This blog is my place to vent and share resources with other parents of children of trauma. I try to be open and honest about my feelings in order to help others know they are not alone. Therapeutic parenting of adopted teenagers with RAD and other severe mental illnesses and issues (plus "neurotypical" teens) , is not easy, and there are time when I say what I feel... at the moment. We're all human!

Thursday, January 17, 2013

Books and Methods - Food/ Hoarding/ Diet

Atypical eating behaviors are common, especially in children with severe neglect and attachment problems.  Many of our kids have food triggers (especially if there has been a time in their life when they didn't have enough food), emotional eating, depression... and the child can develop significant eating and body image issues. They may hoard food, hide food in their rooms, eat as if there will be no more meals--even if they have had years of consistent available foods.  They may have failure to thrive, rumination (throwing up food), swallowing problems and, later in life, unusual eating behaviors that are often misdiagnosed as anorexia nervosa.

My Child Doesn't Remember the Neglect as an Infant, But His Body Does by Foster2Forever
My son doesn’t have a memory of being hungry as an infant, but his brain does. That baby’s developing brain was hard-wired with a terrifying memory of being hungry, not knowing when he would be fed, and believing he was going to die!
The fear response of fight, flight or freeze would kick in – and my baby would fight! – the only way he could as an infant – by screaming. As he got older, his fear response from hunger escalated from screaming to actual fighting!

Attachment and Eating Disorders (ED) - 
"Research indicates that higher levels of attachment anxiety increase risk for severe ED manifestations and adverse treatment outcomes." ~A Place for Eating Disorders within Attachment Theory’s FrameKelsey N. Wallour, BSFCS

Avoidant Attachment
Primary caregivers of children with an avoidant/ dismissive attachment tended to be emotionally unavailable or unresponsive to them a good deal of the time. This child can develop a feeling that they have no value and expects that they will be rejected and their needs neglected. They may learn to "shut down" their emotions and ignore their needs. Their interactions with food may also be avoidant in nature. Their issues with food may come from an overwhelming desire to elude emotions and feelings of fullness. This might lead to issues with anorexia nervosa.
 (This study mentions that adult patients with this type of ED may not do well in group therapy, but have enormous potential for personal reflective functioning and awareness).

When Kitty first came to us, we found that some of Kitty's "anorexic" tendencies improved dramatically as she became more attached and allowed herself to feel again. Both her physical and emotional feelings returned and once the dissociations improved, I think she started realizing that she was hungry (or constipated, or had food on her face, or needed to go to the bathroom...).

Anxious Attachment
The anxious/ ambivalent child’s caregivers were often unreliable and unpredictable. These children may come across as “needy” because they seek constant validation from others. Instead of dissociating from their needs, they constantly mull over their past experiences and memories which keeps them "agitated" and self focused. They often have difficulty recognizing the needs and emotions/ affects of others. Because they are highly dependent on external sources such as society and peers, the extreme fear of rejection from others worsens their desperate need for approval and high body dissatisfaction.

Anxious attachment patterns are more likely to lead to bulimic symptoms or binge eating disorders, because of their issues with interacting with others and their relationship with food. Their hyperactive/ hypervigilant awareness of stress can lead to a high state of reactivity. Their attempts at coping and self soothing might be bingeing or engaging in the binge-purge cycle.
(This study recommends group therapy in a safe and validating environment for it's adult patients with this type of ED).


Dr. Karen Purvis, PhD of TCU, author of The Connected Child, believes there is a strong connection between nutrition & healing the "kids from hard places."  She lists resources on her website: http://www.child.tcu.edu/resources.asp http://empoweredtoconnect.org/ http://www.child.tcu.edu/Resources/Resources_Topics_Neurotransmitters.htm http://findarticles.com/p/articles/mi_m0ISW/is_282/ai_n19170309 empoweredtoconnect.comhttp://adoptionnutrition.org/


Control Issues -Oftentimes, trauma issues can lead to anxiety and control issues. Eating (or not eating) can be one of the few things our children feel they have control over. "Strictly regulating {their own} food and body weight offers a small sphere of control for people who otherwise feel out of control. When this is the case, unintentional weight gain may lead to thoughts of 'I’m losing control' instead of 'I’m fat.'"

Geraud said it’s common for eating disorders, substance abuse and mood disorders such as depression or anxiety to coexist.
“There are often pre-existing anxiety disorders in people who develop eating disorders, especially as children” she said.
Children tend to think in very concrete terms, she said, and when they have anxiety or other uncomfortable emotions and feel the accompanying physical sensations in their body, they may think that if they can change or control their body, they can prevent those emotions and feelings. Alcohol or drugs might be used for the same purpose. ~Lisa Geraud, senior clinical director at The Moore Center in Bellevue

Food Hoarding  - 

Trauma and Food Hoarding -
"Food hoarding is a common issue displayed by foster-adoptive children. Food hoarding can be central in a child’s world and resistant to change. Additionally, hoarding food behavior can bedevil and bewilder parents. So why does a child hoard food? Often food hoarding is directly connected to significant neglect that the child has experienced in consistently having their basic needs for life sustaining food denied or inadequately met. As a result, the child is forced to become prematurely self-reliant in meeting their own basic needs. For example, in a situation where the parent is chemically dependent resulting in inconsistency in providing and having food available, it would be reasonable that when food is available that a child would view this as an opportunity. It would be logical that a “survival mentality” would be for the child to respond to the availability of food in self-reliant ways which could include over-eating and hoarding food in secretive ways. In neglectful situations, food hoarding is a wise alternative to ongoing food deprivation."

Emotional Eating - 

Trauma and Weight Gain -
Emotional trauma is a very painful experience that can lead to weeks, months and even years of emotional distress. People will turn to a variety of things to help them cope with their intense feelings relating to the trauma. For some people, food becomes a source of comfort as they try to — literally — push down their feelings with food. Trauma and weight gain go hand in hand when the person suffering begins to emotionally eat. Sometimes this emotional eating, combined with the mental effects of the traumatic event, can lead to a serious eating disorder known as compulsive overeating.

Human Connection — Our kids often crave sugary, comfort foods to fill the gaps in human connections. Why Comfort Food Comforts.
Marythemom:  Caregivers also frequently emotionally eat - we use comfort foods as a substitute for the love our children cannot provide.  The average RAD mom gains 10-15lbs a year working with a RAD child.

Distraction/ Dissociation — A way of changing the subject or avoiding dealing with a trauma triggering issue.

Marythemom: When my daughter was having a particularly rough therapy session she would often try to dissociate (flight/ escape) using food. She would suddenly feel like she was "starving" and the session would become all about her wanting to leave and go to McDonalds. When she gets upset she still turns to food. I often mention to her that this feeling is based on her emotions, not actual hunger, and sometimes I can get her to recognize it.

The Addictive Brain - 
Professor Peter Cohen argues that human beings have a deep need to bond and form connections. It's how we get our satisfaction. If we can't connect with each other, we will connect with anything we can find -- the whirr of a roulette wheel or the prick of a syringe. He says we should stop talking about 'addiction' altogether, and instead call it 'bonding.' A heroin addict has bonded with heroin because she couldn't bond as fully with anything else.
So the opposite of addiction is not sobriety. It is human connection.
Marythemom - My son has an "addictive brain." We've seen evidence of it for years, and knew it wasn't the drugs themselves, because the addiction shifted often and he could stop seemingly cold turkey (drugs, alcohol, tobacco, but also sugar, sex, adrenaline, chaos...). A large part of  this is because of his attachment issues - the (in)ability to make human connections. 

Endorphins  — 
Your brain naturally produces these neurotransmitters in response to pain or extreme exertion to take the edge off and generally make you feel amazing. Really amazing. Experts actually compare endorphins to opiates because they deliver such intense pleasure, says psychologist Elizabeth Lombardo, Ph.D., M.S., author of A Happy You: Your Ultimate Prescription for Happiness.


We want to avoid drawing battle lines around food!

Interventions: 

As with all behavior and emotional challenges, a child’s special needs and individual circumstances should be considered when designing interventions. Additionally, professional therapeutic assistance can offer help in the assessment and treatment of food issues. In an effort to understand the function of food issues, the following questions can assist in a parent’s understanding of their child’s food issues.

  • Could there be psychiatric or biological issues contributing to the hoarding/ food issue?
  • Does the child’s history reveal reasons for fixation on eating?
  • Does the child substitute a food fixation for a loving relationship with parents?
  • Are there things that trigger eating problems in the child?
  • Is the child displaying an emotional neediness in the way they eat?

Ways to increase endorphins (besides food):


Attachment: 
Focus on increasing attachment. Here's some ideas - The Attachment Challenge
10-20-10 Each day, look for three moments of connection with your children.
     -10 minutes of closeness in the morning
     -20 minutes of closeness when you get home
     -10 minutes of closeness at bedtime

Exercise:
Not just running. Working out stresses your system, so your brain pumps out endorphins to cope.

Work out together:
In addition to being good bonding/ attachment activity, a small British study found that athletes who rowed together could tolerate twice as much pain (a sign that endorphins are present) as athletes who rowed alone. Working out with others can improve your endorphin flow.

Fewer meds:
A study took a group of children with ADHD, half of whom were on Ritalin and the other half did 20 minutes of exercise every morning that "bounced" their brains in an up and down manner (like jogging or trampolines). Both sets of children were sent to school and the teachers could not tell the difference! The exercise lasts a little less time than the medicine, but you can always repeat!

LOL!
When you get a case of the giggles, your body releases endorphins that increase your pain threshold. So go ahead, laugh until it hurts.

Play!
Not only does playing with your child increase attachment - PACE (Playfulness, Acceptance, Curiosity, Empathy), but it's good for you as well! Don't forget to Play!

Kids live for when their parents step outside their comfort zone to join them in something fun.
Children with a history of trauma desperately need to play every single day. It is one of the ways they heal (write that one on your bathroom mirror and read it every morning). That is an area where I was painfully misguided when I first started therapeutic parenting. I took a stance of expecting them to EARN their play (AND I WAS WRONG!).
Now I know better, so I do better. -Christine Moers, Welcome to my Brain 
Make music:
Your brain spews out even more endorphins when you actively take part in creating music. If you're not a classically trained musician (just guessing here), tap, hum, or dance along to your favorite tunes. The sillier the better (laughing increases endorphins).

Eat hot peppers: 
Even if you love the taste of spicy foods, your body senses the heat and responds the same way it responds to pain. Enter, endorphins! Just be careful with this one - forcing a child to eat hot peppers (or anything) can be considered abusive.

Lavender:
Spritz lavender on your pillow everywhere. In a 2012 study published in Journal of Caring Sciences, women who sniffed lavender essence reported less anxiety than women who sniffed a placebo. The study authors say aromatherapy makes nerve cells release a mix of neurotransmitters, including (You guessed it!) endorphins.

Accupuncture:
I'm not sure how this would work with kids
Why would anyone in their right mind want to be repeatedly poked with needles? Research suggests the pain sends a message straight to the brain, which releases endorphins as a remedy. I'm not sure how well this would work with kids!


Interventions focused on neglect based food hoarding:

It is important to understand how the child’s food issues impact you as a parent. Become aware of your own food issues and explore if they influence your ability or willingness to look at the child’s problem with an open mind and creative flexibility. Also study yourself to determine if the child’s food hoarding personally threatens your role as a provider/nurturer.

Food baskets:
Provide food baskets in the home that incorporate the child’s input in creation and consist of snacks that are healthy and appealing to the child. The child should be told the food baskets will be re-filled and are a “better alternative” than hoarding. If the child hoards the food basket; set limits but do not discontinue. Some schools will also cooperate with food baskets; especially if the child is prone to take other student’s snacks.  (Can also use a fanny pack or cabinet/shelf full of appropriate foods.)

Backpacks:
When packing lunches for school or events, pack a “special container” of food that can be removed and is with the child. This provides a traveling sense of food security and food availability for the child.

"Super Snack Day" (suggested by an awesome Trauma Mama):
First thing in the morning, tell him, "Since I am such a super, awesome Mom, I have noticed how hungry you've been lately. So today I have 15 snacks ready for you! (Show him the pile of small! snacks you've prepared). When you feel hungry, just say 'Mom, may I please have a snack?' And I will say yes!" This removes the need for begging or whining for food. If the child doesn't say, "May I please have..." then he's probably letting you know he really doesn't want the snack, instead this is more about being in control (fear and safety). You stay strong in a loving way and redirect the child to something else. Fluctuate the number of snacks available each day until the child trusts that you really will always feed him/ her and have food available. I have found you have to surprise them sometimes with how amazing and generous you are (while still being in control)! Obviously your goal is not to teach him to need 15 snacks a day, but rather how amazing and awesome his Mom is! :-)

Coupling nurturing with food:
Always positively reinforce any progress the child makes on hoarding behavior. If the child utilizes a food basket, nurture the child when they seek items from the food basket. Positively comment on how all family members are always fed. Weave this message into mealtimes and have this message commented on by various family members.

Teach food regulation:
If child has a tendency to gorge, set a “food time out” after a complete meal is consumed. Make certain this applies to all family members. The goal is to assist the child in learning to experience a sense of “fullness”. The “food time out” should not be presented as denying food but rather delaying additional eating for a prescribed period of time. Describe how the physical sensation of “fullness” feels. Fifteen minutes, after the completion of a meal, is an estimate of the time before fullness will be experienced.


Non- Trauma related Food Issues

Marythemom:  Sometimes it's good to remember that just because our kids have one or more diagnoses, doesn't mean they might not have other reasons for their behaviors and issues too!  Allergies, foods and meds have caused constipation, unusual reactions to medications, and behavior issues.  Some people find that changing diet can help alleviate some of these as well.  A gluten free/ casein free diet is often recommended, especially for children on the autism spectrum.  No red dyes, no processed foods, all raw foods, vegetarian, vegan... so many options!

Medications - Another common problem causing food issues for our kids is medications. Many kill the appetite (especially stimulants for ADHD), and some increase the appetite dramatically (many anti-depressants).

Nutrition/ Allergies/ Supplements

Diet can significantly impact the impaired brain. Neuroscience shows the limbic system is a hot spot for traumatized children (and stressed out parents).  When overused (typical for people dealing with stress/trauma) we can “burn out” the stress receptors.  Additionally we often crave the food(s) to which we are most allergic/sensitive.


Marythemom:  Sometimes it's good to remember that just because our kids have one or more diagnoses, doesn't mean they might not have other reasons for their behaviors and issues too!


Kids with Food Allergies - Safe Eats® Allergy-Friendly Recipes! 
You can search to meet your special dietary needs, or you can browse by category. The "free of" boxes indicate that the recipe can be made without those allergens (it may require substitution to make the recipe safe for your particular needs).

Feingold diet.  http://feingold.org/

Dr. Bernui of Hendersonville, TN was one of the recommended practitioners in Jenny McCarty's 2007 book Louder than Words: A Mother's Journey in Healing Autism. He and other holistic practitioners are investigating nutrition and require much more lab work than what we may be used to:  http://www.restoreyou.net/index.php?tag=NFDTC2R1S.

Dr. Daniel Amen (publisher of SPECT scans of addicted and recovering) http://www.energypsychologycafe.com/healing/amen/gift.asp?id=9876
 

Gut and Psychology Syndrome - Dr. Natasha Campbell-McBride –  Gut and Psychology Syndrome (GAP Syndrome or GAPS) is a condition which establishes a connection between the functions of the digestive system and the brain. Describes how it develops and how to treat it effectively with a sound nutritional protocol. Natural treatment for autism, ADHD/ADD, dyslexia, dyspraxia, depression and schizophrenia.        Videos

Is This Your Child? By Doris Rapp - In this breakthrough book, Dr. Doris Rapp offers a simple yet effective approach to handling "problem" children. Is This Your Child? shows parents how to identify the common foods, chemicals, or common allergic substances that could be the culprits that cause some children or adults to feel unwell or act inappropriately. If your child is always sick, hyperactive, a slow learner, or cranky, the first question you should ask is not "What drug should be prescribed?" or "What have I done wrong as a parent?" Instead, find out the cause.

Love Me, Feed Me: The Adoptive Parent's Guide to Ending the Worry About Weight, Picky Eating, Power Struggles and More by Dr. Katja Rowell - who is known as the feeding doctor. 

Our kids can be so complicated!!

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