Читать книгу Healing Traumatized Children - Faye L. Hall - Страница 9
ОглавлениеTrauma in Adopted Children: Meet the Families Trauma in Adopted Children: Meet the Families
We were quite a typical rural central Pennsylvania family—my husband David and I and our teenaged son and two younger daughters. Traditional roles were working well for us. David was an engineer by profession. He maintained our Christmas tree farm and rental properties, while I was trained as an educator and homeschooled our daughters.
This changed when my sister and her husband were in the midst of adopting an infant; a relative of my brother-in-law asked them whether they would be interested in adopting his nephew. He was a little boy being shuffled through the foster care system and in need of adoption. My sister thought that a second boy would create perfect gender symmetry in my family and volunteered us as foster parents!
That little boy eventually became our adoptive son Allan. By the time David and I made the commitment to bring Allan into our family, he was in a shelter with other hard-to-place children. We had to complete foster care training and go through the clearance process. In the six hours of foster care classes we covered such topics as necessary paperwork, possible behavior problems, ways to deal with birth parent visits, legal responsibility of the agency and family and not relying on the foster care subsidy to pay bills.
Learning of our intention to foster a child, friends were extremely enthusiastic. One woman, herself a former foster child, told us how very grateful to us any foster child would be. We heard, “The child will benefit from the pleasures your family could offer,” and “The child will thank you for rescuing him.” Such comments strengthened our resolve to become foster parents.
—Faye Hall
Now that Faye has introduced you to her “real life” story, let’s meet four other families. We have created each of them to represent a composite of the common struggles parents have faced in enabling an attachment-disordered child to become part of a family. We will refer back to them throughout the book in order to illuminate points we are making.
Introducing Amy’s Family, the Smiths
James and Lori Smith adopted two-year-old Amy later in life. James was a research scientist and Lori a teacher. Lori was able to stay at home with Amy. They were happy to finally be parents; they indulged her with all her desires. Amy never had to ask for anything. Lori was in heaven, having a little girl to dote on all day. Lori bought Amy fancy dresses like she had wanted as a child but that her parents could not afford.
Lori grew concerned when Amy began to destroy things. She ripped many of the fancy dresses, broke most of her toys and “accidently” damaged the furniture. It seemed as if her defiance was increasing daily. Lori tried to explain her fears to James. He attributed the behavior to Amy’s age.
Lori planned fun things every day for Amy. Lori had missed having fun when she was growing up, because her mom had to work and never seemed to have time for her. Amy refused to play with Lori but demanded that Lori entertain her. By bedtime, Lori had no energy left for James. Some nights, Amy demanded that Lori sleep with her. James began to resent Amy for taking his wife’s energy and he wanted to find a babysitter. Lori refused, thinking that Amy would be too scared to be away from her. James and Lori were drifting apart.
As Lori and James despaired over how far they were from their imagined ideal family, they decided to seek help. During the initial stages of finding answers, it was difficult and embarrassing for them to describe their parenting styles and Amy’s behaviors. Yet their shame decreased as they found professionals trained in trauma and attachment.
Introducing Corey’s Family, the Joneses
Rebecca and Danny Jones began fostering children soon after they were married. Danny worked second shift, leaving the house at noon every day and often working overtime to supplement their income, as Rebecca did not work outside the home. Rebecca was a good “case manager” for the foster children, arranging meetings and transporting the children to a multitude of appointments. Their home seemed like it was open to caseworkers at all hours of the day. Fortunately, their three birth children were self-sufficient and needed less “mom time.”
Upon placement of a new foster child, they gave him or her a toiletries basket, four sets of clothing and housing rules with a time chart. Their style was to set firm rules for all the children. The family routine included scheduled times for bathing, eating, homework, chores and free time. Weekend schedules did not include homework.
The family adopted foster child Corey, four years old, who had a history of six previous foster placements. Birth children Sara, Andy and Lane were happy to have another brother in the family. Rebecca and Danny did not change their parenting style after the adoption and Corey was expected to maintain the established foster child routine.
Over time, Corey’s behavior problems increased. He did not regulate his eating, always asking for more food. Rebecca found moldy food under his bed and food wrappers in his closet. She discovered that he went to the kitchen during the night for more food. Rebecca began hiding food and locking cabinets. Their birth children constantly complained about Corey “stealing all the food.” Rebecca and Danny could feel the hurt and loss of the children on top of their own frustration at not being able to provide for their children. The inaccessibility of food may be a trigger for a child with early trauma. Rebecca and Danny added more rules to try to stop Corey’s inappropriate behaviors, yet he routinely broke those rules.
Rebecca and Danny debated whether they should arrange for Corey to be placed back in foster care. Maybe he was just not a good fit for their family. The tipping point occurred when Rebecca attended training on attachment and trauma. She was given resources that challenged her way of seeing Corey’s behaviors. Thus began a new parenting strategy.
Introducing Sally’s Family, the Browns
Jane Brown, a successful businesswoman, placed very little importance on dating or relationships. As she grew older and listened to her co-workers talk about their children, her desire to be a mom seemed to awaken. She considered adoption her best option since she could adopt an older child and not take time off from work. She thought that an older child would be more self-sufficient, as well as a good companion. Jane would help society by giving an orphan a home. She envisioned this child thanking her for all the good things she provided. Jane chose Sally from a website. Sally was removed from her birth family at five years of age and began the first of three foster placements. One family declared that they would be her “forever” family, until she hurt their dog. Sally did not like that dog. He was like her mom’s boyfriend’s dog, the one tied to her doorknob to keep her in her bedroom and told to eat her if she tried to leave.
Jane was happy to have Sally. Weekends were for fun, with Saturday activities and Sunday church—their special times together. During the week, Sally stayed home alone, with a neighbor available for touching base if needed. Sally’s routine was simple: She ate a prepackaged meal for dinner, completed her homework and bathed. Because her work commute was long, Jane arrived home just in time to tuck Sally in every night. After a few months, Sally was less fun to be with, complained about weekend activities, refused to go to church, wanted to shop more often and would not finish her morning chores. Jane no longer planned Saturday activities, working instead. She figured Sally could just occupy herself if she wasn’t going to be fun. Sally was given chores and books to read and told to stay home. In retaliation, Sally began sneaking out as soon as Jane left for work. Sunday was Jane’s time to see her friends at church, but she could only get Sally to go to see a boy she’d met there.
Jane had no support system as a parent. She did not want to stress her elderly parents and her sister refused to help because she thought Jane was wrong to adopt in the first place, so Jane asked her secretary to find answers for her. Things began to improve between her and Sally when both began to participate in specialized trauma services.
Introducing Brandon’s Family, the Lewises
Bob and Deena Lewis were first-time parents of newly-placed six-year-old Brandon. Bob and Deena attended all the classes their agency offered, read many books and watched DVDs. They were ready. They knew this child would love them, because they were such loving people. Brandon seemed like a perfect fit for them, since six-year-olds can follow rules, maybe even read a little and do a few chores. They would have a ready-made family! Deena could continue working at the hospital while Brandon was in school. Bob, a teacher, would be home with Brandon during the summer. Bob knew how to manage children—he had created some of the best behavior management programs at his school.
Both parents believed that children comply when rules are explained. Besides, they knew Brandon would be thankful for his new home. They explained to him how he was expected to behave, their family rules and his boundaries. The first week went well, although Brandon seemed to forget the rules. Bob used one of his favorite behavioral charts featuring a reward system. He knew Brandon would enjoy earning rewards! Brandon worked for a week before protesting that the rewards were too hard to earn. However, when Bob made the system easier, Brandon still did not comply.
In the second month, Brandon tore up the chart and stated he didn’t care about Bob and Deena’s stupid rules. By the third month Brandon began breaking valuable figurines and rummaging through their belongings. Bob and Deena did not know how to make him respect their property. Deena dreaded coming home to a discouraged Bob and an out-of-control Brandon. She inquired at the hospital behavioral health department and was given the phone number for an attachment and trauma center. She and Bob changed their parenting style after a few helpful sessions with trauma professionals.
Look in my eyes can you see
Life filled with complete misery?
Look in my eyes can you say
Tomorrow will be a better day?
Well, tomorrow is now and things are the same.
I am still nothing to most but a faceless name.
Hurt more now than ever before
With each day bringing more and more
Unpleasant thoughts to keep me down,
Things to turn my smile to a frown.
Why am I cursed with a life like this?
A faceless name that nobody will miss
A life filled with so much pain
A faceless name with nothing to gain.
—Allan Hall, 2004
SEEING THE WORLD FROM THE CHILD’S POINT OF VIEW
Good mental health is essential for healthy child development and successful adult living. Not all children have sufficiently positive life experiences during the first critical months and years of life. Children become part of the foster and adoptive community, because their birth parents cannot or will not care for them in healthy ways. Many of these children are maltreated and have repeated traumatic experiences. Dr. Alexandra Cook, Associate Director and the Director of Development at the Trauma Center at Justice Resource Institute in Massachusetts, and her colleagues note: “Emotional abuse and neglect, sexual abuse and physical abuse, as well as witnessing domestic violence, ethnic cleansing or war, can interfere with the development of a secure attachment within the caregiving system.”1
In the United States, 20 percent of children and adolescents are diagnosed with mental disorders.2 Foster and adoptive children often have an alphabet soup of psychiatric diagnoses, including Oppositional Defiant Disorder (ODD), Attention Deficit Hyperactivity Disorder (ADHD), Conduct Disorder (CD), Reactive Attachment Disorder (RAD) and others. According to Dr. Cook and her colleagues, “Each of these diagnoses captures a limited aspect of the traumatized child’s complex self-regulatory and relational impairments.”3 During 2006, approximately 129,000 children were in public foster care in the United States and 51,000 were adopted from that group.4 These children may have been abused or neglected, causing a devastating break in the relationship with their primary caregiver, usually the mother.5
Pre-verbal experiential learning creates the internal definition of self, others and the world, forming an “Internal Working Model” (IWM). The IWM helps to interpret experiences, generate emotions and make decisions, mostly below the child’s conscious awareness. Successful or unsuccessful early emotional “co-regulation” of fear by caregivers in the child’s pre-verbal months is instrumental in the formation of the IWM. Will the child’s IWM become one of basic trust in a reliable world or one of mistrust and fright?
EARLY TRAUMA AND RELATIONSHIPS
During removal from the birth family and during subsequent investigations, social workers, police, judges, teachers and new foster parents ask hard questions. Children may feel like they are betraying their birth family by answering. They may have seen their parents being arrested. They may have become separated from birth siblings when placed in different foster homes. Foster children are often overwhelmed with worry, fear and anger. From their perspective, controlling adults are perhaps the reason for their problems. They may feel that silence about their family’s troubles is preferable to this horror. With their world seemingly going from bad to worse, these children erect defensive walls for survival, walls that may be invisible and masked by a charming and engaging façade.
Not understanding this, parents of traumatized children may rely on familiar parenting methods that are destined to fail. They are confused by their child’s maladaptive behaviors and wonder why their parenting skills are being questioned. They may not understand why school concerns, poor peer interactions, developmental delays, sensory issues and even personal hygiene do not improve via consistently applied rewards and consequences. Gently delivered explanations with little expressed emotion never seem to work for these children. Even if they understand the wrongness of a behavior, they will continue to repeat it. Parents become disheartened and ultimately worn out by trying to connect with a child who uses disruptive behaviors to avoid intimacy and maintain a sense of control.
Foster and adoptive parents need help in dissolving the child’s defensive walls that thwart loving outreach. By the time parents seek help, they have often built their own walls that also must be dissolved. David J. Wallin, a clinical psychologist who specializes in attachment theory, notes in his book, Attachment in Psychotherapy, “Parents discover themselves as parents through the impact that they are having on their child.”6 Without successful treatment of their child, parents perceive themselves as inadequate and may become depressed and isolated. Their other relationships often suffer. The children may be removed from the home, may develop emotional disorders and may become physically dangerous. Families deserve relief from the impact of trauma.
In-home family treatment is ideal for many families. This environmental approach is systemic, not focusing on “fixing” the child, but rather on creating healing relationships with a supportive environment. Research supports active parent involvement in treatment. Working with a child in the isolation of a therapist’s office creates a treatment that may become “compartmentalized” without improving the home environment or the parent/child relationship.7 Child psychologist Nicole Cox suggested that family therapy is preferred to individual therapy, because the child is part of the family system. Success or failure is dependent on the health of the system. If the parents are minimally involved, treatment may not generalize back to the family.8 Given that children with traumatic histories may demonstrate a range of maladaptive behaviors that warrant therapy, therapists working exclusively with the child only address that child in an isolated context.9
If the child is focused on the therapist relationship apart from the home environment, problems generated by the original family and those faced by the current family are not adequately addressed. The therapist must consider the unique past and current experiences of each foster/adoptive child.
IMPACT OF EARLY TRAUMA: RECREATING OLD PATTERNS
When foster or adoptive parents bring a child into their home, they desire and expect a reciprocal relationship. A child with early trauma and attachment disruptions will have a different “map of the world” from the new parents’ (remember the IWM). Their views, priorities, values and perceptions are different and this new home with loving, capable adults is unfamiliar. Early interpersonal experiences forced the child to try desperately to be in control of the environment, to be hyper-vigilant in order to maintain safety and meet basic needs. The child may strive to regain a sense of safety and control by creating an environment similar to one from his or her trauma history. Parents will interpret the child’s “normal” as disruptive, unhealthy, dangerous, illegal and dysfunctional. The child may feel comfort and safety, but parents may be frightened and overwhelmed. Some families with sibling groups may consciously or unconsciously divide their home into “theirs and ours.” The adopted children may have different schedules, sleep in separate quarters and even eat in other locations or at different times. Healthy attachment is unlikely under these conditions.
Unrealistic or uninformed parental expectations may get in the way. Some parents become focused on the child’s fitting into the family and on abiding by family rules, instead of inviting this new child to join the family. If disruptive behaviors become more frequent, some parents make more rules in hopes that the child will finally “shape up.” If the parents respond to the child’s behavior with anger and disappointment, they will reinforce the child’s negative belief system (I am bad, The world is evil, etc.). The only way for this child to heal is by forming a healthy relationship with the primary caregiver—thus, the importance of overcoming unrealistic initial expectations and instead empathically meeting with the child on his or her current level.
Families naturally become distressed by a child’s disruptive behavior. Dr. Carl J. Sheperis, chair of Counseling and Special Populations at Lamar University, et al listed behaviors that frequently interfere with family functioning, including tantrums, aggression, interrupting, inability to play independently, whining and crying.10 Here are other common disruptive behaviors:
1. Child is sweet and charming to strangers: “I could go home with you!”
2. Child is bashful and coy with strangers.
3. Child is destructive to property—his own and others’.
4. Child engages in multiple control battles.
5. Child “triangulates” (divides or splits up) adults to maintain control.
6. Child is oppositional to authority and those with whom he has a relationship.
7. Child steals from family and strangers, sometimes useless objects of no practical value.
8. Child is reactionary to parental affection.
9. Child lacks trust in adults.
10. Child’s problem/target seems to be the mother.
11. Child implies false claims of abuse.
12. Child projects that he is not lovable.
13. Child lacks healthy interpersonal boundaries.
14. Child has poor personal hygiene.
15. Child has abnormal eating habits.
16. Child has unusual bathroom behavior.
17. Child has abnormal sleeping patterns.
18. Child uses poor communication skills.
19. Child may dissociate.
20. Child appears hyper-vigilant.
21. Child is aggressive toward anyone with whom he has a relationship.
22. Child displays emotional, physical and cognitive development delays.
23. Child has poor peer relationships.
Our intentional, constant and unrelenting determination to see the traumatized, attachment-disordered child’s world through his or her lens is aided by putting ours aside to understand the disruptive and sometimes outright bizarre behavior of the child. Then we have a chance to replace despair with hope—hope that will take form in myriad “trauma-informed” interactions with the child that over time will heal his or her damaged Internal Working Model. In the following two chapters, we will look more specifically at how the traditional lens creates a foggy, distorted understanding and approach to these children and then focus on what we call “the trauma lens paradigm shift.”
