therapist

"Anyone who does anything to help a child is a hero to me."

                              - Fred Rogers (TV's Mr. Rodgers)

Attachment and Trauma
Understanding Emotional Age
Traumatized Children's Reality
Power Struggles
Survival Brain
Positive Reminders
The Parents Presence
Living with Trauma
Rebuilding Brains
Needs versus Wants
Neurosequential Model
Survival Brain II
Attachment Disorder and anxiety
Dr. Sears and Parenting
Attachment and Trauma

I recently took my 91 year old father who suffers from dementia to a restaurant.

I gently guided him with his walker to a table and left him there as I went to order the food in a long cafeteria style line. I made sure that he could see me in line and every few minutes I turned and waved at him through the crowd of people. When I was out of sight he drummed the table with his fingers, looked questioningly at his walker, and seemed nervous and lost. As soon as he saw me wave he was relieved but this only lasted a couple of minutes.

Since the line was long I occasionally went over to the table to tell him what I was ordering and that I would be back shortly. This eased his anxiety and enabled him to wait instead of searching for me. I was patient with him because I knew he had a disability that limited him. I’m sure observers in the restaurant thought that I was the one acting odd. When I finally joined him he was fine.

This reminded me so much of our foster or adoptive children with behavior problems due to a lack of object permanence or constancy. They misbehave as soon as parents are out of sight because, like my father, they cannot hold the emotional presence of the parent. They missed learning this due to a lack of consistent loving care early in development. Their resulting behaviors are often exasperating and we are tempted to say things to them like “can’t I leave you alone for a minute”. The answer to that question is “no”. They are like emotional toddlers that need a parent’s presence continually. If you have a child that misbehaves as soon as you are out of sight try treating them like I did my father. If that works you know that you have some further permanence work to do. The good news is that with guidance children that suffered early abuse and neglect can develop permanence and their behaviors will improve.

Understanding Emotional Age

Understanding your child’s emotional age due to the abuse and neglect that foster children have experienced their emotional age is much younger than their chronological age. A boy may be 10 years old and still act emotionally like a 4 year old. A 4 year old plays with blocks, breaks things, and can’t be left alone for a minute without getting into trouble. He will not stand patiently in a crowded store while his mother shops. Leave the emotionally young child at home with a caregiver, then you will not become frustrated and angry with your child and you can enjoy a moment with him when you return.

Traumatized Children's Reality

One of the things that I have learned from my dad is to enter his reality. He is in the last stages of Alzheimer’s and if he needs to have a key in his wallet for his car and check on it every few minutes that is okay. This makes him feel that his car is okay even though he can’t drive and his keys don’t fit the car. When he is fussing about going home, instead of confronting him about not being able to fly to Indiana I say “you really need to get home, let me help you get an airline ticket to fly.” Of course he has to wait to fly and his ticket is fake but this helps him to wait a little longer.

How about adopted and foster kids that are recovering from trauma? What would it be like if we entered their reality instead of trying to get them to accept ours? Their reality may be that it is really scary to do just what someone else wants. We can enter their reality by saying “this is really difficult for you, how can I help?” Maybe they just need someone to join them in the task so that they feel less anxious. Once they calm they can do it on their own.

Maybe their reality is that you can’t trust adults. (After four foster homes and three “forever homes” would you believe anything?) We might need to accept their inability to trust even though our reality is that we are different from all of the others who have left them.

Bottom line; start at the child’s reality and slowly help them enter yours.

Power Struggles

“Why do I need to take these pills? I don’t need them!!” Rather than fight my father who does not understand why he needs pills and is very angry I say, “Let’s take a break”. I know that I can always change his mood with a cookie. We sit down with a cookie or brownie and talk a bit. After a few minutes he is in a calmer place and I slip him his pill. What a difference a little break makes.
You may not want to use sugar with your children like I do with my father who is suffering from Alzheimer’s but the idea of taking a break is sound. Why try to reason with a child that is not operating out of the reasoning part of the brain? We know that kids recovering from trauma go to the survival part of the brain for fight or flight when they get stressed. Once they calm you may be able to talk with them and get them to comply. At least the processing part of the brain is available.

Survival Brain

My mother was out with my father who has Alzheimer’s. He tried to get out of the car because he was angry. She stopped at a gas station for help and while she was in the station he got out of the car. A kind lady picked him up because he was stumbling in the parking lot. She took him to the grocery store because that’s where he said he was going. When mom came back to the car he had disappeared.

After calls to 911 and a visit by the fire department and the police my father and mother were reunited.

When I got out of a meeting at work I discovered five frantic calls on my cell phone from my mom saying she lost my dad. I raced home to help and thought I was quite calm considering the events of the day until I found my coffee cup in the refrigerator. When we are traumatized we go to the survival part of our brain and don’t think clearly.

This made me think how futile it is to try to talk with a child in survival brain. Children that have experienced trauma quickly go to a state of alarm and terror when they are stressed. Best to wait until they are calm before you talk with them because, like me, they could look normal but not really have access to the more complex parts of the brain to think things through. I am thankful that I do not have to operate in survival brain many times everyday like children recovering from trauma.

Positive Reminders

“Hi Dad it’s Deb”. Every time that I see Dad I introduce myself even though he is living with me. He has Alzheimer’s and he often does not recognize me. This means that I introduce myself to him at least 20 times a day.
I wonder how it would be with the children that have severe behavior problems to speak kindly to them at least 20 times a day. “Hi Jimmy it’s Mom and I love you”. I know from being a parent of “normal kids” that I had a tendency to talk to them more when they were doing something wrong. How about switching the odds and having 20 positive reminders with only several “don’t do that” comments.
Maybe the child would start to recognize mom and dad as positive influences in their life rather that always on their case. Food for thought. Give it a try.

The Parents Presence

Why is my father sitting in the hall outside of the bathroom having his coffee? My mom is in the bathroom and she is his connection to reality. He has alzheimer’s and the world does not make any sense without her.

How many mothers have said “I can’t even go to the bathroom without my kids bugging me?” I wonder how it feels to be lost in the world without the presence of another person. How does it feel when that one connection keeps telling you to leave them alone? This is the plight of attachment disordered children. They depend on a parent for the world to seem whole but they drive that parent crazy along the way. They usually show there need for the parent by constant nonsense chatter or other obnoxious behaviors. Let’s keep in mind that what they really need is the presence of the parent and we can give them that presence in a respectful and honoring way. “Come here and sit next to me while I work on this project, you can help”

Thanks dad, enjoy your coffee in the hallway.

Living with Trauma

My father passed away a few weeks ago. He taught me many things throughout my life but I would like to focus on the last few months because it relates to treating traumatized and troubled children. Though I tried to understand the experience of parents that love and live with these children I think living with my dad has enlightened me.

My father had Alzheimer’s and came to live with me for several months. I soon found that I did not have a moment to myself unless I hid in the bedroom and my husband stayed in the living room with my father. Dad was continually confused and often angry. He fixated on things like his car or his keys and would argue about if for hours. When he got upset he threatened to run away. This made us all sleep less soundly and my husband sleep on the couch guarding the door. We gave him lots of love though we only saw rare moments of reciprocal response. A couple of times we had to call the police to find him and bring him back home. It was emotionally and physically exhausting. I am in awe of foster and adoptive parents that do this for years. No wonder when they first see me they say “I can’t do this anymore”. Now I understand just a bit more.

Thanks Dad for giving me a window into the experience of families caring for troubled children. Even in illness you continued to teach me and I miss you terribly.

Rebuilding Brains

I really like Dr Sears’s web site. He is a pediatrician that has written many books from an attachment perspective. He talks about how attachment parenting builds better brains.

“The developing brain of an infant resembles miles of tangled electrical wire called neurons. At the end of each neuron tiny filaments branch out to make connections with other neurons, forming pathways. This is one of the ways the brain develops patterns of association.: habits, and ways of acting and thinking, in other words, organization. Attachment parenting creates a behavioral equilibrium in a child that not only organizes a child’s physiology but her psychological development as well. In a nutshell, attachment parenting helps the developing brain make the right connections.” Dr. Sears

I see many children in my practice that have pathways that are confused. I help parents build new pathways by consistent responses the create attachment while teaching acceptance of limits. This is difficult to do once a child gets older. It would be so much better if everyone would have this information when their children were infants and toddlers.

Blessings to all of you that are in the trenches rebuilding the brains of older children that suffered abuse at the hands of another.

Needs versus Wants

I just started taking a great parenting class presented by DeAnna Wahlheim. It focuses on attachment parenting and she gave a great example of understanding needs versus wants when dealing with our children. When she picked her children up from school they would continually fight and fuss. This would frustrate her and she would get angry with them. As she pondered needs she began to realize that the children were tired and hungry at that time of day. When she started having snack bags in the car for them at pickup the fighting diminished. It is not necessary to discipline for everything, often things can be resolved if we look at things through the eyes of the child. Then when we do correct them it will make a greater impact. Follow the link for more information about DeAnna’s class. It is available by webinar or by video recording.

Neurosequential Model

At the Family Christian Counseling Center of Phoenix we look at children’s development through the lens of Bruce Perry’s Neurosequential Model of Therapeutics (NMT) to see what areas of development were missed. This gives us specific interventions to target for emotional repair.

Bruce Perry’s website (www.childtrauma.org) explains the NMT in the following way: “The Neurosequential Model of Therapeutics (NMT) is a developmentally-informed, biologically-respectful approach to working with at-risk children. The NMT is not a specific therapeutic technique or intervention; it is a way to organize the child’s history and current functioning to optimally inform the therapeutic process. The NMT integrates several core principles of neurodevelopment and traumatology into a comprehensive approach to the child, family and their broader community. The NMT process helps match the nature and timing of specific therapeutic techniques to the developmental stage of the child, and to the brain region and neural networks that are likely mediating the neuropsychiatric problems.”

The goal of Family Christian Counseling Center is to remain current in research based interventions that concern children and to apply these approaches for the benefit of our children.

Survival Brain II

From what part of the brain is your traumatized child responding?
Does he or she:

Act out of panic?
Behave in a way that does not make sense?
Become wildly combative when approached?
Hit, kick, or bite?
If this fits your child he or she may be operating out of the brainstem and be in survival mode.
This determines how best to respond. Talking to a child in survival mode is like talking to a brick wall.

Learn more from Bruce Perry and Richard L. Gaskill at their website.

Attachment Disorder and anxiety

I really like this article on anxiety in children and find progressive desensitization useful. Sadly many attachment disordered children need progressive desensitization to their adoptive parents. Their early experiences with caregivers may have filled then with fear. The following article is from the Yale Parenting Center.

Who gets fears and anxiety in childhood? A large majority of children, in fact. Anxiety is a normal part of child development. Here are some common methods used by parents that aren’t as effective, and better tips for how you can successfully handle your child when he or she is anxious.

Talk and explain: Ineffective – A typical parent response to child fears is to reason: “There are no monsters under your bed. There is nothing to be afraid of.” It is fine to talk and explain, but this reflects a misunderstanding of fear and anxiety. Different circuits of the brain are involved in fear than those related to planning and abstract thinking. We are all baffled as to why people fear many things that are unlikely to happen (i.e. being struck by lightning) or could not really happen. It’s always good to talk, but this is not an effective strategy for making much of a difference in your child’s level of anxiety.
One-Shot Comforting: Effective Many fears and sources of anxiety come from infrequent events. Your child may not have a problem that is very pervasive (i.e. related to something at school), but rare events may occur that the child must encounter and that evoke considerable anxiety. For example, taking your child to the doctor or dentist can evoke fear. Comfort your child in a special way to help in these situations. Go through the experience with your child with great sensitivity and care. Watch your child to see how bothered he or she is and ask for feedback on their feelings, but also use your own judgment. Use your comforting skills to help your child cope. Coping here is not more reasoning (although a little is fine), but soothing touches: rubbing his or her arm or the back of their head. If anxiety continues to escalate, take a break if possible. At the doctor’s office, ask the nurse if you can take a break, walk to the water fountain and come back. In this situation, you have just modeled a measured response: coping, staying in the situation and taking breaks as needed. All of this brought anxiety and fear down a notch. This is the short term benefit. The long term benefit is developing a coping skills approach that your child can use when you are not around.
Tough Love: Ineffective This is the strategy where you tell or force your child to face the fear now, once and for all, and in all its intensity. Think tossing Juan into the water to overcome fear and teach swimming all at once. This strategy is often laced with nostalgia (“My father used tough love on me, and look how I turned out”), but it is not effective. While it is not clear that this will damage the child in the long-term (that depends on the details of what and how), this is still not a strategy for alleviating anxiety.
Graduated Exposure: Effective This is a formally recognized psychotherapy technique that has been the product of years of research for anxiety treatment. The procedure can be carried out in everyday life too, but often has to be done in a special way that many parents cannot do. The two key concepts are exposure, presenting the feared object directly, live and in the presence of the child, and graduated, where one must proceed in a special way: slowly so that the child is exposed to small doses. The idea is to not evoke anxiety and stop when anxiety arises. For graduated exposure, one needs a graded sample of situations that vary in full exposure. To solve a child’s problem of anxiety in social situations, throwing a slumber party at your home would not be the answer. That is NOT graduated exposure, but full exposure and is likely to make the child much more anxious and not help eliminate the problem. Graduated exposure is the most well-studied in research, and a very effective intervention, usually done by a professional.

Dr. Sears and Parenting

I am sure by now that you are aware of the magazine cover with the toddler attached to his mother’s breast and the title Attachment Parenting. I thought that you would like to see Dr Sears’s response on the Today Show. He does a good job of explaining a wide continuum of attachment parenting styles. Click here for the link. We now know that children develop most securely when we respond to their needs. I believe that letting a baby cry it out teaches him/ her that he can’t trust his parent; sometimes they respond and other times they don’t. Insecurity and anxiety are the results of such an approach. Unfortunately I have seen some of these “cry it out” children in therapy years later.

"Children are the living messages we send to a time we will not see"

                                                                                           John F. Kennedy