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.
