Category: Child Development

3 Teaching children about trauma-e64c0cff78bc1c36a18b5896fe10be70f88635cd

Teaching Children about Trauma: The “River Speaks” Series

00Child Development, Emotion Regulation, Family Dynamics, Featured news, Grief, Therapy, Trauma March, 16

Source: Freaktography on Flickr

In her latest series of children’s books, River Speaks, author Sandy Stream conveys the emotional turmoil that children and families go through when dealing with trauma.

Children who have undergone loss, abuse, and other traumatic experiences are often unable to fully understand or express their feelings. Their inability to verbalize the emotional impact the crisis had on them makes it difficult for therapists to determine how to best help them heal.

Although research has shown children’s literature to be a helpful tool in therapy, its use is still not particularly common.

The stories found in Stream’s books are meant to help therapists provide relatable experiences for children to help them come to terms with their own trauma. They revolve around a baby bird, Sparky, who is snatched away from his family. In dealing with his captivity, escape, and eventual return, Sparky and his family learn to articulate the complex feelings they experience.

Sparky does return home, but the series does not employ the conventional happily-ever-after ending. Instead, the stories address the turmoil felt by everyone both during his captivity and after his return.

The seven books in this series, Sparky Can Fly, Sparky’s Mama, Tweets and Hurricanes, Feathers, Flex, Roots, and The River, all feature a different main character, retelling the narrative from the perspective of the victim, the parents, the siblings, and the therapist. Each book also deals with different emotional themes, including grief, loss, isolation, and acceptance.

Many of the communication strategies seen in River Speaks can be linked to Jean Piaget’s work on child development. According to Piaget, healthy coping and a sense of self cannot exist without establishing trusting relationships during childhood. Trauma can interrupt this process, and the River Speaks series is intended to restart and re-establish healthy connections.

Research, including that of psychiatrist Bessel van der Kolk, professor at Boston University, shows that children must understand the emotions caused by trauma. This research emphasizes that therapists should teach children to regulate emotional distress, with the first step being acknowledgment of the distress’ severity.

Stream’s metaphorical approach helps children grasp the complex concepts that make the healing process. Comparing Sparky’s inability to express anger and grief to “hurricanes” and “tweets” helps make the abstract more tangible.

This strategy allows the River Speaks stories to personify complex psychological issues such as emotional defense mechanisms like denial, fear of abandonment, and Stockholm syndrome, making her books well-suited to children as young as three or four years of age.

Stream’s stories are accompanied by illustrations from Yoko Matsuoka. The colourful drawings were designed to keep the oftentimes-dark subject matter child-friendly, and work well in conjunction with Stream’s metaphorical portrayals of emotions and trauma.

Such illustrations are a common tool in dealing with childhood trauma. The use of visual art to depict emotional reactions has been found to benefit children during the normal grieving process. A paper by Cynthia O’Flynn at North Central University explains that art therapy can be especially beneficial for children suffering from serious traumatic grief.

The article cites numerous other studies reporting that art allows children to bypass the language and vocabulary needed to explain their grief or loss, making self-expression much easier. The children are able to perceive greater control over their emotions and feel safe while reflecting upon their experiences.

Alexa S. Rabin of Alliant International University reinforced these findings in 2012, stating that art is an exercise which allows children to assert themselves and their boundaries. Rabin explained that such therapy significantly decreases acute stress symptoms, noting that the purpose of trauma treatment is to help children find a way to cope.

Stream’s books bridge the two sets of findings—using both art and language to reach out to children and better their self-expression across both media. A therapist using Stream’s books would be more flexible in tailoring the therapeutic style to the child’s age and individual needs.

Feedback from psychologists such as Jacqueline A. Carlton and fellow author Cheryl Eckl, applaud Stream’s attempt at tackling such difficult subject matter. And while research would be needed to gauge the helpfulness of her specific stories, existing research suggests that her books may ease therapy for both clinicians and children.

– Olivia Jon, Contributing Writer, The Trauma and Mental Health Report

– Chief Editor: Robert T. Muller, The Trauma and Mental Health Report

Copyright Robert T. Muller

This article was originally published on Psychology Today

Autism, Bullying, and Psychological Impacts

An Ice Bucket, an Autistic Child, and a Cruel Joke

10Autism, Bullying, Child Development, Ethics and Morality, Featured news, Health, Law and Crime February, 16

Source: Lee Morley on Flickr

A social media campaign aimed at raising awareness for one health problem becomes the cruel vehicle by which awareness is raised for another.

On August 18, 2014, a 15-year-old autistic boy in Bay Village, Ohio was encouraged by five teenage friends to participate in what he thought would be the ALS ice bucket challenge. Instead, the teenagers dropped a bucket of urine, feces, and tobacco spit on his head. When the boy’s parents found a video of the prank on his phone, they immediately took it to Fox 8 News to show how children with mental illness can be victimized.

The video went viral and was met with outrage by the general public and heralded as a disgrace to the purpose of the ALS Association’s campaign.

In an interview with Fox 8 news, the boy’s mother identifies herself as Diane to protect her son’s identity:

“The bucket challenge is supposed to be raising awareness for this disease and now they’ve turned it into a sick joke. I just can’t understand why kids would do something this cruel.”

But there is nothing that can’t be used to bring about suffering, especially when the victim is an easy target.

In a study by Benjamin Zablotsky of Johns Hopkins Bloomberg School of Public Health and his colleagues, 1221 parents of children with Autism Spectrum Disorder were asked to enroll in the Interactive Autism Network (IAN) and asked about their child’s history with bullies at school. The results showed that 63% of autistic children experienced victimization by their peers at some point in their lives and that 38% were bullied in the past month. An extreme finding when compared to the average bullying rate of 20-30% reported by students in general.

The study also revealed that autistic children in regular classroom settings with peers who do not have ASD are more likely to be bullied than children who are placed in specialized educational settings.

Catherine Cappadocia, a doctoral student, along with psychologists Jonathan Weiss and Debra Pepler in the faculty of health at York University, has studied the effects of bullying on the development of autistic children. She found that autistic children who have parents with mental health issues are three times as likely to become victims, especially at a young age.

Speech difficulties also serve to increase the risk of being bullied. For autistic children who are unable to express themselves to the offenders or to authorities, victimization can become unavoidable.

A combination of many of these factors may be what led to the victimization of Diane’s son. Yet what makes this issue more disturbing is that the five juveniles responsible claimed to be his friends.

Bay Village’s County Prosecutor, head of the office’s Juvenile Division said: “The victim and the five charged juveniles were and are friends and classmates. They regularly associate with one another and, at times, engage in distasteful and sophomoric pranks. However, this incident is clearly different. It crossed a moral and legal line, and even the five alleged perpetrators understand that and have expressed regret.”

Three of the boys involved in the prank were charged with two counts of delinquency, assault and disorderly conduct. The remaining two perpetrators were charged with a single count of disorderly conduct.

Researchers Vicki Bitsika and Christopher Sharpley have shown that a large number of children with ASD often have few or no friends and spend most of their free time at school alone. Around 40% of these children have also said that the few people they believe to be their friends tend to bully them too.

Bitsika and Sharpley also explain that this harassment can create a positive feedback loop, slowing healthy development and increasing autistic children’s difficulty displaying emotions and communicating with others.

For autistic children to grow up in a healthy environment, schools, parents, and children need to be educated not only about bullying, but about autism itself.

– Afifa Mahboob, Contributing Writer, The Trauma and Mental Health Report

– Chief Editor: Robert T. Muller, The Trauma and Mental Health Report

Copyright Robert T. Muller

This article was originally published on Psychology Today

Trauma Survivors at Risk for Future Abusive Relationships

Trauma Survivors at Risk for Future Abusive Relationships

10Child Development, Domestic Violence, Featured news, Identity, Post-Traumatic Stress Disorder, Relationships, Trauma January, 16

Source: David Dávila Vilanova/Flickr

In her 2012 TED talk on domestic violence, Leslie Morgan Steiner discusses what she calls “crazy love,” the irrational and often deadly tendency to be oblivious to the red flags that indicate you are sharing your life with an abusive partner.

After discussing the typical situations that often lead to an abusive relationship, Steiner states that by asking the  question, “Why doesn’t she just leave him?” we are blaming the victim for falling in love with someone who would go on to abuse them.

While Steiner was not a victim of childhood abuse, many women and men who find themselves in similar situations are.

Victims are never at fault; no one asks to be victimized by their relationship partner. But for those who do have a prior history of abuse and who might find themselves in repetitive abusive cycles, what ability do they have to become aware of their vulnerability to future abuse?  And more important, could such awareness be helpful to them?

When children witness or experience abuse, it can have a detrimental effect on their well being as an adult.  Their experiences have been linked to the development of depression, anxiety, substance abuse, as well as eating disorders later in life.  Early exposure can also place individuals at a higher risk of experiencing abusive relationships in the future.

Joanna Iwona Potkanska, a Toronto-based social worker and trauma-informed psychotherapist says, “We tend to remain in patterns that are familiar to us.   We often do not realize that the relationships we are in are abusive, especially if we grew up in dysfunctional families.”

Based on British psychiatrist John Bowlby’s original work on attachment, theorists view the attachment style one develops as a child as related to adult relational patterns.  Internal understanding of how relationships work derives from primary caregivers and is the basis of later interactions.

“It would be foolish to say that observing domestic abuse from a young age doesn’t have an impact on a person’s future relationships.  It contributes to the construction of a child’s belief system – on how a relationship should be and what it should look like,” says Whitney Wilson, a counselor for the Partner Assault Response program at the John Howard Society of Toronto.

Wilson considers exposure to early domestic abuse as altering one’s view of romantic relationships in many ways.  “It’s similar to having a parent that smokes; smoking becomes normalized and may influence your decision to smoke.  Or, you may dislike that your parent smokes and swear off it.  It really depends on your lived experience and how it affects the formation of your beliefs.”

According to Potkanska, when we experience interpersonal trauma, whether physical, emotional, sexual or spiritual, we often lose our sense of self.  The abuse becomes part of our story and is deeply internalized.

She says that when offenders are also caregivers, victims most often blame themselves.  “The idea that we are loved as we are being abused, or that we are being abused because we are loved(many perpetrators use this excuse to justify their actions) can become a template for the way we relate to the world and ourselves.”

So, if a woman grows up with a model of relationships that involved abuse, anger, and shame, will she believe that she deserves a different kind of relationship?  Or might she believe that a relationship based on support and love simply does not exist?

It depends…  The way people make sense of their early relationships, and the conclusions they draw from them, depend a good deal on what occurs in other important relationships in their lives.  And nowhere is this seen more clearly than in the area of counseling and psychotherapy.

By working with a therapist, individuals can learn to identify how they interpret experiences based on ‘old information’ and can learn to recognize the warning signs of an abusive relationship.

Potkanska says that “without learning how to set healthy boundaries, we allow others to harm us and we re-enact conscious or unconscious situations in an attempt to have either a different outcome, or to reinforce what we already believe about ourselves.”

Healthy attachments to other supportive family members and mentors can buffer the effects of childhood abuse.  For those not fortunate enough to experience positive relationships growing up, there are other ways to break the cycle.

The connection a survivor builds with their therapist is meant to act as a model for secure attachment.  This can then translate to the way the individual perceives themselves and how they interact with others.

Potkanska emphasizes safety and space within the therapeutic relationship, noting that “Simple actions like ensuring that adequate physical space exists between myself and my client shows that I respect their boundaries.”

A large part of the therapy process focuses on building an identity that is separate from the abuse.

“Romantic partners and relationships become a way to soothe and regulate, and so when clients are taught to self-soothe, they are less likely to look to their partner to provide what their perpetrator has failed to do. They eventually rely more on themselves and other resources, including healthy relationships, to meet their needs,” says Potkanska.

Even with therapy, breaking the cycle of abuse can be difficult.  Building an identity separate from abuse can take years of self-work, and often people cannot afford therapy or have limited access to resources.

And then there are the socio-political causes that force people to remain in abusive situations.  Potkanska points out, “Without adequate financial support, women and children are reliant on their perpetrators.  Our legal system does a poor job at protecting survivors of violence, even after they leave the abuser.”  Not only that, but it is usually after the victim has left that they are in the most danger.  Simply because, as Leslie Morgan Steiner states, “the abuser has nothing left to lose.”

So what do people who’ve experienced abuse as children, but go on to have normal and healthy relationships do so differently?

According to Wilson, “It’s really an active process for all of us, even those who were not abused.  Because we’ve allowed society to normalize things like verbal or emotional abuse you have to really know what a healthy relationship looks like and know that it’s hard work.”

Being in a healthy relationship is about giving yourself permission not to have to accept abuse.  And for many, that takes practice.  You have to first identify that you’re stuck in a cycle of violence, and then decide you have the right to break it.

– Jana Vigor, Contributing Writer, The Trauma and Mental Health Report

– Chief Editor: Robert T. Muller, The Trauma and Mental Health Report

Copyright Robert T. Muller

This article was originally published on Psychology Today

Parental Pressure Takes a Toll on Young Athletes

Parental Pressure Takes a Toll on Young Athletes

00Child Development, Family Dynamics, Featured news, Parenting, Resilience, Self-Esteem November, 15

Source: Jim Larrison on Flickr

Two young Jiu Jitsu fighters battle for position, and all I hear are the parents, “Ref, you missed those last two points!” “Jeffery, you’re doing it wrong!” Jeffery gets caught in a dangerous hold, and I end the match to spare him risk of a broken arm.  Afterward the parents approach me, angry I ended it so soon.

As a Brazilian Jiu Jitsu referee, many parents appreciate my concern for the welfare of trainees, but all too often, I’m forced to address those parents who try to motivate their children through put downs.  They call them names, yell, compare them to others, and stress the importance of being number one.  The pressure has a detrimental effect on child health, and leaves them feeling distressed and deflated.

According to Frank Smoll, Professor of Psychology at the University of Washington, parents play a pivotal role in determining whether sport is a fun learning experience or a nightmare. Smoll calls it frustrated jock-syndrome for parents who attempt to re-live their own past successes.

Smoll’s research found that children respond most favourably, not to coaches and parents who punish undesirable behaviours, but to those who sincerely reinforce behaviours that are desirable. For example, instead of yelling at a child for fumbling a ball, a parent or coach should congratulate the young athlete for the assist they made earlier in the game.  This encourages the child to try their best.

The money that parents spend can be a factor too.  Financial investment in sport has been associated with parental expectations. Travis Dorsche, a Utah State University professor and former football player, recently told The Wall Street Journal that “when parental sport spending goes up, it increases the likelihood that either the child will feel more pressure or the parent will exert it.”

As parents spend more on private coaching, equipment and travel expenses, the sport becomes less enjoyable for the child, and the child’s sense of personal ownership over their athletic career weakens.

Parent support is necessary for child success, but there is a fine line between supportiveness and pushiness.

Long term negative effects of overbearing sports parents are seen in two of the most successful athletes of all time, tennis player Andre Agassi, and baseball player Mickey Mantle.  In his international best seller, Open: An Autobiography, Agassi writes that he hates tennis with a “dark and secret passion” because of his overbearing father, and that when he won his first Grand Slam title, his father responded with, “You had no business losing that fourth set.”

Throughout their professional careers, both Agassi and Mantle developed problems with substance abuse.

Agassi turned to methamphetamine because it “swept away every negative thought in [his] head.”  Mantle, who had also been under intense pressure from his father, struggled with alcoholism and contemplated suicide.

According to Northern Illinois’ department of education, pressuring children too much in athletics can result in low self-esteem. These children are also at risk for physical injury, often pushed to perform regardless of pain complaints; they return to the field before fully healing.

For parents with children who play sports, about.com suggests encouraging your child to play the sport he or she enjoys, and supporting your child’s desire not to play a particular sport. Paediatrician and youth sports medicine specialist, Paul Stricker, argues that emphasis should be placed on a child’s effort.  Additionally, this should be modeled by parents and coaches, so children can learn the positivity of competition and effort, regardless of winning or losing.

As a coach and referee, safety is imperative.  Standing by my decisions and explaining that I’m not willing to risk safety may help some parents realize that there are things more important than being number one.

– Andrew McColl, Contributing Writer, The Trauma and Mental Health Report

– Chief Editor: Robert T. Muller, The Trauma and Mental Health Report

Copyright Robert T. Muller

This article was originally published on Psychology Today

Sensory Sensitivity Can Strain Parent-Child Relations

Sensory Sensitivity Can Strain Parent-Child Relations

00Attachment, Child Development, Featured news, Parenting, Relationships, Stress, Trauma November, 15

Source: Camp ASCCA/Flickr

“For a child that has sensory hypersensitivity, every touch is painful. A hug is perceived as a painful gesture.”

So says Yael Ohri, a preschool teacher who specializes in identifying and alerting parents to potential issues their children may have with sensory sensitivity.

Sensory sensitivity is an important concern for some children and their parents. Low sensory thresholds characterize sensory hypersensitivity, in which any touch or experience can overwhelm the child, while sensory hyposensitivity occurs when a child is “under-sensitive” to stimuli.

Ohri was trained by clinical-developmental psychologist Rami Katz at Tel Aviv University, who trains professionals who work with children, in the Neuro-Developmental & Functional Approach (NDFA). Developed by Katz, NDFA aims to address early developmental issues by targeting the underlying source of the problem, rather than the external manifestations like the behavioural and learning difficulties resulting from sensory sensitivity.

Sensory hypersensitivity comes in various forms as it may be experienced through any of the five senses: sight, hearing, touch, smell, or taste. Ohri states that “a child’s skin may be so sensitive that she might complain that the tag in the back of the shirt, or the stitching in the socks is bothersome. Every little thing is experienced so intensely in a way that a child with normal sensitivity would not feel at all.”

Also of concern, over- or under- sensitivity in children can negatively affect the formation of attachment between parent and child.

As Ohri explains, “imagine a new mother who gives her baby a bath, and throughout the duration of the bath, the baby does not stop screaming, it can be very frustrating. The mom may blame herself and say, ‘I’m such a terrible mother, I can’t even bathe my baby,’ or worse, she may get angry with her baby for acting up and proclaim, ‘my baby hates me,’ causing an attachment issue right off the bat.”

To help young children struggling with average intensity stimuli, occupational therapists may stimulate the child’s skin with different brushes that allow the body to moderate the sensory input.

This, as well as other techniques, is designed to help sensory sensitivity. Still, Ohri believes that a critical element of treatment is simple awareness.

“It is essential that parents understand their child’s hyper- or hypo- sensitivity, and that it’s not something that the child is doing to them on purpose.” By raising early awareness, the issue is addressed when it is still relatively easy to treat. Ohri views it as much worse when the issue is not targeted early, leading to fights and stress in the family, as well as parents labelling the child as having a personality problem.

A sensory hyper-sensitive child may be labelled as irritable or whiny. Similarly, a hypo-sensitive child, who tends to be rougher, does so “not because he’s doing it on purpose, but instead, because he needs to hold and feel you and in order to do that, he does so more strongly. This kind of child is often labelled as violent.”

The problem is that this type of labelling can result in a self-fulfilling prophecy where the child ends up thinking of himself as difficult or rude, identity characteristics that become difficult to break free of later on.

Ohri argues that awareness helps. “Once parents become aware that the child has a sensory sensitivity, and begin asking themselves the right questions about the child’s day-to-day behaviours, they learn to alter their interaction with their child in order to avoid conflicts.”

Does simply being aware solve the problem altogether? No, but it’s a start.

“It doesn’t necessarily mean that the child stops being sensitive, but it helps moderate the difficulties and makes the child’s environment more understanding. This applies to both the child and the family. As both sides become more aware, living with sensory sensitivity becomes more tolerable. Mothers are amazing, if they are made aware, they find the solution.”

But what about parents who struggle with their own mental health? Parents dealing with personal trauma may find it harder to perceive signals coming from their child and may interpret them inaccurately.

According to developmental psychologist, Sarah Landy, at the Hincks-Dellcrest Centre in Toronto, parents who don’t have their personal needs met due to past trauma, find it difficult to emotionally connect with their children and respond sensitively to their needs. “When parents are unavailable due to trauma,” says Ohri, “awareness alone won’t do the trick, since the parents might not be able to get there on their own.”

So, parents who work toward resolving their own struggles with mental health will likely become better attuned to their children’s cues and respond to them more sensitively.

Sensory hyper- and hypo-sensitivity can be resolved relatively easily when targeted early, but can become a more complex issue when ignored or treated incorrectly, or when parents are not emotionally available to notice the problem.

Through the difficulties, Ohri emphasizes, “awareness is key.”

– Noam Bin-Noon, Contributing Writer, The Trauma and Mental Health Report

– Chief Editor: Robert T. Muller, The Trauma and Mental Health Report

Copyright Robert T. Muller

This article was originally published on Psychology Today

Dysregulation: A New DSM Label for Childhood Rages

Dysregulation: A New DSM Label for Childhood Rages

00Anger, Child Development, Cognition, Featured news, Health, Parenting, Self-Control, Stress July, 15

Source: Mary Anne Enriquez/Flickr

With the many changes in the newest version of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), among the most significant has been the inclusion of Disruptive Mood Dysregulation Disorder (DMDD)—a direct response to the dramatic increase in the diagnosis of bipolar disorder in children and adolescents during the 1990s.

Diagnosing bipolar illness in children is considered elusive at best.  Characterized by extreme and distinct changes in mood, bipolar illness ranges from depressive symptoms to manic “highs.”  In younger populations, the shift between manic and depressive episodes is not so clear.

Children often experience abrupt mood swings, explosive and lengthy rages, impairment in judgment, impulsivity, and defiant behavior.  Such parent-reported symptoms became a popular basis for childhood bipolar disorder diagnoses.

In recent years, Ellen Leibenluft, a senior investigator at the National Institute of Mental Health and an associate professor at Georgetown University, developed the concept of “severe mood dysregulation” as distinct from bipolar disorder.  Her research highlights the difference between unusual intense rages, and the distinct mood swings in bipolar disorder.

Anchored in her research, the DSM-5 task force attempted to develop a new classification for a disorder that shared some characteristics with bipolar disorder but did not include the abrupt shifts in mood.  By doing so, the task force hopes the rate of diagnoses for bipolar disorder in children will decline.

The DSM-5 characterizes DMDD as severe recurrent temper outbursts that are “grossly out of proportion in intensity or duration” to the situation.  Temper outbursts occur at least 3 times per week and the mood between outbursts remains negative.  To separate DMDD from bipolar disorder, children must not experience manic symptoms such as feelings of grandiosity, and reduced need for sleep.

Differentiating between bipolar disorder symptoms and rages unrelated to mood swings may very well be a step in the right direction.

But some studies suggest that DMDD may not be all that distinct or useful as a diagnostic entity different from those already in use, such as oppositional defiant disorder or conduct disorder.  It may be that DMDD is not a condition of its own, but rather a primary symptom of a larger issue.  Irritability and rages may be an indication of a disorder already established in previous versions of the DSM.

Aside from diagnostic labels, taking social situations into account may lead to a sharper understanding of rages in children.

While the role of biology cannot be discounted in the development of mental disorders, childhood behavioral problems may be affected by social and economic circumstances. Financial hardships and other parental stresses have an effect on children’s mental well-being, and stress may be detrimental to the communication between the parent and child.

Along with biological conditions, the DSM task force should consider the impact of the child’s social experience.  Helena Hansen, assistant professor of psychiatry at the New York University School of Medicine, argues that the recent revisions in the DSM-5 have missed key social factors that trigger certain biological responses.  Her article, published in the journal Health Affair, emphasizes the importance of understanding how social and institutional circumstances influence the epidemiological distribution of disorders.

For example, differing temperaments can explain why some children appear to cope well with life stresses while others develop problem behaviors.  Lashing out in the form of rages and tantrums may be a natural response to intolerable anxiety and stress for some children.

As new terms for disorders are coined, such as DMDD, we need to ask if the development of another category is the best alternative.  Is substituting one label of childhood behavioral problems for another really our best option?

Due to the many possible causes for temper outbursts, giving the child a single label may not be all that helpful.  Instead, determining the core issues surrounding the rages may be more useful in providing the patient with an effective treatment plan.

Also, let’s keep in mind that mental disordersare simply constructs, not unique disease states.  They are developed to allow better understanding of a group of behavioral, emotional, and cognitive symptoms, and are regularly revised based on new research and changing cultural values.  While the DSM is useful for the purpose of understanding the challenges faced by patients, it should not be given “bible” status.

Along with mental health care providers, it is important for parents to get informed about DMDD, to ask questions, and to get involved in discussions when considering treatment options for their child.

– Khadija Bint Misbah, Contributing Writer, The Trauma and Mental Health Report

– Chief Editor: Robert T. Muller, The Trauma and Mental Health Report

Copyright Robert T. Muller

This article was originally published on Psychology Today

When a Parent is Incarcerated

When a Parent is Incarcerated

00Behaviorism, Child Development, Featured news, Law and Crime, Parenting, Trauma May, 15

Source: Restless Mind / Flickr

The wildly popular television drama Breaking Bad followed the evolution of a high school chemistry teacher and father turned drug kingpin.  The series came to an explosive end in the Fall of 2013; shows like this often end when the protagonist-criminal’s story ends.

But from a mental health standpoint, just as this occurs new stories begin, particularly for the family.

When parents are arrested or convicted their children face many challenges, one of the most important being the disruption of parent-child attachment.  Research shows that parent-child attachment directly affects cognitive and behavioural development in children, and this disruption can lead to social and behavioural problems later in life.

When a parent goes to prison, young children often develop emotional responses such as sadness, fear and guilt as a reaction to the parent’s incarceration.

These emotional reactions can turn into severe behavioural problems, triggering conflicts between the child and others.  Many children of incarcerated parents develop feelings of anger and aggression, leading to failed friendships in school.  Some may also become depressed and anxious, bringing academic and social challenges.

The child’s attachment to caregivers is important in the development of what psychologists call social cognition (the study of how our thoughts and perceptions of others affect how we think, feel and interact in our everyday life).  Our earliest thoughts about others are learned through our parents.  Children raised without a sufficient parent-child interaction may lose this important experience.  The child may have a difficult time socially, often when they approach adolescence.

The media tend to overlook children of criminals.  In 2005, it was estimated that more than 2.3 million children in the U.S. had a parent in prison.  How can children in this position be helped?

A two-step process, adapted by education professor Glen Palm of St. Cloud State University and the Inside-Out Connections Project, was developed to decrease these children’s odds of developing negative behaviours.

Step 1: Understanding and Awareness

When a parent is incarcerated, the child’s remaining caregivers often don’t know if or how they should explain the parent’s absence to the child.  Once a child understands the situation, they are more likely to adapt to the changes in their life in a positive way.

Clinical psychologist Deonisha Thigpen’s book When a Parent Goes to Prison helps explain incarceration to a younger audience.  It defines what breaking the law is, presents easy-to-understand definitions regarding the justice system, and even provides support to children by explaining that they are not the only one who is experiencing this situation.

And popular children’s television shows like Sesame Street have developed episodes for children with incarcerated parents.  They provide a visual explanation that helps to explain incarceration and how children can eventually explain it to their peers.

Step 2: Visiting the Incarcerated Parent

Once a child understands incarceration and what it means for them, they may be able to visit their parent in prison.  Prison visitations are often portrayed on television and in film, but reality often differs.

Visitors may have to wait an extended period of time before seeing an inmate, which can be challenging when visiting with young children.  Sometimes families of inmates wait for hours, to discover the visiting request has been denied.  When a visit is granted, most correctional facilities have large visiting rooms shared between many inmates and visitors, limiting close parent-child interaction.

A more viable prison visitation program for nurturing a parent-child bond is filial play therapy.  It is only an option for inmates who are not sex offenders and who have not committed any serious violations at their institution.  Once accepted into the program, they are taught how to create a safe and open environment with their child.  Then they meet with their child for one hour a week in a private setting, utilizing these new skills.

Play therapist, Garry Landreth, of the University of North Texas, believes that filial play therapy improves a child’s self-worth and self-esteem, despite the parent’s incarceration.  After a 10-week study, Landreth found that the children began to see themselves as more capable and valuable individuals.

Of course it’s fair to expect convicted criminals to pay for their crimes.  But no child should have to suffer for their parent’s mistakes by being left to grow up on their own.

And when those we incarcerate leave children behind, we’d be wise to consider the kind of future we want for the next generation.  Perhaps a future that gives a shot at something better…for their sake, and for ours.

– Alessandro Perri, Contributing Writer, The Trauma and Mental Health Report

– Chief Editor: Robert T. Muller, The Trauma and Mental Health Report

Copyright Robert T. Muller

This article was originally published on Psychology Today

Child Criminals, Feature2

Children Who Kill Are Often Victims Too

00Adolescence, Attachment, Caregiving, Child Development, Empathy, Ethics and Morality, Featured news, Law and Crime, Parenting, Psychiatry, Punishment, Self-Control, Therapy, Trauma March, 15

Source: torbakhopper/Flikr

In 1993, in Merseyside, England, Jon Venables and Robert Thompson were charged with the abduction and murder of 2-year-old James Bulger.  Bulger had been abducted from a shopping mall, repeatedly assaulted, and his body left to be run over by a train.  Both Venables and Thompson were 10 years old at the time.

The public and the media called for justice, seeking harsh punishment and life imprisonment for the murder of a child.  The boys were labeled as inherently evil and unrepentant for their crimes.

When there are crimes against children, it is common for the public to view the victims as innocent and the perpetrators as depraved monsters.  But what do we do when the accused are also children?

Instances of children (12 years of age and younger) who have killed other children are extremely rare.  In a study conducted by University of New Hampshire professors David Finkelhor and Richard Ormrod for the Office of Juvenile Justice and Delinquency Prevention (OJJDP), murders of children committed by those aged 11 and under accounted for less than 2 percent of all child murders in the US. Cases also tend to differ significantly, so conclusions can be difficult to make.  But there are some similarities that have emerged, telling us about the minds of child murderers.

Children who murder have often been severely abused or neglected and have experienced a tumultuous home life.  Psychologist Terry M. Levy, a proponent of corrective attachment therapy at the Evergreen Psychotherapy Centre, notes that children who have severe attachment problems (which often result from unreliable and ineffective caregiving) and a history of abuse may develop very aggressive behaviours.  They can also have trouble controlling emotions, which can lead to impulsive, violent outbursts directed at themselves or others.

Other similarities among child murderers include having a family member with a criminal record, suffering from a traumatic loss, a history of disruptive behaviour, witnessing or experiencing violence, and being rejected or abandoned by a parent.  Problems in the home can be particularly influential.  If a child witnesses or experiences violence, they are likely to repeat violence in other situations.

What a child understands at the time of the crime is of great importance to the justice system.  The minimum age of criminal responsibility (MACR) is the age at which children are deemed capable of committing a crime.  The MACR differs between jurisdictions, but allows any person at or above the set chronological age to be criminally charged, and receive criminal penalties, which can include life imprisonment.

Many courts consider criminal responsibility in terms of understanding.  So they may consider someone criminally responsible if, at the time of the crime, they understood the act was wrong, understood the difference between right and wrong or understood that their behaviour was a crime.  But this approach has been criticized as being too simplistic.  Criminal responsibility requires the understanding of various other factors, many of which children cannot appreciate.

Children may know that certain behaviours are ‘wrong’, but only as a result of what adults have taught them, and not because they fully understand the moral argument behind it.  Morality and the finality of death are abstract concepts, and according to theorists such as Swiss psychologist-philosopher Jean Piaget (whose theory of child development has seen much empirical support), most children under 12 are only able to reason and solve problems using ideas that can be represented concretely.  It is not until puberty that the ability to reason with abstract concepts (like thinking about hypothetical situations) develops.

Prepubescent children are also not fully emotionally developed, and less able to use self-control and appreciate the consequences of their actions.  This, in combination with the fact that many child murderers are impulsive, aggressive, and unable to deal with their emotions, suggests that when children kill, they are treating their victim as a target, as an outlet for violence.  Most victims are either much younger than or close to the same age as the perpetrators, which may suggest they were chosen because they could be overpowered easily.

Research to date suggests that child murderers don’t fully understand the severity or implications of their crimes.  And psychiatric assessments have shown intense psychological disturbance, making true appreciation of the crime even less likely.  Yet many children have been found criminally responsible and sentenced in adult courts.

Jon Venables, Robert Thompson, and Mary Bell received therapeutic intervention while incarcerated, and have since been released.  As far as the public knows, only Venables has reoffended.  However, Eric Smith (convicted of killing 4-year-old Derrick Robie) remains behind bars today, even though he was imprisoned at 13.

Critics of judicial leniency for children accused of murder often cite the refrain ”adult crime; adult time,” choosing to focus on the severity of the crime rather than the age and competency of the offender.  Make no mistake; the murders of these children were brutal, depraved acts that caused intense suffering for the victims, their families, and communities.

But in our zeal, in our outrage, do we dehumanize these children?  Children who—like their victims—can be victims too.

– Contributing Writer: Jennifer Parlee, The Trauma and Mental Health Report

– Chief Editor: Robert T. Muller, The Trauma and Mental Health Report

Copyright Robert T. Muller

Photo Credit:torbakhopper/Flikr

This article was originally published on Psychology Today

Brain Trauma, feature2

Coping With Traumatic Brain Injury

10Anxiety, Child Development, Cognition, Depression, Empathy, Environment, Featured news, Health, Memory, Neuroscience, Productivity, Sleep, Sport and Competition, Trauma February, 15

Source: Shine In Your Crazy Diamond//Flicker

Traumatic brain injuries (TBI) contribute to many deaths each year, and can lead to the development of secondary mental health problems.  The Centre for Disease Control has reported that approximately 1.7 million TBIs occur every year, and individuals with a TBI commonly suffer cognitive impairments and developmental delays.

The Trauma & Mental Health Report recently spoke with Tricia Williams, a clinical neuropsychologist at Holland Bloorview Kids Rehabilitation Hospital, who works with children who have different forms of TBI.  Williams explained how to improve child development and mental health for individuals coping with a TBI.

Q:  What are the most common injuries that lead to the development of a TBI?

A:  A TBI is caused when an external mechanical force, such as a blow to the head or a concussive force causes harm to the head or body.  Motor vehicle accidents are the leading cause of TBIs.

Other common injuries include falls (which are common in young children and infants), sport injuries, concussions, horseback riding, interpersonal violence (fighting, gun shots, physical hits to the head by person/object,) and war related injuries.

Q:  How is a TBI diagnosed?

A:  Professionals in emergency services diagnose a TBI in the acute state at the time of injury.  They assess the severity of the injury by checking eye responses, verbal responses, motor responses, and mobile ability.  CT scans are initially performed to rule out bleeding and swelling, and then an MRI may be performed as follow up.  Amnesia is another way to diagnose a TBI. The degree of memory loss prior to the event, and difficulty forming new memory can provide more information about the injury. The duration of loss of consciousness can also affect the severity of the injury, which may be ranked as either mild, moderate, or severe.

Q:  What is involved in rehabilitation following a TBI?

A:  In the acute state, the TBI is managed medically, including neurosurgical intervention.  Once stabilized at the hospital, children move on to rehabilitation.  An assessment of physical, functional, and speech abilities are conducted, and occupational therapists and speech and language pathologists then work with the children. Neuropsychological assessments are conducted after the acute state to help children transition back to school.  The children continue with follow-up visits to monitor the impact of the injury on developing cognitive skills.

Q:  As a clinical neuropsychologist, what is your role with patients who have a TBI?

A:  Children are seen as inpatients at the hospital after the injury, and are also seen as outpatients after they have transitioned home.  They can be followed for many years after the injury.  Typically, they are seen during transitional periods such as the transition from primary school to high school.  A thorough assessment of the child’s skills (IQ, memory and learning, language, processing speed, executive functioning, academic skills, visual and motor skills, socio-emotional status) are conducted and compared to previous testing to assess the child’s progress and developing difficulties.

Q:  What daily activities can become difficult for an individual with a TBI?

A:  Activities that can be difficult depend on the nature and severity of the injury, the stage of recovery, and how well they have been supported.  Common complaints across all injuries include:  keeping up with class, forgetfulness, difficulty paying attention, and becoming easily fatigued, overwhelmed, and frustrated.  Because these activities can be challenging, continued support from their physicians and neuropsychologists as well as family support is very important during the recovery process.

Q:  How can secondary mental health symptoms develop from a TBI?

A:  Depression is a common outcome, and can develop as a reaction to the injury or to neurochemical changes in the brain.  Anxiety is also a common reaction to the injury, because if the child is old enough to understand what has happened, they might expect it to happen again.  This is common for children who developed a TBI as a result of a sports injury.  Children can also be anxious about their academic achievement and about performing well in school.  It is important to make patients aware of potential secondary mental health symptoms. But, individuals with a TBI can also have a greater appreciation of life, as they see themselves as survivors.

Q:  What advice can you offer someone with TBI?

A:  Be patient with yourself and try to normalize your emotional variability.  It’s important to ask for and accept help, and to find the balance between accepting what has happened and moving on.  Individuals should keep in mind that while there are variable outcomes, full recovery is possible.  Finding a “new normal” for oneself without becoming centered on the injury is extremely important.

Q:  Do you have any further suggestions for coping with a TBI?

A:  Here is a list of helpful tips:

  • Take additional time on activities as needed
  • Manage fatigue (with exercise/relaxation, sleep)
  • Ask for repetition of key information and written outlines of key terminology
  • Repeat back what people tell you to ensure you are understanding
  • Use your phone or equivalent to make dictated notes and reminders with regularly scheduled playback times
  • Break down (or ask someone to help you break down) larger tasks into smaller manageable parts
  • Choose the time of day when you are most able to accomplish tasks that require more obvious mental effort and sustained attention
  • Recognize the signs that you are losing attention/productivity or becoming overwhelmed and take a break
  • Exercise can help relieve tension, improve sleep and attention
  • Seek out a quiet room to complete work or practice techniques as needed
  • Social support is extremely helpful

Traumatic brain injuries (TBI) contribute to many deaths each year, and can lead to the development of secondary mental health problems.  The Centre for Disease Controlhas reported that approximately 1.7 million TBIs occur every year, and individuals with a TBI commonly suffer cognitive impairments and developmental delays.

The Trauma & Mental Health Report recently spoke with Tricia Williams, a clinical neuropsychologist at Holland Bloorview Kids Rehabilitation Hospital, who works with children who have different forms of TBI.  Williams explained how to improve child development and mental health for individuals coping with a TBI.

Q:  What are the most common injuries that lead to the development of a TBI?

A:  A TBI is caused when an external mechanical force, such as a blow to the head or a concussive force causes harm to the head or body.  Motor vehicle accidents are the leading cause of TBIs.

Other common injuries include falls (which are common in young children and infants), sport injuries, concussions, horseback riding, interpersonal violence (fighting, gun shots, physical hits to the head by person/object), and war related injuries.

Q:  How is a TBI diagnosed?

A:  Professionals in emergency services diagnose a TBI in the acute state at the time of injury.  They assess the severity of the injury by checking eye responses, verbal responses, motor responses, and mobile ability.  CT scans are initially performed to rule out bleeding and swelling, and then an MRI may be performed as follow up.  Amnesia is another way to diagnose a TBI. The degree of memory loss prior to the event, and difficulty forming new memory can provide more information about the injury. The duration of loss of consciousness can also affect the severity of the injury, which may be ranked as either mild, moderate, or severe.

Q:  What is involved in rehabilitation following a TBI?

A:  In the acute state, the TBI is managed medically, including neurosurgical intervention.  Once stabilized at the hospital, children move on to rehabilitation.  An assessment of physical, functional, and speech abilities are conducted, and occupational therapists and speech and language pathologists then work with the children. Neuropsychological assessments are conducted after the acute state to help children transition back to school.  The children continue with follow-up visits to monitor the impact of the injury on developing cognitive skills.

Q:  As a clinical neuropsychologist, what is your role with patients who have a TBI?

A:  Children are seen as inpatients at the hospital after the injury, and are also seen as outpatients after they have transitioned home.  They can be followed for many years after the injury.  Typically, they are seen during transitional periods such as the transition from primary school to high school.  A thorough assessment of the child’s skills (IQ, memory and learning, language, processing speed, executive functioning, academic skills, visual and motor skills, socio-emotional status) are conducted and compared to previous testing to assess the child’s progress and developing difficulties.

Q:  What daily activities can become difficult for an individual with a TBI?

A:  Activities that can be difficult depend on the nature and severity of the injury, the stage of recovery, and how well they have been supported.  Common complaints across all injuries include:  keeping up with class, forgetfulness, difficulty paying attention, and becoming easily fatigued, overwhelmed, and frustrated.  Because these activities can be challenging, continued support from their physicians and neuropsychologists as well as family support is very important during the recovery process.

Q:  How can secondary mental health symptoms develop from a TBI?

A:  Depression is a common outcome, and can develop as a reaction to the injury or to neurochemical changes in the brain.  Anxiety is also a common reaction to the injury, because if the child is old enough to understand what has happened, they might expect it to happen again.  This is common for children who developed a TBI as a result of a sports injury.  Children can also be anxious about their academic achievement and about performing well in school.  It is important to make patients aware of potential secondary mental health symptoms. But, individuals with a TBI can also have a greater appreciation of life, as they see themselves as survivors.

Q:  What advice can you offer someone with TBI?

A:  Be patient with yourself and try to normalize your emotional variability.  It’s important to ask for and accept help, and to find the balance between accepting what has happened and moving on.  Individuals should keep in mind that while there are variable outcomes, full recovery is possible.  Finding a “new normal” for oneself without becoming centered on the injury is extremely important.

Q:  Do you have any further suggestions for coping with a TBI?

A:  Here is a list of helpful tips:

Take additional time on activities as needed
Manage fatigue (with exercise/relaxation, sleep)
Ask for repetition of key information and written outlines of key terminology
Repeat back what people tell you to ensure you are understanding
Use your phone or equivalent to make dictated notes and reminders with regularly scheduled playback times
Break down (or ask someone to help you break down) larger tasks into smaller manageable parts
Choose the time of day when you are most able to accomplish tasks that require more obvious mental effort and sustained attention
Recognize the signs that you are losing attention/productivity or becoming overwhelmed and take a break
Exercise can help relieve tension, improve sleep and attention
Seek out a quiet room to complete work or practice techniques as needed
Social support is extremely helpful

– Contributing Writer: Janany Jayanthikumar, The Trauma and Mental Health Report

– Chief Editor: Robert T. Muller, The Trauma and Mental Health Report

Copyright Robert T. Muller

Photo Credit: Shine In Your Crazy Diamond//Flickr 

This article was originally published on Psychology Today

YN5H0VTR6O

Ritual Abuse, Cults and Captivity

00Child Development, Diet, Environment, Fear, Featured news, Gratitude, Identity, Post-Traumatic Stress Disorder, Sleep, Therapy, Trauma February, 15

It is almost impossible to imagine the realities endured by victims of ritual abuse:  multiple abusers with systematic motives coordinated with the sole purpose of perpetrating and maintaining a cycle of abuse.  Cults and organizations such as David Koresh’s Branch Davidians use torture and sexual abuse to control their members and force them into compliance.

Behind The Abuse

The Ritual Abuse Task Force of the L.A. County Commission for Women defined ritual abuse as involving:

“…repeated abuse over an extended period of time.  The physical abuse is severe, sometimes including torture and killing.  The sexual abuse is usually painful, humiliating, intended as a means of gaining dominance over the victim.  The psychological abuse is devastating and involves the use of ritual indoctrination.  It includes mind control techniques which convey to the victim a profound terror of the cult members…most victims are in a state of terror, mind control and dissociation.”

According to psychologist Louis Cozolino of Pepperdine University, ritual abuse is characterized by a number of perpetrators of both sexes and the presence of many victims.  The abuse is often carried out in contexts where children are in groups, and within families or groups of families.

Often seen are mind-control techniques that involve combinations of extreme abuse and “brainwashing.”  For example, “psychic driving” is defined by psychologist Ellen Lacter (who runs www.endritualabuse.org) as taped messages that are played for hours non-stop, while the victim is in a state of consciousness altered by sleep deprivation, electro-shock, sensory deprivation, and inadequate nutrition.

Researcher Patricia Precin of the New York Institute of Technology, alongside Cozolino, report that many ritual abuse survivors suffer from PTSD.  Clinicians also see a high frequency of Dissociative Identity Disorder (DID) among such adolescent and adult patients.

And in an Australian study of workers at the Center against Sexual Assault (CASA) including psychiatrists, psychologists, and other clinicians, 70 percent of all counselors agreed with a single definition of ritual abuse and 85 percent agreed that ritual abuse was an indication of genuine trauma.  CASA workers were much more likely to believe their client’s ritual abuse and marginally more likely to identify ritual abuse cases than other therapists.

Cozolino references a vast amount of corroborating evidence for the existence of ritual abuse, such as police reports and therapeutic case studies.  In one of his papers he describes one such case:

“A five-year-old victim in the Country Walk case related that one of his abusers at his day-care setting had been killing birds.  This young boy spontaneously repeated the following well-rehearsed prayer to his startled father:

‘Devil, I love you.

Please take this bird with you

and take all the children up to hell with you.

You gave me grateful gifts.

God of Ghosts, please hate Jesus and kill Jesus because

He is the baddest, damnedest person in the whole world.

Amen.

We don’t love children because they are a gift of God.

We want the children to be hurt.’ ”

Although such accounts are well documented, not everyone believes ritual abuse exists. Bernard Gallagher from the Centre for Applied Childhood Studies at the University of Huddersfield considers ritual abuse a result of erroneous diagnosis made by agency workers:

“This includes pressuring children into making disclosures, the misinterpretation of children’s statements and an over-reliance upon preconceived ideas concerning the existence of ritual abuse.  This results in what psychologists and statisticians might refer to as ‘false positives, ” writes Gallagher.

After The Cult

Escaping the torment of a cult is perhaps the most difficult part for a survivor, but recovery and rehabilitation can be just as challenging.  Cozolino and colleague Ruth Shaffer interviewed survivors, focusing questions on recovery.  They reported that the majority considered participation in support groups a necessary adjunct to psychotherapy.

It may seem counterintuitive to treat ex-cult members as a group because their abuse took place in a group setting.  However certain precautions may be taken to make treatment effective.

For example, British researcher Nicole Durocher notes that organizers must take care not to construct a group that resembles a cult gathering in any way.  The support group has to be sensitive to the special needs of each ex-cult member and to the particular context of the cult from which they exited.

The professional in the group must differ from those in other support groups, acting as an advocate-mediator to observe the group, identifying conflicts, clarifying alternatives for resolution, and negotiating compromises.  These support groups occasionally have the professional co-lead the group with an ex-member acting as an observer, guide, and consultant.

One survivor of multi-generational ritual abuse who wishes to remain anonymous, has written a public letter to the Stop Mind Control and Ritual Abuse Today (S.M.A.R.T) organization, reflecting on his own struggle with PTSD.

“My PTSD often reminds me of what it is to be a soldier.  On the battlefield when every moment is life and death, a soldier will do many things and anything to survive.  When the soldier returns to a normal, non-war society he can’t understand why he did the things he did.”

He goes on to say that with the help of therapy, his shattered life and sense of self can be pieced together again:

“I cry, I sing, play guitar, listen to music, sleep normal hours instead of being awake all night, and more than anything else, I try to change who I was… into who I am.”

– Contributing Writer: Justin Garzon, The Trauma and Mental Health Report

– Chief Editor: Robert T. Muller, The Trauma and Mental Health Report

Copyright Robert T. Muller

Photo Credit: https://stocksnap.io/photo/YN5H0VTR6O/

This article was originally published on Psychology Today