Healing from Losses, Violence, Abuse, and Neglect is a therapeutic guide to helping troubled children move beyond the traumatic experiences that haunt them. Author Dr. Richard Kagan, Director of Psychological Services for Parsons Child and Family Center in Albany, New York, presents comprehensive information on how to understandand surmountthe impact of loss, neglect, separation, and violence on children's development, how to discover and foster strengths in children and their families, and how to rebuild connections and hope for children who are at risk of harm to themselves and others. This unique book is designed to be used in tandem with Real Life Heroes: A Life Storybook for Children (Haworth), an innovative workbook that helps children develop the self-esteem they need to overcome the worries and fears of their past through a creative arts approach that fosters positive values and a sense of pride.

Rebuilding Attachments with Traumatized Children helps children move from negative or suppressed memories to a more positive perspective, not by denying hardships, but by drawing strength from the supportive people in their lives. Practitioners can use the book as a framework and detailed guide to assessment, engagement, development of service plans, and implementation of attachment and trauma therapy. The book is a comprehensive model for working to build the trust necessary before other trauma therapy approaches can be successfully initiated.

Topics examined in Rebuilding Attachments with Traumatized Children include:

• attachment theory and research
• types of attachment problems
• PTSD behaviors
• permanency work with children in placement
• ADHD, bipolar, and RAD
• cognitive behavioral therapies
• storytelling therapies
• the myth of perfection
• neuropsychological patterns
• and much more!

Rebuilding Attachments with Traumatized Children is a rich resource for practitioners, academics, parents, adoptive parents, foster parents, grandparents, and anyone working to show troubled children how to learn from the past, resolve problems in the present, and build a better future.

PART I:

LIFELINES

Chapter 1

Attachment

There is no such thing as a baby; there is a baby and someone.

D. W. Winnicott

TRAUMA DAMAGE TO NEURODEVELOPMENT

Life and Death: An Example

Tracy’s eyes sparkled and locked onto my own from the moment I met her. I was struck by her chunky cheeks, carefully braided hair, and cute button nose. Tracy smiled up at me as though she had known me for forever.

“This is Tracy,” her county social worker announced. Four-and-a-half-year-old Tracy reached out her hand and gently placed it into mine. Then, without a look behind at her social worker, Tracy began walking with me past doors, up stairs, through halls to my office, her steps confident and secure, her chin tilted upward, and her golden brown eyes gazing upward at me. I thought of Little Orphan Annie.

Tracy lived with her mother for her first eighteen months and then lived for two years with a friend of her mother’s who brought her to child protective services, saying she could no longer care for her. Tracy was placed with a foster family where she had been living for almost a year. I asked Tracy to draw pictures of her foster mother, her biological mother, and her mother’s friend. She smiled up at me and began to draw primitive sketches, even for her age, huge heads for each figure taking up half a page each, an imaginary line separating each of her mothers.

Each figure had immense, bulging oval eyes. On the picture of her mother, Tracy sketched a jagged slash through her mother’s eye, her memory. (I later learned that Tracy’s mother had cut her in the face with a knife.) Her mother’s friend was drawn with similar jagged scars on the sides of her face.

After sketching her three mothers, I asked Tracy to include herself. She drew a smaller oval head than she had drawn for her mothers, but she included the same bulging eyes. Tracy added two short lines for legs, just as she had in the other pictures. Then, Tracy’s face tensed and she pursed her lips. She bore down on her black marker and began scribbling from left to right, zigzag slashes, repeated over and over until she had totally obliterated her drawing.

“Me.” Tracy said simply. She smiled, gazing up again into my eyes.

Tracy was going to be evicted from her foster family. Her foster mother was a manager with a demanding schedule and had bravely offered to care for schoolage children who could not live in their own families. The county case worker had begged her to take Tracy on a temporary, emergency basis. Weeks stretched into months, and Tracy was no closer to having a secure or lasting home. A year went by. Tracy’s foster mother said she could not keep Tracy any longer. She had worked out a way to provide day care but she could no longer manage what caring for Tracy had done to her own life. Tracy screamed every night, a piercing howl that fractured her foster mother’s sleep. She was exhausted.

Tracy showed me how the loss of a parent is similar to the obliteration of a child’s identity and his or her very being. Despite losing three mothers, Tracy had not given up. She held my hand and gazed at me with an appealing smile. She was still looking for someone to love her.

I have seen hundreds of girls and boys such as Tracy–infants, toddlers, young children, adolescents, and young adults who continue to search. Although they have learned that they cannot trust, deep down they keep wishing for someone to love them.

ATTACHMENT THEORY AND RESEARCH

Shaping a Life

Dependence on an parent is a fact of life for all children, and in fact, all primates. Humans, by nature, have the longest period of dependence of any animal and simply do not survive without the twenty-four-hour-a-day care and support of their parents. Attachment to a caring parent means survival. Abandonment to a young child means death.

Bonding begins before conception. The security of a child’s future life begins with the resources a mother and father bring with them. The parents’ relationships, wealth, heritage, and community can support or constrain their union and their ability to support their child. Was this conception sanctioned or unsanctioned? Will the newborn be accepted and cared for, neglected, or rejected by parents, grandparents, extended family, neighbors, educators, and community leaders? What does the fetus represent, not only to the mother and father, but to the extended families now united through the growing embryo who forms the future of both families? Are the parents living in a neighborhood with playgrounds, enriched schools, and after-school activities or an impoverished battleground dominated by rival gangs and drug dealers. The answers form the emotional and social cradle that nourishes or impedes an infant’s growth.

The brain has developed, according to neurological researchers (Schore, 1994, 2003a; Siegel, 1999, 2003), in sequence from more primitive functions such as the brain stem, which manages basic autonomic functions, to the limbic system, with the hippocampus mediating memory and learning, the amygdala processing emotional memories, and the anterior cingulate working rather like a coordinator of bodily responses to higher-level thinking. The prefrontal cortex provides verbal (left hemisphere) and visual, tonal, and emotional reasoning (right hemisphere), and the cortex serves many distinct functions necessary for visual, auditory, and affective processing. Some connections in the brain are classified as life critical and develop with little adaptation in order to manage basic life functioning such as the infant’s heart rate and breathing. Higher-level connections have been found to be shaped by experiences (Siegel, 1999; Schore, 1994; Perry, 2001). Brain growth builds from conception with each stage of growth forming the foundation for higher levels of functioning.

Neurobiologists have discovered how the infant’s brain is altered by chemicals experienced in utero. Prenatally stressed infants may have difficult temperaments resulting from environmental stress, poor nutrition, and toxic chemicals on their developing nervous systems. A pregnant woman stressed from traumas produces increased hormones, such as cortisol. These hormones strengthen her body in the short term but increase the likelihood of blocking development of connections in the fetus’s developing brain or decreasing the number of brain cells. Parts of the brain needed for memory and learning (e.g., the hippocampus) may be impaired. Studies have shown how cortisol decreases memory ability and the ability to sustain attention.

Similarly, norepinephrine, a critical hormone for self-protection, can have an adverse effect on infants and fetuses. Norepinephrine brings a human to the “fight-or-flight” level needed for survival. Too much, however, can lead to panic. If the infant is exposed to high levels of norepinephrine, the level of agitation can become a persistent state in which he or she is always on guard looking for threats and expecting harm. High levels of norepinephrine increase excitable neurons. The infant’s system essentially becomes sensitized and even normal stressors can ignite the preprogrammed stress response generated by the development in utero or early infancy with too much norepinephrine. This has been called kindling, a level of neuronal excitability caused by repeated stress.

After birth, brain development continues to be shaped by environmental factors that stimulate the organization of neural interconnections (Kotulak, 1996; Shore, 1997; Siegel, 1999). Researchers have classified some neural connections as experience-expectant and thus greatly impacted by culture, heritage, nurture, and the experiences of a child. Experiences of the fetus and young child have a major impact on the cultivation and pruning of neural synapses, and key experiences have been found to be necessary within extended time periods, sometimes called windows of opportunity, for optimal development of different brain centers.

Stress on a parent and child accordingly impacts the infant’s developing brain in different ways at different stages of development. The absence of stimulation through profound neglect, such as a baby being left in its crib, or over stimulation from trauma (e.g., abuse or violence) can result in the failure of the infant to complete certain tasks and distort development of neuronal functions. This is one of the reasons why siblings who experience violence, sickness, or loss at different ages respond to the same trauma in different ways. Parents may misunderstand how one child, who was one year old at the time of violence in the family, became hyperactive and was later expelled from kindergarten for aggressive behavior, while an older child, who was eight years old at the time of the violence, was able to continue to succeed at school, even though the child became preoccupied with the care and protection of a parent at home.

Overemphasis on the impact of damage during prenatal experiences can also lead policymakers and funding bodies to give up on children seen as irreparably damaged in utero. In the late 1980s, it was feared that babies born to crack-addicted mothers would be maimed for life. Instead, it has been learned that the family’s environment after birth may have a stronger effect on a child’s temperament than the experience of cocaine in utero. Schore (2001) found that as many synapses develop in the nine months after birth as in the nine months in utero. Accordingly, the level of stress experienced growing up with a mother who was or had been crack-addicted, may have a stronger impact on a child’s brain than the infant’s experience of cocaine in utero. Well after an infant’s diagnosis as having fetal cocaine or fetal alcohol effects, parenting, educational, and therapeutic interventions make a tremendous difference in his or her life.

A child’s early years have now been well publicized as critical. The public, however, has been less informed about how a child’s environment continues to shape brain development well through adolescence (Thompson and Nelson, 2001) and into young adulthood. Brain centers most relevant for cognition and higher-order thinking operations such as problem solving, reasoning, self-regulation, and strategic thinking develop well into adolescence. Moreover, the adult brain also has been found to reorganize based on life experiences (Greenough and Black, 1992; Elbert et al., 1995; Ramachandran, 1995) with growth of new neurons occurring through-out the life span (Eriksson et al., 1998; Gould, 1999). Although brain growth is especially vulnerable during the prenatal period and a child’s early years, the lifelong process of brain development presents opportunities for remediation.

Windows for Growth

Watching a new parent cradle an infant is a beautiful sight. The infant signals its needs through a whimper or cry. The parent responds with a smile, a caress, a nipple, or a bottle, removing pain and satisfying the needs of the infant. Eye to eye, coo matching coo, the infant feels united with a parent, building a linkage over time and the foundation for trust (Erikson, 1986). Attachment is an interactive process (Schore, 2003a; Siegel, 2003), brain to brain, limbic system to limbic system, a synchronicity of parent and child. Attachment in the child’s first three years centers on communication between the right brains of both parent and child, especially visual, face-to-face images of one another, touch, and tone of voice. These experiences form indelible memories in a child’s limbic system, long before a child develops the capacity to utilize language, including expectations of whether parents will respond to distress, whether the child will be soothed, and whether parents can modulate their own emotions at times of stress.

In the first stages of development, the infant’s needs must come first, but the infant-parent dyad is controlled by the nurturing parent, typically the mother. This is the stage of development where the brain stem and thalamus are being shaped. The infant absorbs the care from the parent and essentially absorbs the self-regulatory system of the parent. When the infant is cared for fully, the infant grows up feeling wanted. When the infant experiences a lack of response, his or her regulatory system fails and the infant may die.

Infants learn whether they can trust that their needs will be met. They are shaped by the sensitivity and responsiveness of their parents. Those who experience a high level of stress at this point of development will often develop a state of hyperarousal. Infants who experience intermittent care learn that the world is unpredictable and become unpredictable in their own lives. Those who experience angry parents become frightened and easily triggered to rage. Infants who experience parents who are depressed and nonresponsive often tend to withdraw, and show a decrease in positive emotions.

From four to six months, the cerebellum and thalamus develop at a high rate. At this point, the infant needs to send clear signals to affect the necessary relationship with the parent. He or she mirrors the gaze and interactions of the parent, and the parent mimics and mirrors the child. Ideally, the infant experiences an attunement between the parent and his or her own behavior.

This is a wonderful stage in which the infant begins to show delight and positive excitement. On the other hand, the infant who has not received the care and stimulation needed will begin to avoid contact with his or her parent and show subdued or inhibited behavior. The infant who experiences inconsistent care will often act chaotic in his or her own behaviors. The infant who experiences a parent who periodically becomes abusive will often avert his or her gaze from the parent and demonstrate the fear learned from his or her parent’s rages.

From six to twelve months, the prefrontal cortex develops at a rapid pace. This is the bridge between the survival functions of the limbic system and the higher-level cognitive functioning of the cortex. The development of regulatory functions is shaped by a child’s experiences during these critical months. The process of attachment between infant and parent is especially critical from eight to eighteen months. The child learns whether the parent can be relied upon.

The child learns from the parent how to manage problems and stressors. With each month of development, the child increasingly takes a stronger role in signaling what he or she needs. The parent’s response to these signals demonstrates whether the child can count on the world around him or her or must try to take control on his or her own of a world that seems out of control. In reality, no parent provides perfect attunement to a child, just as no parent or child lives in a stress-free world. The infant who experiences a sensitive, predictable, and reliable parent learns that his or her parent will regulate intense emotions.

Social and Emotional Development

Mahler, Pine, and Bergman (1975) and Greenspan and Lieberman (1988) described the developmental process of attachment and its impact on a child’s cognitive, social, and emotional development. Schore (1994) denoted the critical impact of a mother and child’s relationship on the physical development of the brain building the child’s framework for future inter- and intrapersonal development. Schore stressed how attunement between a parent and child facilitated growth of the limbic system during the first year. Caregivers provide experiences that regulate hormones in the child and in turn shape gene transcription (Schore, 1997). Interactional experiences modulate genetic development and shape brain circuitry.

From twelve to twenty-four months, the child exercises a great deal of independent action. The parent’s attunement provides the foundations for discipline, social skills, and the development of self-control. Researchers have also described the role of separation and shame in shaping a child’s ability to integrate a sense of self that incorporates both good and bad behavior. When a child experiences a parent breaking attunement after misbehavior, he or she becomes anxious. Reprimands and withdrawal of attention induce discomfort in the child, that, in turn, shapes his or her behavior. This is critical in terms of developing inhibitory circuits.

Discipline within a caring, nurturing relationship helps the infant learn self-regulation and self-control. The parent scolds or withdraws affection, and then reattunes. Reattunement affirms the child’s security with his or her parent. The child calms and over time learns how to regulate his or her own responses in order to keep the parent’s attunement. The parent’s reattunement helps a child develop a sense of autonomy within the security of a continuing bond. The child learns right from wrong and how to succeed. As the child develops, this learning progresses into verbal communication and use of words to understand and regulate his or her own behavior. Without reattunement, the child learns to live in an unstable, insecure, and often dangerous world in which his or her relationship to the parent is always at risk.

Contrary to popular assumptions, babies who are picked up often when they are ...

Table of contents

• Cover
• Half Title
• Title Page
• Copyright Page
• Dedication
• ABOUT THE AUTHOR
• Table of Contents
• Preface
• Acknowledgments
• PART I: LIFELINES
• PART II: REBUILDING ATTACHMENTS
• PART III: THE MAKING OF A HERO
• Appendix A. Important People
• Appendix B. Attachment Ecogram
• Appendix C. Outline of Assessments and Interventions
• Appendix D. Real Life Heroes: A Progressive, Developmental Curriculum
• Appendix E. Chapter by Chapter, Stronger and Stronger
• Appendix F. Utilizing Impasse
• Appendix G. Game Therapy Illustration
• Notes
• References
• Index