Children need love, care, and safety; they need families

The Greatest terror a child can have is that he is not loved, and rejection is the hell of fears...... And, with rejection comes anger, and with anger some kind of crime in revenge for the rejection, and with crime, guilt - and there is the story of humankind. John Steinbeck, East of Eden

Friday, February 12, 2010

Bonding and Attachment in Maltreated Children - Bruce Perry

I'm a huge fan of Dr. Bruce Perry!  Here is an article that gives a brief overview of his work and the neurosequential approach to healing!  I highly recommend all his work!

Bonding and Attachment in Maltreated Children; How you can Help

By Bruce D. Perry, M.D., Ph.D.


The most important property of humankind is the capacity to form and maintain relationships. These relationships are absolutely necessary for any of us to survive, learn, work, love, and procreate. Human relationships take many forms but the most intense, most pleasurable and most painful are those relationships with family, friends and loved ones. Within this inner circle of intimate relationships, we are bonded to each other with "emotional glue" — bonded with love.

Each individual's ability to form and maintain relationships using this "emotional glue" is different. Some people seem "naturally" capable of loving. They form numerous intimate and caring relationships and, in doing so, get pleasure. Others are not so lucky. They feel no "pull" to form intimate relationships, find little pleasure in being with or close to others. They have few, if any, friends, and more distant, less emotional glue with family. In extreme cases an individual may have no intact emotional bond to any other person. They are self-absorbed, aloof, or may even present with classic neuropsychiatric signs of being schizoid or autistic.

The capacity and desire to form emotional relationships is related to the organization and functioning of specific parts of the human brain. Just as the brain allows us to see, smell, taste, think, talk, and move, it is the organ that allows us to love — or not. The systems in the human brain that allow us to form and maintain emotional relationships develop during infancy and the first years of life. Experiences during this early vulnerable period of life are critical to shaping the capacity to form intimate and emotionally healthy relationships. Empathy, caring, sharing, inhibition of aggression, capacity to love, and a host of other characteristics of a healthy, happy, and productive person are related to the core attachment capabilities which are formed in infancy and early childhood.

What Can I Do To Help Maltreated Children?

Responsive adults, such as parents, teachers, and other caregivers make all the difference in the lives of maltreated children. This section suggests a few different ways to help.

Nurture these children. They need to be held, rocked, and cuddled. Be physical, caring, and loving to children with attachment problems. Be aware that for many of these children, touch in the past has been associated with pain, torture, or sexual abuse. In these cases, make sure you carefully monitor how they respond — be "attuned" to their responses to your nurturing and act accordingly. In many ways, you are providing replacement experiences that should have taken place during their infancy — but you are doing this when their brains are harder to modify and change. Therefore, they will need even more bonding experiences to help them to develop attachments.

Try to understand the behaviors before punishment or consequences. The more you can learn about attachment problems, bonding, normal development, and abnormal development, the more you will be able to develop useful behavioral and social interventions. Information about these problems can prevent you from misunderstanding the child's behaviors. When these children hoard food, for example, it should not be viewed as "stealing" but as a common and predictable result of being deprived of food during early childhood. A punitive approach to this problem (and many others) will not help the child mature. Instead, punishment may actually increase the child's sense of insecurity, distress, and need to hoard food. So many of these children's behaviors are confusing and disturbing to adults. You can get help from professionals if you find yourself struggling to create or implement a practical and useful approach to these problems.

Interact with these children based on emotional age. Abused and neglected children will often be emotionally and socially delayed. And whenever they are frustrated or fearful, they will regress. This means that, at any given moment, a ten-year old child may emotionally be a two-year old. Despite our wishes that they would "act their age" and our insistence to do so, they are not capable of that. These are the times that we must interact with them at their emotional level. If they are tearful, frustrated, or overwhelmed (emotionally age two), treat them as if they were that age. Use soothing non-verbal interactions. Hold them. Rock them. Sing quietly. This is not the time to use complex verbal arguments about the consequences of inappropriate behavior.

Be consistent, predictable and repetitive. Maltreated children with attachment problems are very sensitive to changes in schedule, transitions, surprises, chaotic social situations, and, in general, any new situation. Busy and unique social situations will overwhelm them, even if they are pleasant! Birthday parties, sleepovers, holidays, family trips, the start of the school year, and the end of the school year — all can be disorganizing for these children. Because of this, any efforts that can be made to be consistent, predictable, and repetitive will be very important in making maltreated children feel safe and secure. When they feel safe, they can benefit from the nurturing and enriching emotional and social experiences you provide them. If they are anxious and fearful, they cannot benefit from your nurturing in the same ways.

Model and teach appropriate social behaviors. Many abused and neglected children do not know how to interact with other people. One of the best ways to teach them is to model this in your own behaviors, and then narrate for the child what you are doing and why. Become a play-by-play announcer: "I am going to the sink to wash my hands before dinner because…" or "I take the soap and put it on my hands like this…." Children see, hear, and imitate.

In addition to modeling, you can "coach" maltreated children as they play with other children. Use a similar play-by-play approach: "Well, when you take that from someone, they probably feel pretty upset; so if you want them to have fun when you play this game, then you should try…" By more effectively playing with other children, they will develop some improved self-esteem and confidence. Over time, success with other children will make the child less socially awkward and aggressive. Maltreated children are often "a mess" because of their delayed socialization. If the child is teased because of their clothes or grooming, it would be helpful to have "cool" clothes and improved hygiene.

Maltreated children have problems with modulating appropriate physical contact. They don't know when to hug, how close to stand, when to establish or break eye contact, what are appropriate contexts to wipe their nose, touch their genitals, or do other grooming behaviors.

Ironically, children with attachment problems will often initiate physical contact (hugs, holding hands, crawling into laps) with strangers. Adults misinterpret this as affectionate behavior. It is not. It is best understood as "supplication" behavior, and it is socially inappropriate. How adults handle this inappropriate physical contact is very important. We should not refuse to hug the child and lecture them about "appropriate behavior." We can gently guide the child on how to interact differently with grownups and other children ("Why don't you sit over here?"). It is important to make these lessons clear using as few words as possible. They do not have to be directive — rely on nonverbal cues. It is equally important to explain in a way that does not make the child feel bad or guilty.

Listen to and talk with these children. One of the most helpful things to do is just stop, sit, listen, and play with these children. When you are quiet and interactive with them, you will often find that they will begin to show you and tell you about what is really inside them. Yet as simple as this sounds, one of the most difficult things for adults to do is to stop, quit worrying about the time or your next task, and really relax into the moment with a child. Practice this. You will be amazed at the results. These children will sense that you are there just for them, and they will feel how you care for them.

It is during these moments that you can best reach and teach these children. This is a great time to begin teaching children about their different "feelings." Regardless of the activity, the following principles are important to include: (1) All feelings are okay to feel — sad, glad, or mad (more emotions for older children); (2) Teach the child healthy ways to act when sad, glad, or mad; (3) Begin to explore how other people may feel and how they show their feelings — "How do you think Bobby feels when you push him?" (4) When you sense that the child is clearly happy, sad, or mad, ask them how they are feeling. Help them begin to put words and labels to these feelings.

Have realistic expectations of these children. Abused and neglected children have so much to overcome. And, for some, they will not overcome all of their problems. For a Romanian orphan adopted at age five after spending her early years without any emotional nurturing, the expectations should be limited. She was robbed of some, but not all, of her potential. We do not know how to predict potential in a vacuum, but we do know how to measure the emotional, behavioral, social, and physical strengths and weaknesses of a child. A comprehensive evaluation by skilled clinicians can be very helpful in beginning to define the skill areas of a child, as well as the areas where progress will be slower.

Be patient with the child's progress and with yourself. Progress will be slow. The slow progress can be frustrating, and many adults, espsecially adoptive parents, will feel inadequate because all of the love, time, and effort they spend with their child may not seem to be having any effect. But it does. Don't be hard on yourself. Many loving, skilled, and competent parents and teachers have been swamped by the needs of a neglected and abused child.

Take care of yourself. For parents and other adults, caring for maltreated children can be exhausting and demoralizing. Adults cannot provide the consistent, predictable, enriching, and nurturing care these children need if they are depleted; it is important to get rest and support. Respite care can be crucial for parents, who should also rely on friends, family, and community resources.

Take advantage of other resources. Many communities have support groups for adoptive or foster families; as an education professional, you might help by suggesting some, or asking a school psychologist or other counselor to do so. Professionals with experience in attachment problems or maltreated children can also be very helpful. You too will need help; don't be afraid to ask for it. Remember, the earlier and more aggressive the interventions, the better. Children are most malleable early in life, and as they get older, change is more difficult. Take advantage of this time to make a difference in a child's life.



*Adapted in part from: "Maltreated Children: Experience, Brain Development and the Next Generation" (W.W. Norton & Company, New York, in preparation)

Saturday, February 6, 2010

FACES of Virginia Families

If you live in Virginia and are involved in foster care, kinship care, or adoption then you have most likely heard of FACES of Virginia Families!

This is a fabulous organization whose mission it is, "to provide a unified voice for children, youth, and families involved in foster, adoption, and kinship care so all children and youth are treated with dignity, respect, and equality."

Let me tell you what is the underlying and core foundational principles upon which FACES works:


F     Family - We believe that foster, adoptive, and kinship families are our best opportunity to secure strong futures for children and youth not living with their birth parents.

A     Advocacy - FACES advocates for the needs of all foster, adoptive, and kinship families in Virginia.

C     Collaboration - FACES builds partnerships with local agencies, private agencies, state government, and many other organizations working to improve the lives of children not living with their birth parents.

E     Empowerment - FACES provides educational opportunities to families so they are better equipped to be valued partners in protecting the health and safety of children and youth.

S     Support - FACES believes that mutual support strengthens families and improves placement stability for children and youth.

If you are either a foster, adoptive, or kinship family check out FACES!  Join the organization and learn everything you need to know to be a strong support and advocate for children and youth and families in Virginia!

On the FACES website you will discover all sorts of ways to help children and families, AND, you will learn how to get involved in changing the laws and policies of our State to further support our children!

Thursday, February 4, 2010

Dr. Fritz Redl and Dr. David Wineman - Their Classic Work on Treating Hurt Children

Dr.s Fritz Redl and David Wineman are considered by many, to be founders of the moment to treat hurt children with dignity, understanding, compassion, and love. 

Their classic books, collectively considered by some to be the "Bible" when it comes to working with challenging behavior, are Controls from Within: Techniques for Treatment of the Aggressive Child, and, The Child who Hates: a Sensitive Analysis of Anti-social behavior of Children in their response to the adult world.

Written over fifty years ago, these extraordinary works are still, a must read for anyone working with young people who exhibit behavior that today we diagnose as oppositional defiant, aggressive, or violent.

While we have some extraordinary journal articles, robust research, and literally hundreds of books and articles on helping hurt children, I think these classic works still stand out as important as we work to understand and treat those children who are in need of serious treatment.

A few of my favorite quotes from Redl and Wineman....

Remembering Fritz Redl: "'The children must get plenty of love and affection whether they deserve it or not: they must be assured of the basic quota of happy, recreational experiences whether they seem to have it coming or not. In short, love and affection, as well as the granting of gratifying life situations, cannot be made the bargaining tools of educational or even therapeutic motivation, but must be kept tax-free as minimal parts of the youngsters' diet, irrespective of the problems of deservedness' (1952)."

"We are against the application of physical punishment in any form whatsoever under any circumstances. Even for the normal child, we reject the idea that physical pain will 'teach' the youngster, that the entrance to the character of a child leads through the epidermis of the hind quarters, or that physical pain will solve things by giving the child the chance to pay for his sins and thus end his guilt feelings" (1952).

"Boredom will always remain the greatest enemy of school disciplines. If we remember that children are bored, not only when they don't happen to be interested in the subject or when the teacher doesn't make it interesting, but also when certain working conditions are out of focus with their basic needs, then we can realize what a great contributor to discipline problems boredom really is. Research has shown that boredom is closely related to frustration and that the effect of too much frustration is invariably irritability, withdrawal, rebellious opposition or aggressive rejection of the whole show."

While newer books may be more enticing, current in some respects, and appear more appropriate to our modern day, I think these classic works are worth delving into. They are a foundation upon which we can build a repertoire of skills, techniques, and approaches that can truly help a child heal!

Tuesday, February 2, 2010

Oh, Those Difficult, Hard to Manage, Out of Control Kids... Keep Them!

As we diligently work to help our hurt children behave appropriately, manage their anger, and free themselves from defiance and violence, it may help to remember that for which they are fighting for.

Anna Quindlin writes,

Recently a young mother asked for advice. What, she wanted to know, was she to do with a 7-year-old who was obstreperous, outspoken, and inconveniently willful? "Keep her," I replied.... The suffragettes refused to be polite in demanding what they wanted or grateful for getting what they deserved. Works for me.
Could it be that our hurt children, in their struggle for survival are fighting for life? Perhaps they are fighting for attention to know they mean something to someone; for unconditional love to know that they deserve care and kindness just because they are here on this planet?  Maybe their fight is for recognition that they exist, or nurturing to help them grow?

In our modern society we tend to take things away from misbehaving children; we take away their toys, their privileges, their freedom.  We take away parents and loved ones.  We take away hugs, and kisses, and nurturing. 

Perhaps, just as a tender peony wilts when the sun, water, and nutrients are removed, so too our children will wither when their basic needs for love, attention, and belonging are unmet?  Maybe they need more not less?  Maybe they need more nurturing, more kindness, more dedication; more reassurance that they are valuable and worthwhile, and lovable.