How Trauma Affects the Brain
To understand how treatment can be effective, it is helpful to understand brain chemistry. The type of sensory deprivation, neglect and other traumatic events that institutionalized children experience affect the brain's development and may cause dysfunctions such as RAD and PTSD, primarily by increasing stress hormones such as cortisol and adrenaline. Designed to respond to psychological or physical danger, these hormones prepare the body for fight or flight. By prolonged or repeated exposure to trauma (neglect and/or abuse) the child learns that the world is an unsafe place, and the brain remembers this even after the being placed in a loving, safe home. Research suggests that these experiences can also cause imbalances in the brain chemicals serotonin and noradrenalin in genetically susceptible people.
Noradrenaline, the brain's alarm hormone, acts as an emotional accelerator. Traumatic experiences will reset the brain's chemistry so that the child is in a constant state of readiness to respond to any threat - with a racing heart, high blood pressure, easy startle response and instantaneous explosive behavior. Research indicates that high levels of noradrenaline are the chemical signature of PTSD.
Normal levels of serotonin produce feelings of peace, well-being and clear thinking. It is the brakes to the noradrenaline accelerator. If levels are too low, a child may appear overly aggressive, impulsive or depressed. If levels are too high, the brain can be stopped cold, afraid to do anything - like a deer frozen in automobile headlights. In humans, this is linked to the fearfulness and rigidity seen in obsessive-compulsive behavior. Parents provide a safeguard against low serotonin when they comfort infants, tend to their needs, and control inappropriate behaviors by setting limits.
Brain chemistry which is only 5 to 10 percent off normal can result in a wide variety of mental problems. The idea behind the newest mood stabilizer medications such as serotonin re-uptake inhibitors, is that they seem to restore a normal balance to the brain's chemistry.
Chocolate, cookies, and other foods high in carbohydrates will raise serotonin levels. When depressed people binge on these foods they are basically self-medicating. Brain levels of serotonin can also be increased by eating foods rich in tryptophan such as turkey, chicken, salmon, beef, peanut butter, green peas, brewer's yeast, potatoes, and milk.
Dr. Bruce Perry showed that medication which lowered noradrenaline in children with PTSD dramatically reduced their aggressive behavior. Other therapists are attempting to lower noradrenaline by increasing feelings of security through therapy and increased attachments to parents. Even children born with predispositions for high noradrenaline levels and fearful responses should remain clam in stressful situations if they are with a parent they trust. If the child does not feel secure with his caretaker, noradrenaline and hyperactivity go up. This explains why some adopted children do not remain calm in stressful situations, even when they are with their parents: they do not yet trust their parents.
Today there are a variety of treatments available. Holding and other therapies such as EMDR and Neurofeedback, medication, and therapeutic parenting are all designed to do the same thing: increase the level of trust, effect changes in the brain which balance the brain's chemistry, and normalize behavior.
"We have found that "holding"
therapy - first used by Martha Welch, M.D., in her work with autistic
children - is the most powerful vehicle by which therapists and
parents can move a hurt child toward developmental completion.
Therapeutic holdings mobilize development because the close physical
proximity involved in holding a child or adolescent results in
an interpersonal intensity that cannot be duplicated in any other
therapeutic format discovered so far. . . . deep physical pressure
produces a calming of the neurological system. . ."
"When a person is angry, adrenaline and its cousin, noradrenaline, are released. These are "fight and flight" hormones, which have helped humans and other animals survive danger since the world began. With the release of these hormones, blood pressure rises, muscle tension increases, heart rate changes, and respiratory rate increases. The reactions constitute the physical state called arousal. But arousal is the basis of many feelings, not just anger. Anger shares the physiological symptoms of many emotions: joy, excitement, fear, anxiety, frustration, and jealousy. Other causes of increased adrenaline include noise, heat, exercise, hunger, and crowds. People interpret their emotional response to arousal according to their perception of the cause.
It is almost self-evident that our perceptions are colored by emotions and, conversely, that our emotions are affected by our perceptions. . . Imagine how many perceptions are distorted or missed entirely by a child whose life has been dominated by anxiety, frustration, fear, anger, or jealousy because his basic needs have not been met during his early life. It would be harder to convince that child that arousal is pleasurable than it would be to convince a child whose arousal had come mainly from positive sources. The child who experiences arousal as painful or as a sign of danger will work harder to block all arousal, because the block is serving to protect him from painful feelings. However, the block often overreaches, protecting him from good feelings as well. The object is to release that block.
[Welch suggests] that noradrenaline and adrenaline begin to flow during the physical struggle of holding time, the way they would in any exercise as part of the cardiovascular response to muscular exertion. The arousal of the physical struggle usually gives way to the arousal of anger when the mother intensifies her efforts to maintain her hold on the child against his will. As the struggle continues, the child usually experiences a whole range of emotions, but in the safety of her mother's arms. This time the state of arousal is associated with being held lovingly, resolutely, and closely. If the child feels this safety as her mother persists, arousal of emotions reaches a crescendo. After the peak, the arousal is usually transformed to joy and pleasure as the two begin an affectionate embrace.
The neurobiology of attachment suggests that two sets of brain chemicals balance each other to produce the right amount of arousal in a young child. The hormone of arousal, noradrenaline, causes a decrease in clinging behavior, which in turn leads to play and exploration. The other set of brain chemicals, called endogenous opioids, which have been found to decrease feelings of separation anxiety, are released when the child makes comforting physical contact with the mother.
from Holding Time by Martha G. Welch, MDWhat is Holding Time? by Martha Welch and Nancy D'Antonio
For audio & video tapes, books and CD-ROMs: The Martha G. Welch Center for Family Treatment
Eye Movement Desensitization and Reprocessing (EMDR) helps people revisit their trauma, reprocess and desensitize their memories, and resolve their feelings about them. Trauma causes one side of the brain to overcompensate. While the exact mechanism of EMDR's success is not known, Joanne May, PhD. believes that EMDR impacts the information processing center (the connection between the left and right hemispheres), so that both sides of the brain can talk to each other instead of being stuck.
EMDR therapists started using only eye movement, but have found that touch, sound and even vibration work as well. The therapist may use sound, alternating it between the left and right ear or alternate tapping on the client's ankles, arms or shoulders. There are devices which provide a gentle vibration to a small disc which the child can hold, alternating between the left and right hands.
The therapist may do this while the child is expressing the trauma through play or while the mother talks about parts of the trauma or tells a story related to the trauma or adoption. It can even be used to reinforce pleasant feelings such as love and safety or to reinforce concepts that a traumatized child has lost, such as I am worthwhile, or I can ask for help and get it. Some therapists do it during or after Holding therapy to reach deeper feelings of anger, sadness and grief, and reinforce the attachment after the Holding is complete.
When considering this therapy, it is important (and difficult) to find someone who has experience treating young children. This treatment method may not be suitable for the youngest children or those who are severely oppositional, because it does require cooperation on the part of the child.
Recommended books and links:
Small Wonders: Healing Childhood Trauma with EMDR, by Joan Lovett, MD
Through the Eyes of a Child: EMDR With Children, by Robert H. Tinker, PhD and Sandra A. Wilson, PhD
EMDR: A Power Tool in the Treatment of Attachment Disorders
EMDR: New Hope for Children Suffering from Trauma and Loss
EMDR International Association
The Family Attachment and Counseling Center uses narratives (stories) and EMDR to help children process trauma and build attachment. This technique is also appropriate for parents who simply want to address adoption issues with their child.
Joanne May, PhD, founder of The Family Attachment and Counseling Center, says that early neglect/abuse does not necessarily predict the way a traumatized/neglected child will parent as adults. It is rather, the extent to which their life issues are resolved and how they see their own life's story, that determines what kind of parent they will become. Resilience (the ability to overcome misfortune) was the key. In Man's Search for Meaning , Viktor E. Frankl (a concentration camp survivor), defines resilience as the ability to say "I will be different than my beginnings."
The brain in normal people remains plastic (changeable) into old age. Neurons can grow and we can take in new information. But in traumatized individuals, stress releases cortisol which results in the destruction of neurons in the hippocampus, the part of the brain which makes new memories. May postulates that RAD could be a memory disorder, because RAD children can't seem to make or take in new information (like "My new mommy won't leave me, she's not the one who hurt me").
According to May, narratives are as valid as the actual experience because they form new neuro pathways in the brain. RAD kids (especially those who had damage done during first 2 years of life) have formed a conclusion about life: "I'm bad because my birthmother abandoned me". They tend to believe they made it happen. These faulty convictions promote a lot of exasperating behavior The narratives aim to shift the internal working model and change the behavior and produce calm, even in severely dysregulated individuals.
There are three kinds of narratives:
The Family Attachment and Counseling Center
EMDR: A Power Tool in the Treatment of Attachment Disorders
Order Parenting with Stories, a workbook for using narratives
Post-Institutionalized (PI) children suffering from psychological, neurological, or learning disorders might benefit from Neurotherapy. Also referred to as EEG biofeedback or neurofeedback (NF), this treatment involves stimulating or suppressing certain types of brainwaves in specific areas of the brain to achieve optimal levels of human functioning.
In adopted children, the causes of brain dysfunction are many: abuse; neglect; deprivation, emotional trauma, head injury; biochemical imbalances; and genetics; to name a few. These dysfunctions may present themselves as various disorders including, but not limited to: PTSD, RAD, Severe Separation Anxiety, Night Terrors, Learning Disabilities, Attention Deficit, Disorder, Obsessive Compulsive Disorder, and Speech/Language pathologies.
A QEEG, or Brain Mapping is performed prior to the NF treatment. This is a process for analyzing electrical activity in the brain. Electrodes are placed at 24 sites on the child's head. They are connected to a computer where the brainwave patterns are recorded. This Brain Map and subsequent report will provide an overall picture of how the child's brain functions and which areas need modulation. The procedure can take up to an hour and half and requires a child to co-operate and sit still.
The QEEG measures brainwaves at sites that allow us to perform specific tasks; e.g., reading, listening, math, logical thinking, auditory processing, sensory processing, impulse control, etc. If frequencies are too high or too low dysfunction occurs. A trained technician will read the QEEG and measure it against a normal population age-appropriate database to determine the treatment protocol.
During treatment, the child is again connected to a computer, this time using one or two electrodes placed in specific locations on their scalp, and one on each ear. The child chooses a computer game where her brainwaves will actually power the game. For example, if she is daydreaming, wiggling and/or not concentrating, a space-ship will not run. When she is focusing well, the ship will fly through space and she will collect rewards such as planets and stars. Meanwhile, her brainwave frequencies will be measured and the therapist can monitor her progress. This "training" will teach her to "suppress" the brainwaves that interfere with higher level thinking or negative behaviors, and "activate" brainwaves that allow for relaxed, calm states, or states of arousal suitable for classroom learning. Eventually the child will recognize newly trained positive states and switch them on automatically when the need arises.
Neurofeedback alone will not cure RAD. It needs to be combined with other therapies. If you train the brain but don't allow the child to process the emotional trauma of her past, the effectiveness of therapy will be limited.
There are no case studies on NF with Post-institutionalized children. Most studies done on children have been in the area of ADD/ADHD.
The Cascade Center for Family Growth in Orem, Utah, is one of the few treatment centers in the USA that specializes in using NF with RAD and behavior disordered children. Under the direction of Larry Van Bloem, they offer a treatment program that also includes Holding and EMDR.
To find a neurofeedback provider in your area contact EEG Spectrum or Q-metrx. Providers can also be found at Neurology Centers and Pain Clinic Centers in hospitals.
Many, if not most, NF providers will not have experience working with post-institutionalized children. In the case of a typical biological, ADD/ADHD child, a treatment protocol of 15-40 sessions may be adequate. But the parents on Attach-china who have used QEEG brain mapping have found that their children require daily treatment over a period of many months, if not years, since the insult to their brains has been more severe than that of the normal population.
Read about one family's experience with neurofeedback "What Neuro Has Done For Us"
Recommended books and links:
A Symphony in the Brain by Jim Robbins. Overview of the history/development of Neurofeedback including scientific research and technological breakthroughs including case examples.
Introduction to Quantitative EEG and Neurofeedback by James R. Evans (Editor), Andrew Abarbanel (Editor)
Getting Rid of Ritalin: How Neurofeedback Can Successfully Treat Attention Deficit Disorder Without Drugs by Robert W. Hill, Eduardo Castro
Mindfitness Training: The Process of Enhancing Profound Attention Using Neurofeedback by Adam Crane, Richard Soutar
Change Your Brain, Change Your Life by Daniel Amen of the Amen Clinic. Does not specifically discuss NF, but gives a good understanding of the areas of the brain and behavioral problems associated with them.
Inside the brain: Revolutionary Discoveries of How the Mind Works by R. Kotulak.
Behavioral Medicine Associates, Inc.
Frequently Asked Questions (FAQ) about Biofeedback Home Training
According to their website, Theraplay® was developed by clinical psychologist Ann M. Jernberg, Ph.D. It is a therapist-directed play therapy for children and their parents. It is designed to enhance attachment, raise self-esteem, improve trust in others and create joyful engagement in family relationships.
Theraplay is based on the natural patterns of healthy interaction between parent and child., and focuses on five essential qualities found in parent-child relationships: Structure, Engagement, Nurture, Challenge and Playfulness. Theraplay sessions attempt to create an empathic connection between the child and the parents. The goal is to change the child's view of the self from bad, shameful and undeserving to worthy and lovable. It attempts to change the child's view of relationships from unreliable to positive, trustworthy and rewarding. Parents are actively involved in the treatment and direct their child in the theraplay interactions.
Some Attach-China parents have found that a combination of Theraplay and Holding has proven successful in strengthening their child's attachment.
Therapies Which DON'T WORK for Children with RAD
The reason these therapies don't work for children with RAD is that they all depend on a relationship of trust between the child and therapist and/or child and parent. A child with RAD is by definition a child without trust. His or her primary goal needs to be learning to trust his or her parents first, not a therapist. It is imperative that parents be included in the therapy sessions, which is not usually the case in the below mentioned therapies.
Play Therapy involves the child and therapist using puppets, drawing, games, and play-acting to resolve problems.
Sand Tray Therapy is a method used to assess the psychological well-being of children and adults by analyzing how they express themselves through the manipulation of objects in small, tabletop sandboxes (or trays). Sand Tray participants are invited to create a miniature world by arranging toy people, animals, and other items in the sandtray. It relies on the child to work out the trauma herself. But a child who has never had a view of the world which included safety, trust and adults meeting her needs will not know how to achieve that goal on her own.
Talk Therapy involves helping the child to face the memory, and talk through the various upsetting parts. This is used more with older children and teen-agers. However, children with RAD are experts at manipulating therapists by "giving them what they want" and becoming the ideal patient.
Cognitive-Behavioral Therapy uses
small rewards or successes as motivators to replace negative thoughts,
feelings, and behaviors with more useful ones, in a systematic,
stepwise manner. RAD children tend to see these rewards as another
way to trick their parents and prove how stupid adults are.
DisclaimerThis Attach-ChinaWebsite was founded by a parent for parents of children adopted from China who have PTSD or other attachment issues as a resource for these issues. The content selected for the website is intended to share information about various therapies, and although certain articles speak to the success some families have had with those therapies, the website is not intended as an endorsement of any particular therapeutic course of treatment. Families with children with possible PTSD and attachment issues are urged to seek medical advice. If a family begins a therapy without medical advice, they do so at their own risk. Children may have unusual or unique reactions to various types of therapies and "one-size-does-not-fit-all" when dealing with these issues. In particular, some parents have noted that children traumatized while in institutional or foster care may have more extreme or unexpected reactions in holding therapy, and therefore, "Holding" should only be done under the supervision of a licensed therapist with experience in this therapy. This website is not intended to take the place of professional therapy and Attach-China can assume no responsibility for a family's therapeutic choices for their child. |
|
|
