Blog

trauma

Plan for a Sensory Summer

Despite the fact that it’s only 45 degrees and raining today, I have faith that summer weather will come. I know that summer vacation will, and it’s sooner than we think.

For me, the end of a school year brings joy, excitement, and nostalgia for the innocence of my own childhood days. I remember camping trips that lasted forever (in my childish memory), campfires, bike riding from sunup to sundown, picking berries and mowing the lawn. And yes, I enjoyed mowing the lawn…still do actually. Magically I never got tired, thirsty or hungry.

As a parent, I still have those same feelings but some doubt and anxiety sneak in too. With the loss of the school routine it means: long, seemingly endless days with my children and NO break. This has the potential to stress any parent; for the parent of a child from the hard places, it can make you curl into a ball and hide with your head under the blanket.

Here are some tips for managing the transition to summer vacation and for a summer filled with the awe and wonder all children should have.

1. Start now, today. Mark the calendar for the end of school and discuss what this means. Ask your children how they are feeling about summer vacation. Talk about changes to routine. If they’re going to a sitter or day camp every day, begin the planning process. What will their day look like there? What resources will they have to help them regulate? Talk to other caregivers and make sure they’re ready to provide nutrition and hydration every two hours…more on hot days, that they can meet sensory needs, especially proprioception, have calm down activities/fidgets available. Do they know your child’s biggest triggers?

2. Plan the activities in advance. I’m a big picture sort of girl. I am not much of a detail planner. I prefer to make it happen on the fly. But as caregiver to child(ren) from hard places, it means I MUST be mindful of my time, environment, energy, and yes, I have to plan, in advance. This doesn’t mean every minute of each day has to be planned out. But, think ahead…how will I meet their sensory needs each day? Summer provides some wonderful sensory experiences unavailable at other times of the year, especially in the northeast.

Are there some special activities you want to do together? Put them on the calendar so that trip to the zoo and the day trip to your favorite beach aren’t pushed off until it’s too late. Have a rain date backup.

3. Visual schedule. I am a HUGE fan of visual schedules. When we started using them with our four year old, the perserevating suddenly stopped…that day! The constant kicking and screaming and undercurrent of anxiety, were simply gone. Now, four years later, we only need the schedule on certain days AND she is beginning to verbalize when she needs it. Schedules don’t have to include every minute or even each activity of the day. Who can really plan that much detail? It might look like this, in picture… Breakfast, indoor play, clean up, snack, walk the dog, read a book, lunch, outside play, nap (if your child doesn’t nap anymore, schedule rest breaks and establish the boundaries for rest time…where, when, how long, what is allowed during rest time such as books, quiet toys, etc.) snack, special activity, dinner, family yoga, bath, bed. Allow some flexibility, give some control, make compromises, and always have a wild card ready.

4. Go with the flow… planning is great, but flexibility is a must. Perhaps you planned a day of wildflower picking to meet sensory needs and the ground is soaked from last night’s thunderstorms…plan B. Maybe your child will discover a new interest, such as fireflies or the sandbox becomes Thunderball Beach. Just because our children have experienced trauma doesn’t mean they don’t have preferences and imaginations. Let them experience the joy of discovery. Return to “the plan” with adjustments as needed.

5. Model how to enjoy summer. Instead of complaining that there’s no school or it’s 95° out, express gratitude for the time together, and really mean it. Show them how to make juice pops and make silly voices into the fan. Mention your body is hot and sweaty and you don’t like it. It makes your engine run yellow or red…then show them how you will regulate with a glass of iced tea and a good book or a game of cards.

6. Remember that connection comes first and summer is a wonderful time to make lasting memories that build trust and healthy attachment forever.

trauma

The Impact of Childhood Trauma on the Brain’s Development

Following World War I, many soldiers returned home with injuries that could not be seen. Amnesia, paralysis, inability to communicate, tics and sleeplessness were called war neuroses or hysteria. For too many soldiers, who went to war labelled as heroes, their return left them labelled as weak. World War II brought the term shell-shock. Unfortunately, empathy and compassion was still rare for these brave and traumatized men. Fortunately, the work of clinicians like Abram Kardiner, author of “The Tragic Neuroses of War” began to consider these symptoms as psychological injury rather than flaws of the men’s character.

Then came Vietnam. In summer of 1967 a small march took place in New York. Veterans began to advocate for themselves to redefine “post Vietnam syndrome” not as a weakness but as a normal response to the experiences of atrocity. This campaign helped to put what is known as PTSD into the Diagnostic and Statistical Manual of Mental Disorders III (DSM). This manual, though now at its 5th revision, is the defining resource for psychiatrists and mental health clinicians. Today, we use the terms combat trauma or PTSD and they are commonly accepted (though more advocacy and education is needed.)

The injuries are organically real. The term psychology is defined as the scientific study of the human mind and it’s functions, particularly as it relates to behavior. So what is happening in the brain? What are the psychological injuries that occur? It was found that veterans with PTSD had deterioration in important brain structures including the hippocampus, which is an important component in the “limbic system” in humans and is responsible for memory, learning and emotions. One of the known contributing factors to the deterioration is cortisol. Cortisol is a stress hormone emitted in low levels among healthy individuals. However, during intense stress, cortisol and adrenaline flood the human brain and body, giving enhanced capacity for the survival tactics of fight, flight, or freeze. While this is necessary for survival and it aids in every day life

(the sudden rush of adrenaline when you see a deer and you slam the brakes before it even registers in your conscious thought that it was a deer,)

for individuals who experience ongoing stress, it actually becomes a threat to survival. This is because elevated levels of cortisol is linked to deterioration in sensitive regions of the brain, such as the limbic system. These neurological changes have the ability to significantly affect behavior across many domains.

So, what happens when it is an infant, child, or adolescent that is experiencing the high levels of cortisol? Quite a lot actually. Unlike an adult brain that experiences deterioration, the child’s brain fails to develop to begin with. Without a fully developed brain that is functioning efficiently, multiple systems are impacted.

Image result for comparison of trauma child brain

  • High levels of these hormones keep your blood pressure elevated, which weakens the heart and circulatory system; keep your glucose levels elevated, which can lead to type 2 diabetes; and disrupt your immune system and inflammatory response system, which can lead to lupus, multiple sclerosis, osteoporosis, and depression, and reduce your ability to fight infection.
  • Hormone level changes early in life when brain development is most rapid can have a drastic impact on brain architecture and function, as well as other organs, thus lifelong physical and mental health problems
  • The thymus gland which is located behind your sternum and between your lungs, is only active until puberty. After puberty, the thymus starts to slowly shrink and become replaced by fat. Thymosin is the hormone of the thymus, and it stimulates the development of disease-fighting T cells. While this gland is not operating for the entire lifespan, during its active period, it has a big job with a lot of responsibility. It is instrumental in preparing the body to fight against viruses, bacterial infections and even autoimmunity (when the body fights itself.) Trauma prior to puberty, when the thymus gland is actively producing defensive cells for the body’s lifetime, is linked to a twisting or rotation of the thymus gland. While the gland has remarkable capacity to regenerate itself if injured, it does not compensate for lost time during its injury. Whatever period of time that it is “offline”, the T-cells that would have been produced during that time, are never created. This sets in motion a chain reaction…atrophy of the spleen and lymph nodes, telomere (the tip of a chromosome, much like the plastic piece at the end of a shoelace, that keeps it from unravelling into individual threads) shortening, and increased stress hormones, which impairs immunity and increases inflammation —>Impaired immunity and inflammation—> increase risk for cancer, cardiovascular disease, diabetes, anxiety, depression, viral infections, autoimmune diseases, allergies, and asthma.
  • The first to be noticed, and often the one that caregivers find the most challenging are the neurons.
  • We are born with around 100 billion neurons (the messengers of the brain) but the synapses (the roadways for the messengers to travel on) are not developed. It is these connections that develop vision, hearing, language, and higher cognitive functioning. It follows that a developing brain under stress is unable to develop the pathways for information to travel on, consequently limiting cognitive ability and less capable of coping with adversity as they grow up.

Genes are a basic component of biology. They are decided in the womb. But, they’re not set for life. Epigenetics (the study of how environment and experiences alters genes) has shown that a person may be born with the genetic capacity to grow tall, thin, and a confident extrovert. But being undernourished and abused as a child will likely lead to that child becoming a short, obese, and fearful adult. Studies are also showing that early life trauma brings genetic alterations leading to mental health, obesity, drug addiction, immune function, metabolic disease, and heart disease.

What does all of this look like in a child? Impaired sleep cycles, sudden irrational outbursts, aggression, lack of focus, clumsiness, anxiety, difficulty separating from caregivers, constant motion, lack of control over body movements and pressure, hypersensitivity to sensory input, emotional chaos, reduced cognitive ability, impaired speech and language processes, fine and gross motor challenges.

Now let’s talk about what to do? Beyond the obvious of prevent or at least reduce the opportunity for having any of the risk factors, is there hope? YES! There is HOPE!

The human brain has the amazing ability to reorganize itself by forming new connections between brain cells, throughout the entire lifespan. This is called brain plasticity. How do we harness that ability? TBRI is one of the proven methods to care for a child who faced all of those threats to their development and health because of an (or several) event beyond their control, that will place that child back on the trajectory of typical development. Through dedicated, thoughtful, planned caregiving that is balanced in nurture and structure, and targeted to each of the domains impacted by the adversity. TBRI teaches specifically and concretely, how to be the caregiver that child needs to become a healthy adult and stop the cycle of adversity.

trauma

Where Do I Start?

“We should have called a long time ago.” “We are in crisis, that’s why I called.” “It’s so crazy you wouldn’t believe it.” “I don’t know what to do.”

Within the first five minutes of the initial phone call from a caregiver, I inevitably hear one (or more) of these phrases, almost every single time. And that’s ok.

(Grammar police, I know that’s not a complete sentence.)

After a few more minutes, I usually hear “what do I do?” or “where do I even start?”

(Ok, grammar police, someone tell me the correct punctuation when a sentence is a statement but contains a question… I’ve never figured that out.)

I will help the family to identify what they need right now and assist them to move out of crisis mode, also known as survival mode (when the amygdala or “little brain” is in control) so that the caregiver can engage their own prefrontal cortex

(the “big brain” that makes able logical, coherent thought processes happen.) Using my vast social work skills

(really just good, thoughtful listening.)

While this is different for each family, there is one commonality that just about every caregiver needs. It’s called the re-do.

Was that confusing? May I have a re-do? While I help each family identify their own unique needs, almost every one needs to start here, by offering “try agains” or “re-do”s.

Was that better? Thanks for the re-do!

Now I know a better way to communicate that information. I already feel more confident for the next post that I write.

That’s the power of a re-do. The first step to changing our view of unwanted behaviors as “willful disobedience” into a view of “communicating unmet needs”, caregivers need to stop the old way of dealing with those unwanted behaviors. Grounding, spanking, time outs, yelling, taking away treasured items, generally all of these actions are based in fear. The caregiver hopes the punishment or consequence is severe enough that the child will fear the consequence and not behave that way again. But if you have read anything else on this website, or done any research at all, you know that a child from a hard place has a brain that is wired differently than that of a child that didn’t come from a hard place. What children from hard places need are opportunities to learn. The mechanisms that children learn from,

(observing the environment, nurturing touch and verbal communication from a loving caregiver, opportunity to explore the world around them safely, given adequate nutrition and hydration that made them feel better)

were absent somewhere in their life or they wouldn’t be facing any of the six risk factors. Consequently, they need those learning experiences. Re-dos provide the opportunity for a child to be taught the correct way, practice it, and then move on feeling connected to, and cherished by, that caregiver.

What does a re-do look like? Imagine the five year old just walked over and yanked the toy away from their sibling. Caregiver immediately comes to the five year old

(I mean physically moves to the child, not calling the child to them)

and playfully but firmly says “Hold up there Sweetheart.”

(insert lopsided smile)

“Do you want to try that again with respect?” Caregiver then places toy back in front of sibling and demonstrates how to politely ask sibling for a turn with the toy. Five year old tries

(maybe needs a little coaching)

and is praised for the new way of doing it. High five and good job, caregiver exits scene.

Re-dos work with teens too. Imagine the 13 year old that just rolled their eyes and huffed with a foot stomp when told they could not play computer now. Before the yelling “I hate you” can even come out of the 13 year old’s mouth, caregiver gives eye contact to child and gently but firmly says, “Whoa there! Let’s try this again with respect.” Caregiver then says, “Mom/Dad/Joan can I play computer now?…

(insert change of place)  Not right now…

(back to child stance)  “When can I play computer?”

(switch to caregiver) “As soon as you have finished putting your clothes away you can have 15 minutes.”

Caregiver gives direct eye contact to teen, with a smile and says, “Now it’s your turn.”

Teen asks again—> caregiver says no—> teen this time instead of stomping, eye rolling, –> calmly asks when can I play–>… you get the point. High five, well done, I knew you could do it, now get the clothes put away so you can play!

A redo minimizes power struggles while increasing learning capacity, increasing confidence, improving self-regulation skills, maintains connection and trust, and reduces fear response. Because it is action-based, TBRI research has shown that 70-80% of problem behaviors can be solved at this level of playful engagement. That’s a BIG number.

Here are some tips for a successful and effective re-do.

  1. Be consistent – Work on a couple behaviors at a time and request a re-do every time. As a child becomes proficient on a behavior start working on new behaviors. There may be resistance in the beginning but once they get the hang of it a re-do should become a quick and easy fix, like pressing pause in the middle of a conversation to quickly correct a behavior.
  2. Connection before Correction – TBRI® explains that caregivers cannot influence their children to correct behavior until they have a connection with them. The better connection you have with your child the better they will respond to correction. The best and most effective way to build connection? Play together! Every day!
  3. Respond immediately – To request a re-do, it is recommended to respond within 3-5 seconds of the behavior, if possible.
  4. Stay calm– Use a calm and friendly tone of voice and body posture. Try to keep the interaction playful. Get down to your child’s level and keep eye contact. If faced with resistance parents can respond in a firmer voice without being scary. If a child becomes dys-regulated, an adult will need to help them to calm down before the child can attempt a re-do.
  5. Don’t lecture – Children learn best when parents speak to them at their level. Keep re-do’s short and sweet, (preferably 5 words or less, children from hard places have processing challenges) and use life value terms as reminders.
  6. Work Together – Caregivers should encourage their child that they are in it together, like a team. Caregivers should be helpful and supportive.
  7. Practice – Keep at it until they get it right. Model appropriate behavior if needed. Also incorporate re-do’s into role plays and pretend play to practice intermittently.
  8. Be patient –Learning a new behavior takes time. Be careful not to Relapse into old ways of responding because of your own needs (tired, frustrated, embarrassed.)
  9. Praise – Give your child praise for a job well done! High-fives work great too!
  10. Exit Scene – Afterwards press play, continue with daily activities like normal
trauma

Legacy of Hope

This is a poem written by Brandon Reyes. You can watch a video of Brandon reciting this spoken word poem here: https://vimeo.com/201565403

Legacy of Hope

by: Brandon Reyes

Distant, unfocused, struggles making friends
Or keeping simple rules
Tends to act out in violence
Keeps falling behind in his school

There was a time when these labels
Would’ve meant the end of a kid
And rather than ask why he did what he did
As you might with a friend with whom you had bonded
We only noticed he’d flipped his lid
Put our foot down, drew a line, and responded

But it turns out that when your thoughts
Are centered on survival
You don’t care much for math
Or the pilgrim’s arrival

When your belly is empty
Because you couldn’t find food
And instead of hugged
You were belittled or bruised

When your safety is threatened
Whether real or merely perceived
The only reasonable reaction really
Is to fight flight or freeze

So be careful to judge based on surface commotion
We all are more complicated than our outer emotions
See a sad child can come across hateful and angry
And a scared kid can look downright wild or crazy

But if only we can see past bad behavior
To the unmet needs that are hiding beneath
We can take that fear captive
Love can get traction
Healing can happen
And a kid can be freed

Now for those that might be skeptic
Or for those who have never heard this
And are maybe feeling a little nervous
Let me tell you what we’ve learned
From the work of Dr. Karyn Purvis

See when a brain develops
It needs safety and nurture
As a precursor to develop further

When instead of loved
One’s abused or neglected
Brain development slows
And everything is affected:

Emotions and the ability to regulate one’s self
Relationships, behaviors, reason, focus, and health

And when all of one’s efforts are spent staying alive
The brain of a nine year old
Can look closer to five

Then when that same kid’s expected to act his age
Of course he’s going to disengage

But every brain’s plastic
And what this means
Is that each can still change
Whether toddler or teen

This gives us great hope
That with informed interventions
A person can heal
As their brain makes new connections

This doesn’t just happen though
We must be intentional
With some dos and do nots
That may at first seem unconventional

Now before we dive in
We must address expectations
As trust must be established
And this demands patience

For compliance that’s won
From compulsion or shame
Is to win the match but to lose the game

If we want to attain a constructive affect
We must learn to “connect” before we “correct”

This leads me right in
To something every kid needs
It’s the “do-over” and with it
A poor choice is redeemed

Then in place of punishment
Or tongue lashing
That leads to self-loathing
It becomes an opportunity
For learning and growing

Then if they take advantage
The second time around
And behave in ways that are healthy
Hugs and praises abound

In this way the relationship
Is strengthened and cultivated
Good conduct is enforced
And no one’s left feeling hated

In addition we all yearn
To be given a voice
A safe way to encourage this
Is to offer a choice

This book or that one?
Red shirt or blue?
It means mountains to kids
But costs little of you

Then you don’t come across
As leading with oppression
And having gained some control
There’s less need for aggression

Moving on, another strategy
For preventing hostility
Empowers and brings unity
But requires great humility

Get down at their level
Smile and wait for their eyes
Then set aside pride
And invite compromise

Now when you’ve tried your best
But it just wasn’t enough
And now emotions are high
And behaviors are rough

Don’t banish them off
To sulk in isolation
Stay with them
Be patient
Spare them the desolation

Let your words be few
Then once they’ve calmed down
Remind them how much they’re cherished
And wanted around

How nothing they could ever do
Could chage their high inherent worth
It’s no more on their best day
No less on their worst

Just try this and see
As they learn that you care
That with love and security
There’s no more need to despair

Now if you’re worried this is too
Touchy-feely or weird
Let me assure you
You have nothing to fear

This wasn’t dreamed up
In a vacuum or bubble
But through research and practice
With real kids in real trouble

And with patience and grace
And faith that God is redeeming
There’s not a single kid out there
Beyond hope
Help
And healing