Monday, January 13, 2014

Attachment Trauma

Donald and Harold are examples of children who have been exposed to attachment trauma.  Starting before they were born while their fetal brains were developing, their mother was unable to make a commitment to them and her pregnancy that would result in good pre-natal care and a safe environment.  She is on the run, and they are at risk. Thus they are born prematurely already having experienced a series of insults that could have jeopardized their lives, read "threat of death".  Then they suffer the loss of their mother and her daily consistent care.  Remember, because infants do not have "object constancy", that is the ability to hold the concept of a person or object in their memories when the person is not physically present, they suffer the loss of a primary caregiver as similar to a death.  Certainly, another caregiver like a grandparent can mitigate the disruption in attachment, but it requires constant consistent care.  For Donald and Harold this was obviously interrupted if child welfare services was concerned enough about their safety to make repeat visits to investigate. 

     Then starts the second level of attachment trauma, the introduction of multiple caregivers starting with foster parents and then their adult sister.  With their sister they are exposed to traumas of commission as well as omission.  To be certain, with their grandmother, foster parent, and sister there were likely many occasions when they felt safe and loved, but it never lasted.  Their sister's substance abuse leads to unmet needs; gnawing hunger, untreated illness, lack of developmental play, as she cycles between intense interaction and depressive withdrawal.  A note: hunger at this age can cause serious help problems and even death, and feels like it.  The boys experience adults as highly unpredictable.  The relationship violence in the home leads to intense anxiety and fear, trouble sleeping, and anger in twins barely two years old.  No wonder they started developing some really interesting survival skills; watchful hyper-vigilance, sneaky food hoarding, and the ability to either tune out or run from danger.  These are the still small children who stroll into the first, second, and third foster/adoptive homes.  Despite their best intentions and training none of these subsequent parents can offer consistency from one home to the other.  This is the third level of attachment trauma, no one sticks around long enough to trust. These children are in survival mode.

     At this point the boys move into the next home as if they are traveling salesmen.  Full refrigerator, check. Television with cable, check. A place to park my carry on bag, fine.  Someone at the front desk to keep things running, ok. Chores?  "Wait a minute, I don't clean my own room!" Responsibilities? "This isn't my house!" Say thank you? "You're getting paid for this!"   Here's where all of those nifty survival skills become symptoms of some serious mental health disorders.  The new parent repeats herself with her voice rising in pitch each time.  The new teacher complains that the boys do not follow directions or complete their homework.  It's sounding a lot like Attention Deficit Hyperactivity Disorder.  One boy refuses to turn off the television, and the other refuses to go to bed.  When the new parent removes privileges or says no, one boy flies into a rage and the other ignores it.  It's sounding a lot like Oppositional Defiant Disorder.  When stuff starts disappearing or getting broken and the teacher sends one boy to the principal's office, we're heading toward Conduct Disorder.  Throw in two hour tantrums alternating with sullen crying bouts, and Bi-Polar Disorder looks like a real possibility.  "These boys need medication."  "Not taking it." "You need therapy!" "I won't talk." "These children have to move!"  "Fine, I'm checking out anyway."

     Here's where the situation could go either way.  We could begin focusing on the boys' behavior, putting them in a room alone with a therapist, exploring their "feelings" and offering them rewards and punishments for going with the program.  The new therapist would report some success each session.  But the parent would report no change at home.  Or, we could begin understanding the behaviors as symptoms of a much more complicated diagnosis.  You see, if you put these two boys in a house with no parent, they would probably do just fine.  Ok, like any nine year olds, they would eat cookies for breakfast and forget to flush the toilet.  But they probably wouldn't have these huge blow-ups, even with each other.  The problem is... the parent.  The nice parent is scary.  The predictable parent causes anxiety.  From the earliest age the most primitive parts of their brains are primed to fear parents, to fight care, to flee love, even while their minds tell them they need and want it.  It's post traumatic stress disorder, and the relationship is the trigger.  Like the negative poll of a magnet they are repulsed by attempts to get close to them.  And if, by chance, there is a positive pull, they are unable to break free to function independently.  This is relational PTSD.  The abuse these children experienced happened in the context of what was supposed to be a nurturing relationship.  Now they are in a pretty safe situation, but their brains and bodies don't believe or feel it.  Like soldiers back from the war they are hypervigilant with and distrustful of the person they need the most...the parent.

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