The Impact of Trauma on
Brain Development and
Attachment
Contents
Contents ..................................................................................................................................... 2
Diversity issues in the training setting ....................................................................................... 3
The Concept of Attachment ....................................................................................................... 7
Essential carer qualities to meet a child’s attachment needs ................................................... 9
Stages of Normal Attachment Formation ................................................................................ 13
Four Main Categories of Attachment ...................................................................................... 16
Secure Attachment in Children ................................................................................................ 16
The Emotional Style of Carer of a Securely Attached Child ..................................................... 17
Insecure/Anxious/Ambivalent Attachment ............................................................................. 18
Insecure /Avoidant Attachment .............................................................................................. 21
Supporting Children with Avoidant Attachment ..................................................................... 22
Disorganised Attachment Style................................................................................................ 24
Supporting Children with Disorganised Attachment ............................................................... 28
Links between Developmental Trauma (Complex Trauma), Childhood Brain Development,
Attachment and Destructive Behaviour .................................................................................. 29
Child Development .................................................................................................................. 37
Resilience and Coping in Vulnerable Children and Adolescents ............................................. 39
Intervening with children & young people whohave experienced trauma ............................ 42
Abuse – Physical, Sexual, and Emotional ................................................................................. 47
Dissociation .............................................................................................................................. 48
Long-Term Effects of Abuse and Neglect................................................................................. 49
The Role of Caregivers ............................................................................................................. 50
Brain Quiz ................................................................................................................................. 52
References ............................................................................................................................... 53
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Diversity issues in the training setting
People who present courses for Reconstruct make some assumptions, even
though we’re supposed not to, about participants.
These are that the group will contain people from a diverse range of
backgrounds, some visible some less visible, some personal some professional.
This diversity will cover gender, race, sexual orientation, disability and a lot
more including personal experiences, class and religious persuasion.
So this means that the course will
 be presented using variety because people have different learning styles,
 describe concepts using a variety of examples.
The presenters will
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avoid jargon (or at least explain it),
be aware of individual differences within the group and respect these,
avoid the stereotyping of particular groups in society,
be aware of the effect of language,
accept that everyone has the right and the responsibility to challenge.
Additionally the facilitators hope that participants will:
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arrive punctually and stay (but explain unavoidable absences),
respect each other,
maintain the confidentiality of sensitive information,
recognise and value difference,
share experiences,
ask questions,
challenge views constructively.
We hope that this will provide a useful framework within which learning and
development can take place.
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INFLUENCES ON A CHILD’S DEVELOPMENT
Cultural
Environmental
* opportunities such as
sensitive and supportive
parenting
Biological
* inherited characteristics eg
temperament
Access to education
* antenatal and perinatal
history
* threats such as social
and economic deprivation
* general health
* Experience and
encouragement
* vision and hearing
Developmental Progress
Of course there are a variety of influences on a child’s emotional, social and
cognitive development. However evidence from neuroscience identifies the
important impact of a child’s environment and quality of caregiving by the
significant adults around them. Although biology (genes) is thought to play a
part in how we develop as humans, this influence is thought to be much less
than family environment.
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Stages of Emotional Development in Children
Emotional
Age
Emotional Awareness
Expression
Birth-4m
Responds to maternal
facial expressions
Crying
Smiling
Facial expressions of
distress, disgust,
pleasure
5-6m
7-12m
Facial expressions of
anger
Responds to emotions
in the face and voice
of carers
Displays wariness
and fear with
unfamiliar people
Social referencingchecking back to
carers face and voice
to make sense of
experiences
Facial expressions of
sadness(in response
to maternal
separation)
2-3y
Emotional
Regulation
Self-soothing
behaviour such as
thumb sucking, body
movements
Disengaging/avoiding
attention
Information seeking
eg.
Able to label others’
emotions correctly
Displays shame and
embarrassment
Social referencing
Shows empathy
Begins using
emotional language
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4-5y
Expresses complex
emotions
Sophisticated
understanding of
causes and
consequences of
emotions
Uses emotions to
negotiate
interactions with
others
Hiding/modulating
emotions and
expressing socially
appropriate
emotions
Mary D Sheridan –From Birth to Five Years; Children’s Developmental
Progress
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The Concept of Attachment
An attachment is an emotional bond and refers to the social and emotional
relationships children develop with the significant people in their lives. Often
not adequately emphasised in definitions of attachment; attachment is in the
main about developing and maintaining a sense of both physical and emotional
safety, in the face of any experience that provokes a greater level of fear or
anxiety than the baby or child can tolerate without help.
The Importance of Attachment Relationships
Infants are born with an innate relationship seeking and bonding system which
is designed to keep the parent/carer close when the child is most vulnerable
These bonds are referred to as attachment relationships and are crucial as they
have survival value; a child’s physical and psychological safety is dependent on
a secure attachment with at least one significant adult. Although most
preferable, the attachment figure does not need to be the child’s biological
mother; fathers, grandparents, foster and adoptive parents, aunts, uncles can
all provide a secure attachment relationships for a child. The primary task of
the parental relationships is to establish a secure base, made possible and
sustained by the presence, reliability, predictability and consistency of an
attachment figure. Therefore it is not the blood link with the child that
determines attachment formation, rather it is the quality of the relationship
the child will have with a particular adult.
Although infants use a range of signalling behaviour to alert their caregivers
to their needs at crucial times of needing food or comfort, from about five
months onwards a baby’s attachment system for a preferred carer will be
triggered by the following:
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Illness/hurt
absence of parent/carer
strangers present
alone
new/unusual experiences
danger/fear
hunger
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• fatigue
•
Once the baby is mobile (ie crawling or toddling), although they still use facial,
body and verbal signals they are now able to approach the parent themselves
to get their attachment needs met (proximity seeking). Seeking proximity will
also result from experiences of the above conditions.
It is now widely accepted that significant separation from, or loss of the parent
results in psychological trauma for the child. Once attachment is established,
when the attachment figure is out of the child’s sight they experience
separation distress.
Attachment need and seeking is a lifelong feature of being human. Even as
adults when we are ill, stressed or upset we seek comfort from our attachment
figure(s).
The originator of attachment theory John Bowlby, said:
‘Intimate attachments to other human beings are the hub around which a
person’s life revolves, not only as an infant or a toddler or a schoolchild but
throughout adolescence and years of maturity as well, and on into old age.
From these intimacy attachments a person draws strength and enjoyment of
life and, through what she/he contributes, gives strength and enjoyment to
others. These are matters about which current science and traditional wisdom
are at one'
(Bowlby,1980)
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Essential carer qualities to meet a child’s attachment needs
In order to meet the child’s needs for comfort, soothing and reassurance the
following capacities:
Accessibility: parent/carer is present and available- physically and emotionally
Attunement: parent/carer is tuned into to the baby/child’s cues/needs,
emotions and communications with an ability to read them and reflect them
back.
Responsivity: carer sensitively, accurately and directly addresses the
baby/child’s needs
Figure 1-3 outlines diagrammatic representations of the activation of the
child’s attachment system and the most helpful parental responses to enable
the child to feel safe, secure and grow into a healthy child, adolescent and
adult.
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Stages of Normal Attachment Formation
Pre-attachment stage (0-3months)
The infant is totally dependent
responds to and shows preference for the mother’s voice
can discriminate the mother’s smell
smiles and cries indiscriminately- not directed at any one individual but to get
needs met
all reactions are functional to create and maintain proximity with carer for
survival
as yet no specific attachment with one individual
Beginning of attachment around basic safety and security as the carer
structures the infant’s environment through routine and repetitive, predictable
patterns of care giving.
Recognition / discrimination stage (3-8 months)
 Demonstrates protest and distress on separation- vocalizes differently
and cries in a distinct fashion if carer leaves (from about 5m)
 joy on reunion with carer after brief separations
 able to hold eye contact and control level of engagement with carer (e.g.
looking away when too intense)
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Established Attachment (8-9 months –3 years)
 expresses a clear preference for primary carer
 child is comforted on carer’s return
 uses him/her as a reference point for understanding experiences and
situations (social referencing)
 begins exploring – practices separating (within own level of tolerance)
 begins to develop a sense of separateness from carer
 gradually moves to more independent exploration with frequent return
to dependent contact (particularly in presence of novel or frightening
stimuli).
Partnership (3 years and beyond)
 attachment becomes solid
 the child is now able to communicate needs verbally
 can begin to negotiate differences with others
 can tolerate separation from parent for short-medium periods
From the development of a secure attachment bond, a child develops a secure
base and begin to:
 Show basic security/safety and trust
 is curious and explores the environment with increasingly confidence
gradually increasing the physical distance but still requires the
availability of the carer as a secure base for safety, comfort and
reassurance when experiences hurt, fear or anxiety
 shows independence in exploratory play and learning
 develop a capacity to relate to wider groups of individuals others socially
with increasing confidence and pleasure
 develop increasingly complex thinking capacity (cognitive development
through childhood and adolescence) and use of language
 develop self-esteem/self-concept & identity
 gradually develop an age appropriate healthy independence
 develop a capacity for emotional regulation- an ability to tolerate and
express a range of positive and negative feeling states including intimacy
and anger
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It is now known that there is a strong link between secure attachment and
emotional regulation. Repeatedly studies have demonstrated that secure
attachment and a sense of safety in children fosters healthy brain
development and an ability to manage a range of distressing emotions.
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Four Main Categories of Attachment
The function of attachment behaviour in babies is to seek as close and safe a
relationship with a caregiver as the caregiver can manage. This demonstrates
the reciprocity within the caregiving relationship whereby the baby becomes
attuned to the carer’s responses to their range of attachment seeking
behaviours. As described previously not all carers are equally attuned to their
baby’s signals and needs although I have emphasised attunement in the
caregiving relationship just needs to be good enough tol enable the baby to
feel safe and secure. However if the carer is unable to respond in a good
enough manner, the baby will have to adjust their behaviour in order to keep
the carer as close as is possible. This is how attachment styles or strategies are
formed and shaped.
John Bowlby, the originator of attachment theory in collaboration with Mary
Ainsworth, outlined three categories of attachment. Later on a group of
children involved in their research who at the time did not seem to fit any of
the three groups were identified by Mary Main and colleagues.
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Secure – (60-65%)
Insecure Ambivalent /resistant- (15-20%)
Insecure Avoidant- (15-20%)
Disorganised – (4-15%)
Secure Attachment in Children
Carers of securely attached infants have been found to be accessible i.e.
present and available, physically and emotionally to the child. They are attuned
(see indicators of attunement page 5) i.e. tuned in to the child’s needs,
emotions and communications with an ability to read them and reflect them
back. Being emotionally aware and literate themselves, overall they respond
with relative calm, warmth and affection to their child’s needs.
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The Emotional Style of Carer of a Securely Attached Child
• Their own attachment issues are secure or resolved if insecure (they may
have moved along the continuum towards greater security because they
have a secure relationship with their partner)
• They are able to tolerate range of emotions- both positive and negative
• They are able to anticipate & respond to infant’s /baby’s needs
• They are available physically & emotionally to their baby- particularly
when the baby is frightened, anxious or unhappy
• They are emotionally attuned to baby’s/child’s emotional cues/ thinking
and effectively reflect that back to the baby by either holding the baby’s
feelings in mind or direct verbalisations (reflective function).
From the experiencing of attuned caregiving the securely attached child
internalises a positive model for relationships (Bowlby termed internal
working model) which is demonstrated by a positive view of self and others as
well as a capacity to manage stress and challenge (known as resilience). The
internal security that these children, adolescents and then adults carry is
underpinned by the following implicit and explicit beliefs:
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The World is a relatively safe place
The world is an interesting place which I am curious about discovering.
I am lovable and worthy of love
I can develop connection, trust, safety and security in relationships with
others
• I can experience a range of different emotions and trust I can manage
and cope with them (including negative emotions), and know when I
need help.
• I can be vulnerable and reach out to others when I am distressed and
trust I will get my needs me
• I can take healthy risks and believe that I can succeed (self-efficacy)
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Insecure/Anxious/Ambivalent Attachment
From attachment research, carers of anxious/avoidant infants are found to be
unpredictable and inconsistent in their responses to the child’s attachment
seeking cues; sometimes loving and supportive and at other times brusque and
rejecting. Some carers can look to the child to meet their needs and reject the
child when this does not happen. These children have to learn lots of strategies
to gain their parent’s attention and can endeavour to seek constant proximity
to the parent. Because of the lack of security in the relationship the child feels
too anxious to explore and in strange settings the quality of their play is more
subdued than usual.
When the parent re-joins the child after separation the child is angry and
resistant, often hitting out or pushing the carer away. In addition the child is
not easily comforted and can take quite a long time to calm down
Emotional Style of Carer
• Unresolved from own anxious attachment experiences in childhood
• Shows inconsistent caregiving- from available and marginally responsive
to preoccupied or rejecting
• The parent’s mood often dictates their availability rather than the child’s
needs
• When overanxious or overprotective the carer can project their anxieties
on to child
• Can reject child’s approaches for care and the child’s negative feelings
when this is not met (anger)
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Presentation of the Ambivalent Child
• Child highly anxious and insecure- preoccupied with carers availability
(and eventually all other relationships)
• Develop signalling behaviours that are designed to gain carer’s attention
which are reinforced when they work e.g. coercion, demanding, clingy,
coy or aggressive behaviour. Once reinforced these behaviours become
the default position for getting attention and care.
• Can be judged negatively by others as ‘attention seeking’ and ‘approval
seeking’
• When older shows ‘developmentally inappropriate’ separation anxiety
• Often displays extreme emotional reactions to situations and can resist
comfort when offered by carer
• Developmentally inappropriate overreliance on adults help- can lack
confidence in own capacity to manage away from carer- can translate to
other relationships including school.
• Often lack social Needing constant reassurance in relationships- can be
clingy and possessive
• Lack competence in creating and maintaining healthy relationships with
others
• Oscillates from being clingy to withdrawing and rejecting in
relationships.
• Oversensitive to rejection
• Can show high levels of control and coercion in their relationships with
others to gain predictibility
• Can find focus and concentration difficult as they are easily distracted
due to being emotionally preoccupied and constantly focused on the
adults around them (also peers in adolescence
Responding to the Ambivalently Attached Child
 Since high levels of unpredictability have contributed to this attachment
profile development, it is very important that the environment of these
children is highly structured, predictable, consistent and reliable.
 This means the availability of supportive adults around them who are
consistent, predictable and reliable in their availability and create
routines which are adhered to as strictly as possible. Because of the
inconsistent nature of their attachment experiences these children carry
an implicit believe that people do not follow through on their promises,
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i.e. do what they say they will. Therefore following through on
commitments and promises is vital to gain their trust and create security
in the relationship.
Preparing all children for change and transition is important but more so
for a child who feels so insecure in their world. Therefore ideally any
change needs to be planned (with the child if possible) by saying
goodbye somehow from what is being left and introducing to what is
new. The use of drawings and pictures can be very helpful. Creating
visual timetables, calendars and story boards of their day, or events
about to happen can be very helpful.
Create and hold consistent and predictable boundaries with open
dialogue about consequences for negative behaviour. Be careful that the
child is not overly punished; they need to learn the consequences of
their behaviour not that it is wrong to express their needs. Help them
understand this message by ensuring the consequences are delivered
firmly but lovingly.
It is important that these children learn that they do not have to resort
to acting out behaviour to feel noticed and seen through adult attention.
Therefore letting the child know at regular intervals that they have been
seen and validating something about their uniqueness gives them the
message that they are noticed without having to work for it, which will
hopefully over time remove the need to constantly draw negative
attention to themselves.
Symbolic transitional objects (eg. Polished stones, picture cards, shells,
soft toys) can be extremely comforting for a child on separation. The
object is presented to the child as something for them to hold on to
whilst they are away from the person it represents…” so that we can
remember each other” we might say to the child.
These children have problems calming down (self-regulating/selfsoothing when distressed). Help them understand this so that they do
not believe that they are bad or defective in some way. Let them know
that their emotions are acceptable and valid. Gently reflect their
emotions to them so they learn emotional literacy and feel more
comfortable with vulnerability. Teach self-soothing strategies.
Support the child in developing their independence gradually through
breaking tasks into small manageable chunks. Once one part has been
mastered give lots of praise and encouragement to take on the next
part. As their confidence in their ability builds, give increasing levels of
responsibility (age appropriate).
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 Use stories to explore issues of separation, identity and independence.
 Manage endings of relationships extremely carefully- slowly work
towards separation with lots of discussion and preparation
acknowledging the impact of loss for all of us.
Insecure /Avoidant Attachment
Emotional Style of Carer
Carers with avoidant attachment styles have needed to develop a strategy to
be accepted by their own carers or avoid maltreatment in childhood. They did
this by denying/dismissing or minimising their own neediness and vulnerability.
In turn the carer responds to her own child’s attachment seeking behaviour (ie
distress and fear) by blocking, diverting, rejecting or punishing the child or
disconnecting emotionally. Therefore these carers can be harsh and rejecting
or emotionally cut off. There is a strong motivation in their parenting style to
encourage physical and emotional independence and exploration in the child,
from an inappropriately early age. These carers can be difficult to engage as
they often do not perceive a problem with their own emotional disconnection
as it feels safer to avoid intimacy in relationships and therefore they can deny
the significance of this for their child.
Presentation of the Avoidant Child
• In some studies the avoidantly attached child has been found to have lower
quality play than the securely attached child.
• The child learns to minimise attachment seeking behaviours in order to
keep the parent close.
• The child becomes unhealthily self-reliant for their developmental stage
• Behaviour becomes undemanding and compliant- anxious to please
• They do not seek comfort or care when distressed, hurt or otherwise needy
but block or disconnect from the feelings. They often show little seeking out
of contact and or comfort from the parent under circumstances that would
make any child of their age anxious/frightened e.g. separation from the
parent of a one year old. The child downplays the attachment to the parent
and respond to a parent as if they are the same as a stranger. When
separated from the parent they appear as if they are not bothered. We
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•
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know from research that this is not the case as when the heart rate and
cortisol levels (stress hormone) of these children when measured are much
higher than the healthy range.
The child gets the message that emotions are complicated and something
to be avoided as
As they find strong feelings overwhelming and threatening, they avoid
thinking and talking about feelings and supress feelings they perceive as
negative, such as sadness and anger. This can result in unpredictable
explosive outbursts of distress and /or anger (tantrums in younger children)
as they can no longer keep a lid on it.
The suppression and denial of feelings can make them more prone to selfharm/suicide
Because they avoid emotional intimacy socially they can be isolated- always
on the margins
They gradually become avoidant of relationships altogether or relationships
where intimacy is demanded as this is too risky.
They may focus on learning (and eventually work) to avoid relationships
Have problems asking for help from school staff when at school
They have a strong fear of failure
Supporting Children with Avoidant Attachment
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Be respectful of this child’s anxiety about closeness but do not give up
when the child pushes you away. You need to be vigilant for
opportunities to provide nurturing in a way the child can accept. For
example if the child is touch averse you could use hand clapping games
which may well be more acceptable to them than loving touch and hugs.
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
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Over time a graded approach to touch can be used to increase the
child’s tolerance and prevent triggering emotional dysregulation by
moving too quickly. Also help the child to learn that when children are
hurt it is important that adults are their to help the hurts (e.g. comfort,
plasters for a grazed knee etc).
Teach the child that their needs are important and they have a right to
time and focus to have them met
Notice when the child might be struggling with a task on their own and
gently offer to help. You could say….“I can see that you are really good
at……..but everyone needs help from time to time”.
Support the child to develop a balanced perspective of himself/herself in
their strengths and expectations of themselves
The child will need help to cope with failing and getting things wrong; to
learn that there is no such thing as perfection, that everyone loses and
they do not have to be the best at everything. Through gradually helping
the child to recognise what their unique strengths are and to accept the
aspects of themselves which are not perfect, the child will learn to belter
to deal with failure and losing.
In line with the need to hide their distress when their attachment needs
are triggered, these children come to perceives emotions such as anger
and sadness as negative. This leaves these children alienated from
themselves, presenting a false-self to the outside world
(Winnacott,1960)
Be alert that avoidant children are often very compliant and eager to
please. We can inadvertently reinforce this by showing immense
approval and pleasure when the child is ‘good’. These children need to
feel safe in expressing all parts of their personalities and feelings
without being rejected for this. Adults need to communicate this to
them “I would still like you and accept you even if your behaviour was
naughty”. And of course if the child takes a risk in testing this out it is
important that they experience acceptance and validation of their
feelings even if the behaviour is not acceptable.
The child experiences problems connecting with emotions particularly,
emotions of anger and sadness perceived by the child as negative and
not permitted. Look out for situations where it is valid that the child
might feel angry about something and acknowledge this without
expecting them to express it openly (might yet be too frightened to do
so).
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 Sometimes children with an avoidant style of coping will have a sudden
unpredicted outburst of anger (may appear like a tantrum). Do validate
the child’s feelings of anger although you may need to check destructive
behaviour.
 Also presenting emotions in distanced way in the form of talking about
other peoples’ emotions e.g using stories, films, music videos (age
appropriate) is much easier for a child who has needed to emotionally
cut off to deal with his/her emotions. As with addressing the issue of
acceptance of nurture and touch the child needs time to gradually feel
safe with the increased stimulation and contact.
Disorganised Attachment Style
In the early days of Bowlby and Ainsworth’s work, there was a group of
children who they were unable to categorise in term of their attachment styles
in that they did not readily fit into either of the above three types. As
attachment research has gathered momentum a fourth category first identifies
by Mary Main and her colleagues has become more clearly defined and better
understood.
As outlined earlier babies and small children need the secure base in the form
of a receptive and attuned caregiver who is appropriately responsive, to
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retreat to when they feel frightened or anxious in the face of threatening
stimuli. For some children what should be the secure base
This attachment classification is thought to be a result of negative and even
dangerous extremes in the carer’s parenting style. I will draw your attention
back to the circle of security diagram with the child’s healthy exploratory
behaviour and the constancy and predictability of the secure base. The baby
has an awareness that retreat to the welcoming and reassuring arms of the
caregiver is a predictable option if their anxiety on separation reaches levels
too distressing for them to tolerate. This enables them to increasingly widen
their circle of exploration in the world. But what if what should be the secure
base is itself the source of threat for the baby or child? This is what happens in
the formation of disorganised attachment. The child experiences an anxiety
provoking stimulus such as a stranger or separation from the parent but the
parent who should be the attachment base is herself/himself the source of
danger.
This attachment profile is complex as children may show features of both
ambivalent and avoidant attachment. However what is distinct about this type
is that the child has no strategy to cope with fear or stress whereas the other
two profiles are coping strategies in themselves.
Emotional Style of the Carer of Child with Disorganised Attachment
This attachment classification is thought to be a result of negative and even
dangerous extremes in the carer’s parenting style. Recent research has
identified three main features of parents whose children develop disorganised
attachment (Shemmings & Shemmings, 2011).Disorganised attachment in
children is thought to be associated with:
 A number of unresolved loses in childhood accompanied by dissociation
 Demonstrate disconnected and extremely insensitive parenting
 Show low mentalisation and reflective function (a capacity to be able
enter the child’s world and understand the child’s feelings ,experiences
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and perspectives- one of the highest risk factors for maltreatment of the
child
The parents of children who develop a disorganised attachment style may be
either:
a) Frightened- disempowered, developmentally delayed, emotionally
unstable, fragile and highly anxious and therefore unable to provide the
reassuring safe base. These parents collapse under the child’s expressed
need for care and attachment and in many cases the child takes the
position as carer.
or b) frightening- completely dissociated from their own childhood needs and
hurt is triggered by child’s neediness/vulnerability and as a result become
hostile, angry, dismissing, rejecting in the face of the child’s attachment
seeking cues and/or humiliating towards the child when own childhood pain,
abuse and ongoing vulnerability triggered.
As a result these children appear to have no organised strategies for coping
with stressful situations. The child faces a paradox in that the carer is supposed
to be the safe haven but is also the source of the threat and fear (sometimes
terror). (See p28 for further discussion re the mind of the maltreating carer).
The experience of fear without resolution disorganises the child’s attachmentseeking behaviour and they are unable to develop a strategy to cope. Without
the safe haven of a secure attachment figure to buffer them from stressful
experiences, and the addition as the parents as a source of threat, the child’s
whole developmental trajectory is derailed.
Presentation of the Disorganised Child
• Child has no coherent strategy for dealing with the rejection and lack of
bonding or frightening stimuli that present in their environment and
tend to be frightened or confused by their carers
• When their attachment systems are activated, they become
disorganised in emotions, thoughts, behaviour presenting bizarre
behaviours such as freezing, spinning, sexual self-stimulation, unusual
bodily movements or approaching the parent whilst head turned away.
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• Child becomes orientated with self- protection from emotional (and
often physical) threat
• Hyper-vigilant – scanning; inappropriate responses- in survival mode‘here and now’ thinking – fight or flight
• Greater potential for aggressive and violent acting out or bullying
behaviour- especially as a means of hiding anxiety & vulnerability
• Or can become victimised by others (freeze) or victimising of others.
• Behaviour can be very disruptive- demonstrate lots of problems with
impulsivity, hyperactivity and inattention (misdiagnosis for ADHD)
• Or can present as overly compliant but can reject efforts of others to
provide care and concern
• Or can appear completely switched off, withdrawn
and shut
down(dissociation)
• Poor capacity for awareness, ability to reflect on and management of
emotions (emotional regulation).
• Arrested development socially, emotionally and cognitively
• Often underachive educationally- immature learning stage for their
chronological age
• Poor interpersonal relationships as not learned rules of social
engagement and experiences relationships as threatening/unsafe
• Studies have found a high risk for psychiatric problems in adolescence
and adulthood- personality can become disordered
• Emotional experiences –problems differentiating emotions; regulating
emotions; tolerance of emotions- unpredictability of response- easily
overwhelmed by emotions
• Can lack of curiosity about the world- focused on immediate safety and
predictibility
• Can be described by others as manipulative
• Have a need to control their environment and often the people in it-as
these children move into middle childhood and beyond they develop
strategies for controlling relationships with others, including parents to
create predictability. The child feels both powerful and frightened at the
same time.
• Fragment when there is no structure provided in the immediate
environment.
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Supporting Children with Disorganised Attachment
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Firstly these children need to feel safe and secure before they can
function in an emotionally regulated way in any environment.
Dysregulated and disorganised behaviour is often a sign of anxiety and
not feeling safe.
The child requires structure and predictable routines as well as adults
who respond in a safe, predictable and consistent manner.
Talk about the importance of finding safety with the child and with them
build safe spaces in their environment, such as nests, caves or tents.
Encourage the child to create it in a way that feels safe for them.
Adults need to be able to manage and contain their emotions when
triggered by these children to enable the child to feel safe
Factor in the developmental delays these children have experienced, it is
important to take their emotional developmental age rather than their
chronological age into account when interacting with them.
Avoid creating environments which are over stimulating for these
children- ie not too many resources/toys and try and keep relative calm
Use objects to symbolise connection on separation from adults
important to the child
Give the child choices when trying to engage cooperate=ion- avoid
power struggles and backing them into a corner, however it is also
important to gently and kindly let them know that it is the adults job to
take care of them and keep them safe.
Play and physical activities which involve rhythm are very regulating for
these children-e.g. movement to music and dance. This includes
spinning, hanging upside down or hanging from monkey bars.
Provide sensory play experiences such as water, sand, food and paint
Give the child lots of positive feedback about themselves and their
efforts to achieve/do the right thing
Can have a short focus and attention span so take this into account
when setting tasks
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Links between Developmental Trauma (Complex Trauma),
Childhood Brain Development, Attachment and Destructive
Behaviour
Current neurobiological studies demonstrate brain development as experience
dependent whereby key developmental processes are sequentially guided by
childhood experience. This environmental experience whether positive or
negative essentially becomes the organizing framework for a child’s developing
brain. Therefore the infant, baby then child requires adequate levels of
nurture, safety and stimulation to develop along healthy lines.
Unfortunately all too many children in the UK grow up without such basic
facilities, and in fact are subjected to the most extreme forms of neglect and
maltreatment. It is now widely accepted that children require a relatively
secure attachment bond with at least one primary caregiver. This relationship
not only provides the haven of safety necessary for the child to be able to
utilise various developmental drivers in the environment, but also the
availability of the mind of another that helps to structure brain development
around social relationships and self-organisation. A nurturing and facilitating
relationship also enables the child to develop a capacity to manage a range of
emotions; both positive and negative. Furthermore secure attachment
relationships provide a buffering or inoculation against stressful or traumatic
experiences; children who are exposed to trauma in the context of a secure
attachment relationship will overcome the challenges much more readily than
children who have no responsible adult attachment available.
The security of an attachment relationship and the resulting capacity for
thinking and reflection facilitated by the caregiver, stimulates development of
the more sophisticated parts of the brain, the orbitofrontal cortex. This is
involved in complex control and processing mechanisms such as learning,
cause and effect thinking, capacity to reflect on behavior, problem solving,
impulse control, as well as emotional resonance and literacy. Over time
healthy brain development results from an integration of communication
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between this area and the more primitive areas of the brain charged with
survival and emotional responsivity; the brain stem and limbic system which
includes the amygdala and hippocampus.
A caregiver’s ability to facilitate a secure attachment relationship with the child
is determined on the whole by their own childhood experiences of a caring
environment and attachment relationships, and whether they have been able
to address the corresponding issues within themselves if this has not been
provided. This should encourage us to recognise the unconscious mechanisms
that determine these patterns and to hold a compassionate position with
those parents who appear to fail in their capacity to parent in a constructive
way. In the psychological literature it is now well accepted that
intergenerational attachment styles will continue to be transmitted unless the
cycle of deprivation, neglect and abuse is broken by effective interventions
from adults who step into the void.
Attachment studies in infants and children have identified four main categories
of attachment which result from the quality of care and emotional
management from the carer to the child. By far the most extreme and serious
attachment disorder that can develop is a disorganised one. This occurs as a
result of parenting at the hands of a carer who is either frightened or
frightening in the child’s presence. Unlike healthy attachment relationships,
the carer does not function as the child’s haven of safety either because they
are fearful themselves and not adequately robust to manage their own and the
child’s feelings, or they can be the source of threat and fear. Children in such
relationships are left feeling disorientated and chaotic, with no organised
strategy for dealing with stressful experiences; in fact in the face of stress they
crumble and cannot cope. Maladaptive coping mechanisms employed often
include emotional disconnection, withdrawal, extreme passivity or aggression
in order to get their needs met (Solomon, 1986; Perry 1997,2005).
Disorganised attachment pattern has been linked to borderline and antisocial
personality disorder as well as a host of mental illnesses (Green & Goldwyn,
2002).Moreover epidemiological studies demonstrate a strong link with a
number of physical health conditions such as type 2 diabetes, cardiovascular
disorders, obesity, arthritis, gastrointestinal problems, chronic pain, asthma,
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chronic fatigue syndrome (fibromyalgia) and childhood abuse an trauma
(Sachs-Ericsson, Blazer,Plant & Arnow,2005;Drossman et al,2005;Williamson et
al 2002;Golding, 1994,1999; Golding et al 1998;Stein & Barnett- Connor,2000) .
Individuals who experienced negligent, rejecting or extremely harsh parenting
don’t tend to develop a capacity for healthy emotional regulation and
management, particularly in the face of stress or complex social interaction.
Due to constant threats in the environment i.e. lack of attachment, neglect,
trauma and abuse, the child’s attention. energy and brain resources are given
over to keeping themselves safe. This results in poor neurobiological
integration and underdevelopment of the areas of the brain involved with
reflection, problem solving and impulse control, the orbitofrontal cortex
(frontal lobes). The healthy integration of the thinking brain and the emotional
brain remain unsynchronised resulting in an inability to put the brakes on
behavior when in high states of emotional arousal, particularly fear and threat
(van der Kolk, 2003; Perry,1997, 2001b,2005,) Children who have underdeveloped frontal lobe control as a result of the disorganized attachment,
abuse and neglect are therefore more likely to exhibit impulsive behavior.
Research into the impact of neglect, trauma and abuse on a child’s
development overwhelmingly demonstrates that children who are maltreated
are more likely to develop Complex Trauma, a chronic form of Post-Traumatic
Stress Disorder (PTSD; WHO, 2004). The World Health Organisation describes
complex trauma as lasting personality changes following catastrophic stress.
Developmental Traumatology (De Bellis et al.,1999a; De Bellis et al., 1999b)
refers to the effects of maltreatment during childhood, leading to extreme
stress and dysregulation of key systems in the body, including physical
processes (such as brain development and hormonal systems), and
psychological processes (including emotion regulation, attention, and
impulsivity).Healthy responses to fear or danger employ the more primitive
brain mechanisms of the brain stem and limbic system; particularly the
amygdale and hippocampus, which helps to appraise the nature of the threat.
This incorporates a complex series of psychoneuroendrocrine reactions which
result in the mobilisation of resources and responses that help us survive
threat. In everyday life a healthy system is charaterised by a cycle of arousal
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and resolution in response to stress. However the chronic stress of trauma
leaves the child in a constant state of physiological and psychological alarm; a
fight or flight state. The neuroendocrine chemicals flooding the brain do not
switch off (De Bellis et al.,1999a;Carrion et al.,2002; Elzinga et al.,2003; Tarullo
& Gunnar,2006;Pervanidou,2008).This protracted fear without resolution is
what is thought to do children harm in the long term, where certain areas of
the brain are damaged from the persistently high levels of stress hormones.
Over time this state can become set in the brain with an enduring sensitivity
to, and poor capacity for the management of stress, as the thermostat for
stress tolerance resets (Perry,1997,2005 ). An overactive amygdala is thought
to be responsible for symptoms such as general hypervigilance, an exaggerated
startle response, irritability and anger outbursts. Children can adopt a range of
mechanisms to cope with and to manage the resulting unbearable brain states,
for example experiencing relief through evacuation by having a fight or selfmedicating through illicit substances to address their agitation or as an
illusionary attempt to gain control over it. Moreover they may shut down
emotionally, dissociating or numbing from all feeling as a means of survival and
flight from the unbearable pain.
Children who have suffered abuse and neglect at the hands of their caregivers
often develop significant emotional and behavioural difficulties as well as
mental health problems. They are left to grow up in a world in which they feel
alone and consistently fearful, often without adequate and effective
intervention from a care system that is charged with keeping them safe. In the
extreme these children can go on to develop dangerous ‘coping mechanisms’
including severe mental health problems and violent, antisocial behaviour.
Other children in the community may feel extremely threatened by initiators
(other young people who are entrenched in street culture), and be forced to
adapt to survive life on the streets, also turning to aggressive behaviour and
developing mental health problems as a result of the need for self-protection
and chronic stress. The cycle of aggression and violence can spread like a virus,
generating anger, resentment, and fear (Camila Batmanghelidjh,2008).
There is an observed correlation between the levels of a child’s
mental/emotional fragmentation and their ability to manage their daily lives.
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There is wide reaching evidence that this is related to disrupted attachment
relationships and repeated and protracted traumatic experiences.
These children and adolescents are frequently been involved in antisocial
behaviour and carry a host of diagnostic labels from the mental health systemmany with multiple diagnoses such as ADHD, Autistic Spectrum Disorder (ASD),
Conduct Disorder and Oppositional Defiant Disorder. Often these diagnoses
have been granted without the developmental trauma being factored into the
assessment criteria. Because of the trauma and resulting emotional
dysregulation that in turn stems from the negative impact on brain
development, these children and young people present with emotional profiles
and behaviour that is similar to that included in the diagnostic criteria for the
above psychiatric illnesses. The current psychiatric diagnostic classification
system does not have the assessment framework and treatment formulations
necessary to capture and accommodate the full range of difficulties that
chronically traumatised children are faced with (Cook et al 2003, van der Kolk,
2005).
One critical element in determining psychopathology outcomes is when and
how often trauma occurs in the context of a relationship with the primary
caregiver; either as a direct perpetration by the caregiver or in the presence of
their lack of ability to keep the child safe. This differentiates chronic or
developmental trauma from discrete traumatic experiences, which can lead to
symptoms of Post Traumatic Stress Disorder (PTSD).The current PTSD diagnosis
does not capture the profound psychological harm that occurs with prolonged
and repeated traumatic experiences. Complex Trauma describes a
psychological injury that results from protracted exposure to prolonged
social/and or interpersonal trauma with a lack or loss of control,
disempowerment, and in the context of either captivity or entrapment i.e. the
lack of a viable escape route for the victim. In children, it describes the
simultaneous or sequential occurrence of child maltreatment that occurs
within the care giving system, and also incorporates the impact of exposure to
traumatic events on immediate and long-term developmental outcomes.
Complex Trauma is associated with enduring sequelae that not only
incorporates but also extends beyond PTSD, which rarely captures the extent
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of the developmental impact of multiple and chronic trauma exposure
(Luxenburg et al., 2001). The addition of a category specific to the repeated
and enduring experiences leading to Chronic/Developmental Trauma to DSM
V(the Diagnostic & Symptoms Manual used for mental illness diagnosis) ,
would set out not only the pervasive impact on development and functioning,
but also specific treatment considerations that would accommodate the need
for a diverse range of interventions.
These children experience places of safety and establish trust in services that
are primarily child centered and needs led. Once they feel safe and secure they
begin to share the stories of their traumatic lives littered with episodes of
abandonment, violence, violation and overall neglect. These children present
with profound emotional problems that require therapeutic intervention,
however having been violated in what should have been an attachment
relationship; many find it too difficult to trust in order to be able to avail of
these interventions, at least initially until the trust is given time to develop.
The level of emotion and cognitive chaos that these children and young people
carry, coupled with their attachment issues, renders them susceptible to
difficulties in managing their lives, particularly once they are living alone. They
present with marked problems of impaired emotional regulation leading to
particular deficits in interpersonal skills, stress and frustration tolerance (often
leading to aggression and violence), as well as a poor capacity for problem
solving. Unresolved developmental trauma can result in a revolving cycle of
destructive behaviour and life experiences (a psychological phenomenon
recognized as ‘a compulsion to repeat the trauma).Therefore these children
and young people are extremely vulnerable to a host of social problems
including homelessness, prostitution, substance misuse and often crime,
stemming from a need to feed themselves or their families or to fund the drug
habit. They are wide open to the exploitation and abuse from others as they
have needed to resort to basic survival actions and are often ill equipped with
the skills to keep themselves safe.
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In Conclusion
It appears that enduring and psychological injury results from persistent
exposure to prolonged social and/or interpersonal trauma with loss of control
and disempowerment. In children, it describes the simultaneous or sequential
occurrence of child maltreatment that occurs between a child and their
primary care-giver (including failure of attachment), whether a parent or
within the care-system, and also incorporates the impact of exposure to
traumatic events on immediate and long term developmental outcomes
(Luxenberg et al., 2001).
Childhood maltreatment can have devastating effects on a number of areas of
a child’s life, and has been shown by Perry (2002) to derail the child’s entire
developmental trajectory across the domains of psychological, emotional,
social and cognitive functioning. Parts of the brain involved in socialbehaviours, learning and memory become impaired leaving the child
disorganised and having to adopt a range of maladaptive coping mechanisms
to manage the brain chemistry and difficult emotions.
Physical abuse and chronic neglect have been found to be the strongest
predictors of future victimization and antisocial behaviours (Widom, 1989;
Maas et al., 2008). Research using brain scanning techniques in adults who
exhibit antisocial behavior has shown similar patterns of abnormal structure
and functions as seen in adults and children with a history of abuse
(Raine,2002; Yang et al.,2005; Glenn & Raine et al.,2008; Rubia et al.,2008;Yang
et al.,2008).
This constitutes a significant public health problem and can be viewed in three
ways:
1.
The individual cost to the child or young person in terms of
emotional wellbeing, mental and physical health, and education
2.
The impact on intergenerational patterns of parenting and care
living expanding the number of people with attachment disorders
and associated social/mental health problems.
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3.
The cost to society of antisocial behavior in terms of police and
criminal justice resources, public safety, national health service
resources, and the continuation of the cycle of abuse and violence.
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Child Development
Indicators of Developmental Problems
Physical Development
 Problems with fine and gross motor skills- picking up/manipulating
objects, physical coordination problems- e.g. clumsiness
 Stunted Growth – short stature syndrome (result of neglect- non-organic
failure to thrive)
 Speech and language problems- receptive (difficulties understanding
what is said eg an instruction from a teacher) or expressive- difficulties
expressing their thoughts and emotions)
 Problems with toilet training- wetting/soiling (after the age of about 3)
 Impaired brain development- lack neuronal wiring up- smaller
hippocampus, cortex and corpus collosum.
 Physical bone growth problems from rickets - malnourishment or lack of
calcium/vitamin D in their diet (brittle bone disease)
 Self-neglect- despite an expectation that the average child/young person
can care for themselves physically and nutritionally by the age of 16there is evidence of poor personal hygiene
Cognitive Development- (thinking, planning, problem solving, emotional
regulation, reading social and emotional cues)
 Poor imagination (may be related to ASD autistic spectrum disorder)
 Unable to read social signals/body language (may be related to ASD)
 Not learning from experience – unable to link cause and effect
 Inappropriate responses to common experiences
 Unable to see/understand another’s point of view
 Inflexibility in responding to others or situations
 Difficult to make choices
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 Poor communication/self-expression skills (expressive and receptive
language delay)
 Lack of awareness about safety
 Poor problem solving- gives up easily
 Poor attention span
 Poor impulse control
 Working memory problems
 Poor planning/ sequencing capacity
Emotional & Social Development
 Problems with regulation of emotions- anger, distress, anxiety and
excitement-emotional outbursts, impulsive behaviour
 Destructive acting out- aggression, violence, bullying. Also includes
premeditated or sadistic behaviour.
 Excessive attention seeking- constantly demanding of attention and
affection
 Withdrawn – avoiding eye contact (unless other explanations account for
this eg cultural or autistic spectrum disorder).
 Reluctance or fear of communicating verbally. Selective mutism- chooses
to speak or not speak in certain contexts.
 Problems relating to others- may avoid engagement with others (loner)
e.g. in play or groups.
 Over familiar in relating or poor relationship boundaries
 Sexualised behaviour- age inappropriate
 Lacking empathy or compassion
 Low self-esteem
 Desensitisation to pain/ dissociation- abnormally high pain threshold
 Inflexible responses to others or situations
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Resilience and Coping in Vulnerable Children and Adolescents
Resilient children are better equipped to resist stress and adversity, cope with
change and uncertainty, and to recover faster and more completely from
traumatic events or episodes.
What do we know about resilience?
Evidence from longitudinal studies indicates that a large proportion of children
recover from short-lived childhood adversities with little delectable impact in
adult life. Prospective studies of representative populations tend to find a
weaker relationship between early trauma and adult outcomes than
retrospective studies.
An excessive pre-occupation with the identification and elimination of risk
factors may weaken the capacity of children to overcome adversities. Gains
made by removing risk factors should be greater than any negative unintended
consequences that may occur through intervening. All interventions in health,
education and social care may do harm as well as good. Where children,
families and communities have the resources to deal with adversities without
remedial help, services should not seek to provide unnecessary interventions.
Where adversities are continuous and severe, and protective factors are
absent or minimal, resilience in children is a rare phenomenon. Contrary to the
beliefs of many adults, the most common sources of anxiety for children tend
to be chronic and transitional events, such as bullying, an absence of friends,
extended parental conflict or changing schools, rather than, for example,
bereavement, acute illnesses or environmental risks such as abduction.
Chronic problems will usually have more lasting effects than acute adversities.
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While self-esteem is a crucial factor in the promotion of resilience, high selfesteem is not, as often assumed, always a protective factor. There is little
empirical evidence to support the widely held belief that, for example,
bullying, delinquency and anti-social behaviour are strongly associated with
low self-esteem. Self-esteem is more likely to grow and be sustained through
developing valued skills in real life situations, than just through praise and
positive affirmation.
It is necessary to promote children’s ability to resist adversities as well as
moderating risk factors.
Resilience can only develop through exposure to manageable stressors. Both
physical and psychological resistance develop through gradual exposure to
difficulties at a manageable level of intensity, and at appropriate points in the
life cycle.
A supportive family is the most powerful resilience-promoting factor. The
acquisition of valued social roles, the ability to contribute to the general
household economy and educational success are resilience promoting factors.
Poor early experiences do not necessarily “fix” a child’s future trajectory.
Moreover compensatory interventions in later life can trigger resilient
responses.
Factors that promote resilience:
Children and young people who are best equipped to overcome adversities,
especially those which occur during period of transition will have, or be helped
to have:
 strong social support networks
 the presence of at least one unconditionally supportive parent or
parent substitute
 a committed mentor or other person from outside the family
 positive school experience
 a sense of mastery and a belief that one’s own efforts can make a
difference
 a range of extra-curricular activities that promote the learning of
competencies and emotional maturity
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 the capacity to re-frame adversities so that the beneficial as well as the
damaging effects are recognised
 the ability – or opportunity – to “make a difference” by, for
example, helping others through volunteering, or undertaking part time
work
 exposure to challenging situations which provide opportunities to
develop
 both problem-solving abilities and emotional coping skills
In order to promote resilience in children, services should:
• ensure that well co-ordinated health and social care services are delivered to
low income mothers from early pregnancy
• provide reliable lay or professional support to isolated mothers during the
child’s infancy
• encourage the involvement of male partners in child care
• make available high quality pre-school provision based on sound pedagogic
principles
• seek to identify children’s strengths even if they are not directly related to a
formal curriculum
• encourage early mastery of skills and encourage independent thought and
action
• not shelter children excessively from risk
• encourage problem-solving as well as emotion-coping strategies
• offer opportunities and support in adolescence for volunteering, part-time
work and other situations that enable children to exert agency.
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Intervening with children & young people whohave experienced
trauma
In order to meet the complexity of need and myriad of developmental deficits
experienced by children and young people who have endured trauma, a
multifaceted approach is required. This takes into account the neglect and
fragmented functioning that result from the experiencing of
complex/developmental trauma, particularly during their most formative years
of development. One of the many pieces of good news from Neuroscience
research is that the brain is now thought to be plastic or malleable long into
adulthood and despite adverse childhood experiences, with appropriate care
and intervention, it is possible for different areas of the brain to ‘wire’or
connect as we learn from new experiences. Therefore models which focus on
the provision of comprehensive reparative care, which are designed to address
the underlying brain deficits and provide children with the relationships, care,
structure and enrichment experiences that facilitate optimal development, are
vital for recovery in the most traumatized children.
Create a place of safety: This includes psychological safety as much as physical
safety. Environments which lack care and empathy maintain the child in a state
of self-protection and defensiveness. Adults who find it difficult to regulate
their emotions, manage stress and contain anger create emotionally unsafe
environments for traumatized children.
Provide predictability, reliability and constancy in the relationship: This helps
build trust and enables the you person to feel secure in working relationship in
order to be able to use it for personal growth and development.
Recognise behavior as a communication:
Over time children learn how to express and regulate their emotions, lessening
the need to act them out as is seen characteristically in very young children.
This capacity is underdeveloped in traumatized children and therefore they are
more likely to act their feelings out rather than express them openly. Therefore
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it is helpful to reflect on the behavior of a traumatized child and ask yourself
the question ‘what are they trying to tell me when they act out in this way?’
Taking a moment to reflect on this buys you a window of time to understand
and also to manage your own arousal so that you can respond constructively to
the child’s behavior, giving them an opportunity to think and reflect
themselves. For example ‘I can hear that you are feeling angry that you were
stopped going on the trip to Brighton,it is ok to feel angry about that, however
it is not ok to hit Connor/kick the chair’ etc. With repeated acknowledgement
of feelings and reflecting them back as well as separating them from the child’s
behavior, the child will begin to understand their complex emotions better and
gain greater control over their behavior.
Understand that the child will need help to learn how to manage their
emotions and to be able to express them openly and comfortably without
acting them out. Following on from the previous point, responding
constructively to a child’s feelings through empathic attunement and
validation as well as the giving of emotional vocabulary, enables the child to
develop a capacity to manage a range of emotions, particularly when in high
states of emotional arousal.
Enable children to talk about their experiences: once feeling safe emotionally
many children will seek opportunities to express the realities of their
experiences. It is helpful to the child for this to be facilitated with sensitivity,
empathy and validation. Children who have experienced repeated adversity
can carry with them feelings of blame, distorted perceptions/belief systems as
well as conflict and confusion about their past experiences. Creating
opportunities for a child to explore their experiences safely e.g. through life
story work, helps them to resolve many of the conflicts through the
development of a coherent narrative of their experiences, enabling them to
move on to achieve their personal potential.
Enable the child to see their qualities &strengths: children need to experience
themselves as other than the problems that have blighted their lives. Lack of
attachment and repeated trauma can leave children feeling empty of selfefficacy (I can do something/I am good at something) and self-esteem. Foster a
child’s self-esteem by helping them cultivate what they are good at.
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Traumatized children can lack motivation in trying to learn. There can be many
reasons for this. Often it is because of a fear of failure and the humiliation it
can bring. Helping a child build on small successes can ignite their desire to
learn and achieve and to take risks in the process.
Relational Approaches to Working with Children & Adolescents
Dan Hughes who has extensive experience working with the most traumatized
adolescents advocates the PACE approach in his model of therapeutic
intervention. His emphasis is on the potential healing power and impact of the
relationship built between the child/young person and practitioner. When
conceptualizing the influence of the relationship in working with young people
he considers the following:
Intersubjectivity- The impact of one’s subjective experience on another and
vice versa- reflecting back one’s experience of the inner life of anotherconveyed through non-verbal expressions eg eye gaze, voice pattern, gestures
and posture within an interaction between two people.
Dan advocates approaching relationships with PACE
Playfulness- practitioner engages with a young person using humour
appropriately as a way of creating a connection and a positive relational
experience. There are times when approaching difficult situations using
humour can help ease tension and enable parties to talk about difficult issues.
Acceptance- this entails accepting the young person totally without negative
judgment or evaluation. This is not inferring that we accept dangerous or
destructive behavior without checking it or setting boundaries, but rather it is
the unconditional acceptance of the person the young person is.
Curiosity- always being curious is incredibly important in order to develop a
clear understanding of the unique experience and perspective of the young
person in order to be able to envisage how we can help them.
Empathy-underpins all if we are to develop effective working relationships
with young people. This includes attentive listening and attunement to the
feelings behind the words which the young person expresses.
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Relationships based on intersubjectivity have meaning for young people and
include the following considerations:




What is salient to the child or adolescent
Impact of adult responses through matching intensity of feelings
Adult intention matches that of young person
Adult focused on all aspects of young person’s life- not agenda
driven/technique/diagnostic orientated
which only encourages
resistance & withdrawal
 Adult not primarily focused on rules and enforcing appropriate
behaviour but able to approach the exploration of issues in an empathic,
supportive and respectful way.
Intersubjective Relating Principles Foster the Relationship & Working Alliance
through:
 Matching- non-verbal expression of affective state (attunement &
empathy)- rhythm and intensity of thoughts and emotions enables a
person to feel felt. There is a need to defend the self from someone who
is dissatisfied with it and therefore wanting to change it. The self needs
to be respected and accepted before consider allowing another to try
and influence him to consider changing his behaviour.
 Pay Even Attention to all Aspects of the Young Person’s Life- not just
problems- interests, strengths, successes, challenges, dreams,
relationships. More effective to follow the adolescent’s attention than to
force him to follow the adults.
 Have an Intention to Get to Know & Enjoy Being with the Young Person
–the relationship need to be reciprocal. Intentions of adult and
adolescent congruent. A cooperative/collaborative stance is required
when interacting- not likely when the adult’s intention is to fix, change,
rescue or improve the adolescent- this will be experienced as an
intrusion into the self- a threat to the identity the young person is
working to establish- will only feel safe if self accepted and not judged.
Needs to have an impact on the adult –something to offer the adult
from their ‘self’- Intimacy in relationship and working alliance
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enjoying time together with adult genuinely moved by adolescents
strengths, courage, honesty and compassion
Helping children learn to think before acting (impulse control)
 How do we ensure that children who have experienced developmental
trauma have their individual needs assessed so that we can create
individualised care plans to address neglect and trauma and resulting
developmental deficits?
 How do we ensure structure, routine and predictability within the
environments we provide for the child?
 Do we plan and discuss situations with a child in order to prepare them for
what is expected of them in new and unfamiliar situations such as how to
behave in a restaurant, at the theatre or the doctor’s surgery. How can we
teach children how to deal with situations they find challenging in order to
demonstrate appropriate behaviour? One way would be using role play.
 How do staff read and understand and interpret a child’s emotional
expression and behaviour?
 How do we provide a consistently calm and peaceful presence whilst
modelling the behaviours we hope the child to display?
 How do staff model self-regulation i.e. being calm, nurturing and
authoritative when dealing with challenging behaviour
 Are we alert to rising levels of impulsive activity in the child and can we
redirect him/her to a quieter activity such as reading a story together in
order to prevent overarousal/stimulation
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Abuse – Physical, Sexual, and Emotional
Physical abuse can cause direct damage to a baby’s or child’s developing brain.
For instance, we now have extensive evidence of the damage that shaking a
baby can cause. According to the National Centre on Shaken Baby Syndrome
(2009), shaking can destroy brain tissue and tear blood vessels. In the shortterm, shaking can lead to seizures, loss of consciousness, or even death. In the
long-term, shaking can damage the fragile so that the child develops a range of
sensory impairments, as well as cognitive, learning, and behavioural
disabilities.
Babies and children who suffer abuse may also experience trauma that is
unrelated to direct physical damage. Exposure to domestic violence, disaster,
or other traumatic events can have long-lasting effects. An enormous body of
research now exists that provides evidence for the long-term damage of
physical, sexual, and emotional abuse on babies and children. We know that
children who experience the stress of abuse will focus their brains’ resources
on survival and responding to threats in the environment.
This chronic stimulation of the brain’s fear response means that the regions of
the brain involved in this response are frequently activated. Other regions of
the brain, such as those involved in complex thought and abstract cognition,
are less frequently activated, and the child becomes less competent this type
of information.
One way that early maltreatment experiences may alter a child’s ability to
interact positively with others is by altering brain neurochemical balance.
Research on children who suffered early emotional abuse or severe
deprivation indicates that such maltreatment may permanently alter the
brain’s ability to use serotonin, which helps produce feelings of well-being and
emotional stability.
Altered brain development in children who have been maltreated may be the
result of their brains adapting to their negative environment. If a child lives in a
threatening chaotic world, the child’s brain may be hyper alert for danger
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because survival may depend on it. But if this environment persists, and the
child’s brain is focused on developing and strengthening its strategies for
survival, other strategies may not develop as fully. The result may be a child
who has difficulty functioning when presented with a world of kindness,
nurturing, and stimulation.
Dissociation
Infants or children who are the victims of repeated abuse may respond to that
abuse – and later in life to other unpleasantness – by mentally and emotionally
removing themselves from the situation. This coping mechanism of
dissociation allows the child to present that what is happening is not real.
Children who “zone out” or often seem overly detached may be experiencing
dissociation. In some cases, it may be a form of self-hypnosis. Dissociation is
characterised by first attempting to bring caretakers to help, and if this is
unsuccessful, becoming motionless (freezing) and compliant and, eventually,
dissociating. Dissociation may be a reaction to childhood sexual abuse, as well
as other kinds of active, physical abuse or trauma. Children who suffer from
dissociative may retreat to the dissociative state when they encounter other
stresses later in life.
This type of response may have implications for the child’s memory creation
and retention. The brain may use dissociation to smother the memories of a
parent’s abuse in order to preserve an attachment to the parent, resulting in
amnesia for the abuse. However, the implicit memories of the abuse remain,
and the child may experience them in response to triggers or as flashbacks or
nightmares. In its most extreme form, the child may develop multiple
personalities, known as dissociative identity disorder.
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Long-Term Effects of Abuse and Neglect
Maltreatment during infancy and early childhood can have enduring
repercussions into adolescence and adulthood. As mentioned earlier, the
experiences of infancy and early childhood provide the organising framework
for the expression of the children’s intelligence, emotions, and personalities.
When those experiences are primarily negative children may develop
emotional, behavioural, and learning problems that persist throughout their
lifetimes, especially in the absence of targeted interventions. The Adverse
Childhood Experiences study is a large-scale, long-term study that has
documented the link between childhood abuse and neglect and later adverse
experiences, such as physical and mental illness and high-risk behaviours.
Some of the specific long-term effects of abuse and neglect on the developing
brain can include
 Diminished growth in the left hemisphere, which may increase the risk
for depression
 Irritability in the limbic system, setting the stage for the emergence of
panic disorder and posttraumatic stress disorder
 Smaller growth in the hippocampus and limbic abnormalities, which can
increase the risk for dissociative and memory impairments
 Impairment in the connection between the two brain hemispheres,
which has been linked to symptoms of attention-deficit hyperactivity
disorder
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The Role of Caregivers
Many children who have suffered abuse and neglect are removed from their
homes by the child welfare system for their safety.
These children may be temporarily cared for by extended family, foster
parents, or group home staff, and some will be adopted. In these cases,
educating caregivers about the possible effects of maltreatment on brain
development may help them better understand and support the children in
their care. Child welfare workers may also want to explore any past abuse or
trauma experienced by parents that may influence their parenting skills and
behaviours.
It is important for caregivers to have realistic expectations for their children.
Children who have been abused or neglected may not be functioning at their
chronological age in terms of their physical, social, emotional, and cognitive
skills. They may also be displaying unusual and/or difficult coping behaviours.
For example, abused, or neglected children may:








Be unable to control their emotions and have frequents outbursts
Be quiet and submissive
Have difficulties learning in school
Have difficulties getting along with siblings or classmates
Have unusual eating or sleeping behaviours
Attempt to provoke fights or solicit sexual experiences
Be socially or emotionally inappropriate for their age
Be unresponsive to affection
Understanding some basic information about the neurobiology underlying
many challenging behaviours may help caregivers shape their responses more
effectively. They also need to know as much as possible about the possible
particular circumstances and background of the individual children in their
care.
In general children who have been abused or neglected need nurturance,
stability, predictability, understanding and support. They may need frequent,
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repeated experiences of these kinds to begin altering their view of the world
from one that is uncaring or hostile to one that is caring and supportive. Until
that view begins to take hold in a child’s mind, the child may not be able to
truly engage in a positive relationship. And the longer a child lived in an
abusive or neglectful environment, the harder it will be to convince the child’s
brain that the world can change. Consistent nurturing from caregivers who
receive training and support may offer the best hope for the children who
need it most
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Brain Quiz
Answer True or False. (Explain your answer on Flip chart)
1. Basic brain connections are laid down before birth?
2. Babies are born with the ability to learn all the languages in the world?
3. A human baby’s brain has the greatest density of brain cells connectors
(synapses)by the age of three?
4. Because the brain is making so many connections pre-birth to age three
the first three years of life are the most critical for brain development
.After age three ,the window of opportunity” closes?
5. Good nutrition is one of the best ways we know to aid healthy brain
develop
6. Reading to a new born infant is the best way to help a child learn to read
in the future?
7. Living in an orphanage as a baby will likely to resulting a negative, long
lasting effects on the brain?
8. There are times when a negative experience or the absence of
appropriate stimulation is more likely to have serious and sustained
effects on the child?
9. The large majority of what we have learned from research conducted on
animals rather than humans?
10.Brain research has been misunderstood and
contexts?
misapplied in many
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References
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