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How does trauma impact the family?

A fact sheet from the National Child Traumatic Stress Network.

All families experience trauma differently. Some factors such as the children’s age or the family’s culture or ethnicity may influence how the family copes and recovers. After traumatic experiences, family members often show signs of resilience. For some families, however, the stress and burden cause them to feel alone, overwhelmed, and less able to maintain vital family functions. Research demonstrates that trauma impacts all levels of the family:

■ Families that “come together” after traumatic experiences can strengthen bonds and hasten recovery. Families dealing with high stress, limited resources, and multiple trauma exposures often find their coping resources depleted. Their efforts to plan or problem solve are not effective, resulting in ongoing crises and discord.

■ Children, adolescents, and adult family members can experience mild, moderate, or severe posttraumatic stress symptoms. After traumatic exposure, some people grow stronger and develop a new appreciation for life. Others may struggle with continuing trauma-related problems that disrupt functioning in many areas of their lives.

■ Extended family relationships can offer sustaining resources in the form of family rituals and traditions, emotional support, and care giving. Some families who have had significant trauma across generations may experience current problems in functioning, and they risk transmitting the effects of trauma to the next generation.

■ Parent-child relationships have a central role in parents’ and children’s adjustment after trauma exposure. Protective, nurturing, and effective parental responses are positively associated with reduced symptoms in children. At the same time, parental stress, isolation, and burden can make parents less emotionally available to their children and less able to help them recover from trauma.

■ Adult intimate relationships can be a source of strength in coping with a traumatic experience. However, many intimate partners struggle with communication and have difficulty expressing emotion or maintaining intimacy, which make them less available to each other and increases the risk of separation, conflict, or interpersonal violence.

■ Sibling relationships that are close and supportive can offer a buffer against the negative effect of trauma, but siblings who feel disconnected or unprotected can have high conflict. Siblings not directly exposed to trauma can suffer secondary or vicarious traumatic stress; these symptoms mirror posttraumatic stress and interfere with functioning at home or school.

Download the complete fact sheet at http://TraumaToolbox.com and learn more practical tools on how to have a trauma-informed home. Contact Ron Huxley today to set up a therapy session or organize a seminar for your agency or event at rehuxley@gmail.com / 805-709-2023. You can click on the schedule a session link now on the home page if you live in the San Luis Obispo, Ca. or Santa Barbara, Ca. area.

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How Trauma Affects A Child’s Brain

Ron Huxley Trains: I am conducting a lot of trainings around the country on “The heArt and Science of Trauma” for parents and professionals, so this video is interesting and validates the information I have researched and teach in my presentations. If you would like a free consult on bringing this training to your organization or system of care, email me at rehuxley@gmail.com

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The Hormone Surge of Middle Childhood

VIEWED superficially, the part of youth that the psychologist Jean Piaget called middle childhood looks tame and uneventful, a quiet patch of road on the otherwise hairpin highway to adulthood.

Said to begin around 5 or 6, when toddlerhood has ended and even the most protractedly breast-fed children have been weaned, and to end when the teen years commence, middle childhood certainly lacks the physical flamboyance of the epochs fore and aft: no gotcha cuteness of babydom, no secondary sexual billboards of pubescence.

Yet as new findings from neuroscience, evolutionary biology, paleontology and anthropology make clear, middle childhood is anything but a bland placeholder. To the contrary, it is a time of great cognitive creativity and ambition, when the brain has pretty much reached its adult size and can focus on threading together its private intranet service — on forging, organizing, amplifying and annotating the tens of billions of synaptic connections that allow brain cells and brain domains to communicate.

Subsidizing the deft frenzy of brain maturation is a distinctive endocrinological event called adrenarche (a-DREN-ar-kee), when the adrenal glands that sit like tricornered hats atop the kidneys begin pumping out powerful hormones known to affect the brain, most notably the androgen dihydroepiandrosterone, or DHEA. Researchers have only begun to understand adrenarche in any detail, but they see it as a signature feature of middle childhood every bit as important as the more familiar gonadal reveille that follows a few years later.

Middle childhood is when the parts of the brain most closely associated with being human finally come online: our ability to control our impulses, to reason, to focus, to plan for the future.

Young children may know something about death and see monsters lurking under every bed, but only in middle childhood is the brain capable of practicing so-called terror management, of accepting one’s inevitable mortality or at least pushing thoughts of it aside.

Other researchers studying the fossil record suggest that a prolonged middle childhood is a fairly recent development in human evolution, a luxury of unfolding that our cousins the Neanderthals did not seem to share. Still others have analyzed attitudes toward middle childhood historically and cross-culturally. The researchers have found that virtually every group examined recognizes middle childhood as a developmental watershed, when children emerge from the shadows of dependency and start taking their place in the wider world.

Much of the new work on middle childhood was described in a recent special issue of the journal Human Nature. As a research topic, “middle childhood has been very much overlooked until recently,” said David Lancy, an anthropologist at Utah State University and a contributor to the special issue. “Which makes it all the more exciting to participate in the field today.”

The anatomy of middle childhood can be subtle. Adult teeth start growing in, allowing children to diversify their diet beyond the mashed potatoes and parentally dissected Salisbury steak stage. The growth of the skeleton, by contrast, slows from the vertiginous pace of early childhood, and though there is a mild growth spurt at age 6 or 7, as well as a bit of chubbying up during the so-called adiposity rebound of middle childhood, much of the remaining skeletal growth awaits the superspurt of puberty.

“Adulthood is defined by being skeletally as well as sexually mature,” said Jennifer Thompson of the University of Nevada, Las Vegas. “A girl may have her first period at 11 or 12, but her pelvis doesn’t finish growing until about the age of 18.”

The 18-year time frame of human juvenility far exceeds that seen in any other great ape, Dr. Thompson said. Chimpanzees, for example, are fully formed by age 12. With her colleague Andrew J. Nelson of the University of Western Ontario, Dr. Thompson analyzed fossil specimens from Neanderthals, Homo erectus and other early hominids, and concluded that their growth pattern was more like that of a chimpanzee than a modern human: By age 12 or 14, they had reached adult size.

Life for Neanderthals was nasty and short, Dr. Thompson said, and Neanderthal children had to get big fast, which is why they hurtled through adolescence at the equivalent of today’s chapter-book age. Our extreme form of dilated childhood didn’t appear until the advent of modern Homo sapiens roughly 150,000 years ago, Dr. Thompson said, when adults began living long enough to ease pressure on the young to hurry up and breed.

And what an essential luxury item middle childhood has proved to be. “It’s consistent across societies,” Benjamin Campbell, an anthropologist at the University of Wisconsin in Milwaukee said. “In middle childhood, kids start making sense.”

Parental expectations rise accordingly. “Kids can do something now,” said Dr. Campbell, who edited the special issue. “They can do tasks. They have economic value.”

Boys are given goats to herd and messages to deliver. They hunt and fish. Girls weave, haul water, grind corn, chop firewood, serve as part-time mothers to their younger siblings; a serious share of baby care in the world is performed by girls not yet in their teens.

Workloads and expectations vary substantially from one culture to the next. Karen Kramer and Russell Greaves of Harvard compared the average number of hours that girls in 16 different traditional cultures devoted each day to “subsistence” tasks apart from child care. Girls of the Ariaal pastoralists in northern Kenya worked the hardest, putting in 9.6 hours daily. Agriculturalist girls in Nepal worked 7.5 hours a day.

Then you come to the more laid-back lives of the foragers. The researchers focused on the Pumé, a foraging group in west-central Venezuela, where preadolescent girls do almost nothing. They forage less than an hour a day, significantly less than their brothers, and are very inefficient in what little they do. They prefer hanging out at the campsite. “Pumé girls spend their time socializing, talking and laughing with their friends, beading and resting,” Dr. Kramer said.

But most cultures mark the beginning of middle childhood with some new responsibility. Kwoma children of Papua New Guinea are given their own garden plots to cultivate. Berber girls of northern Africa vie to prove their worth by preparing entire family meals unassisted.

In the Ituri forest of Central Africa, Mbuti boys strive to kill their first “real animal,” for which they will be honored through ritualized facial scarring. And in the United States, children enter elementary school, for which they will be honored through ritualized gold starring.

In middle childhood, the brain is at its peak for learning, organized enough to attempt mastery yet still fluid, elastic, neuronally gymnastic. Children have lost the clumsiness of toddlerhood and can become physically gymnastic, too, and start practicing their fine motor skills. And because they are still smaller than adults, they can grow adept at a skill like, say, spear-tossing, without fear of threatening the resident men.

Middle childhood is the time to make sense and make friends. “This is the period when kids move out of the family context and into the neighborhood context,” Dr. Campbell said.

The all-important theory of mind arises: the awareness that other people have minds, plans and desires of their own. Children become obsessed with social groups and divide along gender lines, girls playing with girls, boys with boys. They have an avid appetite for learning the local social rules, whether of games, slang, style or behavior. They are keenly attuned to questions of fairness and justice and instantly notice those grabbing more than their share.

The mental and kinesthetic pliancy of middle childhood can be traced at least in part to adrenarche, researchers said, when signals from the pea-size pituitary at the base of the brain prod the adrenal glands to unleash their hormonal largess. Adrenal hormones like DHEA are potent antioxidants and neuroprotectants, Dr. Campbell said, and may well be critical to keeping neurons and their dendritic connections youthfully spry.

Evidence also suggests that the adrenal hormones divert glucose in the brain to foster the maturation of the insula and anterior cingulate cortex, brain regions vital to interpreting social and emotional cues.

In middle childhood, the brain is open for suggestions. What do I need to know? What do I want to know? Well, you could take up piano, chess or juggling, learn another language or how to ski. Or you could go outside and play with your friends. If you learn to play fair, friends will always be there.

via nytimes.com

Ron Huxley Reacts: I was intrigued by this topic of this article by the New York Times as middle childhood doesn’t get much press. I am not much on “evolutionary” talk but if you can get by that, you will find this a very enlightening post on the 6 to 12 year old child.

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What 9/11 has taught us about trauma

Scientific American has a useful piece on how the immediate treatment of psychological trauma has changed since 9/11. The issue is interesting because recent progress has turned lots of psychological concepts on their head to the point where many still can’t grasp the concepts.

The article notes that at the time of the Twin Towers disaster, the standard form of treatment was Critical Incident Stress Debriefing – also known as CISD or just ‘debriefing’ – a technique where psychologists would ask survivors, usually in groups, to describe what happened and ‘process’ all the associated emotions by talking about them.

This technique is now not recommended because we know it is at best useless and probably harmful – owing to the fact that it seems to increase trauma in the long-term.

Instead, we use an approach called psychological first aid, which, instead of encouraging people to talk about all their emotions, really just focuses on making sure people feel secure and connected.

Although the article implies that 9/11 was a major turning point for our knowledge of immediate post-trauma treatment, the story is actually far more complex.

Studies had been accumulating throughout the 90s showing that ‘debriefing’ caused harm in some, although it wasn’t until around the turn of the century that two meta-analyses sealed the deal.

Unfortunately, the practice of ‘debriefing’ by aid agencies and emergency psychologists was very hard to change for a number of interesting reasons.

A lot of aid agencies don’t deal directly with the scientific literature. Sometimes, they just don’t have the expertise but often it’s because they simply have no access to it – as most of it is locked behind paywalls.

However, probably most important was that even the possibility of ‘debriefing’ having the potential to do damage was very counter-intuitive.

The treatment was based on the then-accepted foundations of psychological theory that said that emotions always need to be expressed and can do damage if not ‘processed’.

On top of this, for the first time, many clinicians had to deal with the concept that a treatment could do damage even though the patients said it was helpful and were actually and genuinely getting better.

This is so difficult to grasp that many still continue with the old and potentially damaging practices, so here’s a quick run down of why this makes sense.

The theoretical part is a hang-over from Freudian psychology. Freud believed that neuronal energy was directly related to ‘mental energy’ and so psychology could be understood in thermodynamic terms.

Particularly important in this approach is the first law of thermodynamics that says that energy cannot be created or destroyed just turned into another form. Hence Freud’s idea that emotions need to be ‘expressed’ or ‘processed’ to transform them from a pathological form to something less harmful.

We now know this isn’t a particularly reliable guide to human psychology but it still remains hugely popular so it seemed natural that after trauma, people would need to ‘release’ their ‘pent up emotions’ by talking about them lest the ‘internal pressure’ led to damage further down the line.

And from the therapists’ point of view, the patients said the intervention was helpful and were genuinely getting better, so how could it be doing harm?

In reality, the psychologists would meet with heavily traumatised people, ‘debrief’ them, and in the following weeks and months, the survivors would improve.

But this will happen if you do absolutely nothing. Directly after a disaster or similarly horrible event people will perhaps be the most traumatised they will ever be in their life, and so will naturally move towards a less intense state.

Statistically this is known as regression to the mean and it will occur even if natural recovery is slowed by a damaging treatment that extends the risk period, which is exactly what happens with ‘debriefing’.

So while the treatment was actually impeding natural recovery you would only be able to see the effect if you compare two groups. From the perspective of the psychologists who only saw the post-trauma survivors it can look as if the treatment is ‘working’ when improvement, in reality, was being interfered with.

This effect was compounded by the fact that debriefing was single session. The psychologists didn’t even get to see the evolution of the patients afterwards to help compare with other cases from their own experience.

On top of all this, after the ‘debriefing’ sessions, patients actually reported the sessions were useful even when long-term damage was confirmed, because, to put it bluntly, patients are no better than seeing the future than professionals.

In one study, 80% of patients said the intervention was “useful” despite having more symptoms of mental illness in the long-term compared to disaster victims who had no treatment. In another, more than half said ‘debriefing’ was “definitely useful” despite having twice the rate of postraumatic stress disorder (PTSD) after a year.

Debriefing involves lots of psychological ‘techniques’, so the psychologists felt they were using their best tools, while the lack of outside perspective meant it was easy to mistake instant feedback and regression to the mean for actual benefit.

It’s worth saying that the same techniques that do damage directly after trauma are the single best psychological treatment when a powerful experience leads to chronic mental health problems. Revisiting and ‘working through’ the traumatic memories is an essential part of the treatment when PTSD has developed.

So it seemed to make sense to apply similar ideas to those in the acute stage of trauma, but probably because the chance of developing PTSD is related to the duration of arousal at the time of the event, ‘going over’ the events shortly after they’ve passed probably extends the emotional impact and the long-term risks.

But while the comparative studies should have put an end to the practice, it wasn’t until the World Health Organisation specifically recommended that ‘debriefing’ not be used in response to the 2004 tsunami [pdf] that many agencies actually changed how they went about managing disaster victims.

As well as turning disaster psychology on its head, this experience has dispelled the stereotype that ‘everyone needs to talk’ after difficult events and, in response, the new approach of psychological first aid was created.

Psychological first aid is actually remarkable for the fact that it contains so little psychology, as you can see from the just released psychological first aid manual from the World Health Organisation.

You don’t need to be a mental health professional to use the techniques and they largely consist of looking after the practical needs of the person plus working toward making them feel safe and comfortable.

No processing of emotions, no ‘disaster narratives’, no fancy psychology – really just being practical, gentle and kind.

We don’t actually know if psychological first aid makes people less likely to experience trauma, as it hasn’t been directly tested, although it is based on the best available evidence to avoid harm and stabilise extreme stress.

So while 9/11 certainly focussed people’s minds on psychological trauma and its treatment (especially in the USA which is a world leader in the field) it was really just another bitter waymarker in a series of world tragedies that has shaped disaster response psychology.

So unusually for a psychologist, I’ll be hoping we’ll have the chance to do less research in this particular area and have a more peaceful coming decade.
 

Link to SciAm piece on psychology and the aftermath of 9/11.

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via mindhacks.com

This isn’t a typical piece for a parenting blog but seeing as how I work with so many traumatized children and since today is 9/11 it seemed appropriate to share a couple thoughts.

One of the first things I teach my clinical interns is that you have to “stabilize” before you can do “interventions.” As therapists and parents we want to help a child talk about their traumas and get it all out. As the article explains above, this is an out dated and incorrect hypothesis about how to manage trauma. What children need FIRST is to know that they are safe and connected to others. This is the first law of attachment if you will and the very thing that so many traumatized children lack. Think about it: trauma destabilizes your sense of safety, so what would be the best intervention? Recreating safety.

It is a common problem for new therapists to want to talk it out. I get social workers and parents pressing me to do this all the time. The fact is that it is the worst thing for the child at first. Before working out issues, let’s create safety and stability at home and school. Build more support system. Give more hugs. Stay longer in the room at night and read that extra book or two. Be more tolerant of the meltdowns and resistance to changes in routine. Follow a routine if you don’t have one. Give back rubs and an extra scoop of ice cream.

What do you do to create safety and stability after a child experiences something traumatic?