Category: trauma

Parenting often provides daily challenging experiences. For example, everyone is buckled in the car ready to go and one child announces they need to go back inside to go potty. After getting 3 minutes down the road another child points out that he doesn’t have any shoes on. At this point you are running late and feeling your anxiety level increase. Although in the big picture these events are minor, they still cause irritation.

As a parent, you will need to react appropriately, but your body is reacting to the stress by:

releasing adrenaline
increasing your heart rate
reducing your ability to problem-solve tightening of the muscles…
These physiological responses would be appropriate if you were facing a life or death situation but aren’t appropriate for forgotten shoes or a last minute potty run. Many caregivers have deep, unconscious fear losing control of a situation or a child. Others are lacking capacity to shoulder the child’s emotion on top of their own. Mindfulness exercises will help you live in the present moment and remain peaceful and relaxed. They will reduce your anxiety levels and help enhance concentration. We automatically do what our instincts tell us to do, unless we train ourselves for a different response. Imagine if emergency personnel didn’t train themselves to respond with thoughtfulness and just rushed in to a scene. There would be more people hurt, including the rescuers and the danger could escalate. This is what happens when caregivers, whether teacher, doctor, parent or caseworker are not trained to be mindful (and logical) in the moment. It breaks my heart when I hear a child saying “you scared me” or crying uncontrollably and running away because the sense a threat of harm, whether verbal or physically from the caregiver who doesn’t mean harm, but is doing so anyway.

According to definitions.uslegal.com, the definition of willful disobedience is the intentional disobedience by a free agent who knows what he is doing, although not necessarily acting with malice or evil intent. Vocabulary.com states that Willful means “deliberate” or “stubborn.” A child who exhibits willful disobedience knows she is doing something wrong (even if she tries to convince you otherwise). For most people, willful disobedience is the child’s deliberate choice to disobey even after he has been reminded and given a chance to correct his behavior.

Is there a time when a child or even an adult would choose to disobey? Yes. In childhood, this is a part of development; learning to think independently, assess a situation, negotiate needs, use moral compass to make decisions. We would not be comfortable with a child that mindlessly obeys. Just think for a moment of the many tragedies that have or could arise out of blind obedience.

Why do we seek obedience as caregivers? Generally, we would like our children to grow up to be more or less civilized. We would like them to feel comfortable doing what they are supposed to do. How do we teach this to children?

We must remember that true obedience is based on a foundation of love and trust, not fear. We teach obedience through discipline. Now let’s clarify what discipline means… it may not mean what you think it means. Discipline means to learn. It does not mean to issue a punishment or ensure consequence. In working with children from hard places, we must be careful to show great love in the process of discipline [teaching/learning]. It really matters where our hearts are. No learning takes place when anger is present. A child may act out of fear, and it will resemble obedience. But it is not the same. Nothing is learned, character isn’t shaped, bonds are not forged, and positive growth doesn’t occur.

A child may also act out of fear and it does not resemble obedience. More often than not, this is what is seen in children from hard places. (**Remember that this does not just mean abuse/neglect but there are six risk factors to a child’s healthy development: difficult pregnancy, difficult birth, early/prolonged hospitalization, abuse, neglect, trauma**) The fear response, also known as fight, flight, or freeze originates in the amygdala of the brain (aka small brain, lizard brain, survival center.)

Common fight responses:

Kicking

screaming

biting

spitting

throwing

Long after a traumatic experience is over, it may be reactivated at the slightest hint of danger and mobilize disturbed brain circuits and secrete massive amounts of stress hormones. This precipitates unpleasant emotions intense physical sensations, and impulsive and aggressive actions. These posttraumatic reactions feel incomprehensible and overwhelming. Feeling out of control, survivors of trauma often begin to fear that they are damaged to the core and beyond redemption. Imagine if you shout, “Look over here!” and your child startles, dropping to the ground. Do you think that your child was willfully disobedient or scared? We don’t equate an adult’s fear response with willful disobedience. Why would we? It’s an instinct, a reflex to survive.

So let’s make the switch in how we view our children’s fear responses. Instead of seeing the behavior as willful disobedience, we must view the behavior for what it is – a survival instinct. We must change the lens through which we view behavior. It is an expression of need that children are unable to verbalize. They may not be aware of the fear that they feel (it is a reflex after all… the husband who is suddenly rushing to lift the car off of his wife is not able to say “I’m so scared I must run and lift this vehicle.” He can only react to that fear.)

Are you ready to make the switch?

“A lot of ‘seeing the need’ is understanding the impact of trauma on kids. Having compassion and understanding helps us to see the need. Seeing the need is changing your frame of reference so you realize that these aberrant behaviors are survival strategies rather than willful disobedience. If you look at your child’s behavior through the lens of his history, his actions make perfect sense. Understanding attachment and any deficits in early development also helps us to see the need behind behavior.” – Dr. David Cross

Ask yourself, “what does my child need?” when faced with challenging behaviors. By conducting a quick mental inventory of the current environment, previous events of the day, and any known triggers, we can often make a good guess at what our child needs when she is struggling. If you’re not sure, say, “Buddy, I want to help you. Can you use your words or show me what you need?” in a calm, non-threatening tone. Your child’s answer may surprise you.

It’s time to stop parenting the shark we see on top of the water ad get to the needs of the goldfish underneath.

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.

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.

• 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.

“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