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!

Monday, June 23, 2014

PRESCHOOL BEHAVIOR MGMT Chap 6 ABUSE

PRESCHOOL BEHAVIOR MGMT
CHAPTER 6

ABUSE

Disclaimer:  Most of this information is not my own, a lot is from my favorite attachment guru Katharine Leslie.  

           a.    Physical Abuse
           b.    Verbal/ Emotional Abuse
           c.    Night terrors
           d.    Fight/Flight/Freeze
           e.    Overwhelm / Small Tolerance Window
           f.    Shut down/ Dissociation
           g.     PTSD - Hypervigilance

a.  Physical Abuse - Children should NEVER be physically forced or restrained in any way (except VERY brief restraint in emergency circumstances if unavoidable to prevent the child from harming themselves or others).  This includes holding the child in any way so that he or she cannot move, or placing your legs over a child to force them to lie still during nap.  You must not withhold food, drink, or the restroom.  You should avoid withholding any part of the regular day, such as a planned activity, game, or art project. 

b.  Verbal/ Emotional Abuse has been shown to cause more severe long-term damage than physical abuse!

  •          Shaming - Shaming should be avoided at all costs (our kids do enough of this to themselves).  
  •          Criticism - Criticism should never be public or demeaning, embarrassing or humiliating.  Walk up to the child and talk to him or her softly - preferably away from the group, or just use eye contact or a subtle gesture (when my children get loud or hyper, I hold my hand out flat and lower it – signifying lowering the volume.  At first I also said “Please take it down a notch”).
  •         Belittling – these are subtle ways of ridiculing a child.  They can be any question that you don’t expect an answer to – ex.  “How many times do I have to tell you?”  “What do you think you’re doing?” “Do you ever listen?”  “Helllooo!”
  •        Avoid Threats – A threat is any consequence we say is going to happen, when we know it really won’t.  If you’re not going to follow through it’s a threat, and threats give away your authority and credibility as do repeating an instruction, and giving warnings and not following through.  It can seriously damage the child’s trust.

Some Common Reactions to Abuse 

c.  Night terrors - Despite what the following quote says about night terrors not being common in adolescents, my children are very prone to these.  Many doctors and psychiatrists do not understand night terrors at all (I've had some dismiss the possibility entirely for Kitty).  To me it makes total sense that kids with trauma issues, particularly PTSD would have these.  Kitty will sit up and scream in the middle of the night and talk to herself.   She's been known to sleepwalk as well.  Bear has spoken of being kicked by the devil who was laughing at Bear.

An important thing to note:  people with night terrors usually do not remember having them upon awakening.
night terrorsleep terror or pavor nocturnus is a parasomnia or sleep disorder, causing feelings of terror or dread, and typically occurs during the first hours of stage 3-4 non-rapid eye movement (NREM) sleep.[1] Night terrors tend to happen during periods of arousal from delta sleep, also known as slow-wave sleep.[2][3][4] During the first half of a sleep cycle, delta sleep occurs most often, which indicates that people with more delta sleep activity are more prone to night terrors.[3] However, they can also occur during daytime naps.[5]
Night terrors have been known since the ancient times, although it was impossible to differentiate them from nightmares until rapid eye movement was discovered.[4] While nightmares (bad dreams that cause feelings of horror or fear) are relatively common during childhood, night terrors occur less frequently according to the American Academy of Child and Adolescent Psychiatry.[6] The prevalence of sleep terror episodes has been estimated at 1%-6% among children and at less than 1% of adults.[7] Night terrors can often be mistaken for confusional arousal.[2]Sleep terrors begin between ages 3 and 12 years and then usually dissipate during adolescence. In adults, they most commonly occur between the ages of 20 to 30. Though the frequency and severity vary between individuals, the episodes can occur in intervals of days or weeks, but can also occur over consecutive nights or multiple times in one night.[3][5]
Night terrors are largely unknown to most people, creating the notion that any type of nocturnal attack or nightmare can be confused with and reported as a night terror.[4]
Mayo Clinic:  Sleep terrors differ from nightmares. The dreamer of a nightmare wakes up from the dream and may remember details, but a person who has a sleep terror episode remains asleep.
Children usually don't remember anything about their sleep terrors in the morning. Adults may recall a dream fragment they had during the sleep terrors. Also, nightmares generally occur in the last half of the night, while sleep terrors occur in the first half of the night. 

d.  Fight/ Flight/ Freeze - A child who is dysregulated and/or in fight/ flight/ freeze mode is “thinking” with the reptilian part of the brain (survival!).  Their behavior is a purely instinctual response to what the brain believes is a life or death situation.  The rational part of the brain just isn't online.  Their eyes frequently glaze over, they are out of control, and it is like the child isn't "home."  Afterwards they do not remember what happened just before or during an episode.  Holding a child responsible for what happens when in a true fight/ flight/ freeze is pointless- it’s better to just move on after it's over and try to figure out what triggered it so you can avoid it in the future. 


A “meltdown” is different from being in Fight mode which usually looks more like a rage.  During a meltdown, the child has some control over how far things go. It is still possible to "reach" the child and de-escalate the situation and calm him/her down. 

Our bodies' nervous system is very basic - it doesn't know the difference between say, excitement and anxiety. Medications, calming techniques, and maturity can help the body stay calm and keep from sending "AiieeeAiieeeAiiee" signals to the brain stem. Bear tends to go into "Fight mode" when he's upset, worried, anxious, afraid...  Whereas Kitty tends toward "flight" or "freeze" and she dissociates (distracts herself).  

e.  Overwhelm/ Low tolerance
Kids of trauma usually have a very small window of tolerance.  They react to what appears to be routine problems with meltdowns, rages, dissociation... It is believed that they may be lacking some crucial skills in the domains of flexibility/adaptability, frustration tolerance, and problem solving.  As therapeutic parents, we try to solve the problems that triggered explosive episodes, and teach our child the skills he/she needs to avoid the escalation.  

It is sometimes necessary to simplify a child’s life a LOT to lessen the feeling of “overwhelm.”  This can be like "childproofing" – avoiding and removing things and events that can be triggers.  It can help to strip the child’s room to only a bed, one or two stuffed animals, a book, and not much else.  In times of extreme stress, we’ve removed all of our child’s clothing and the child has to bring dirty clothes to “check out” clean ones.  This helped with hygiene issues, and lessened the amount of times that could make a room feel messy or cluttered. This gets harder as the kids get older, but it is important!

f.  Shut down/ Dissociation
- Unlike the fight/ flight response, this is a more long-term response to continued trauma.  A child may shut down both her physical and emotional sensations as a reaction to not getting her needs met as a child and to protect herself from perceived future harm.  Surprisingly the two are linked.  This meant Kitty wasn't ticklish and thought it was funny to tell people to pinch her forearms or kick her shins, because she couldn't feel it.  At the same time, she had very little affect.  She seemed to only experience one emotion - anger.

To get our child's physical and emotional sensations back, we had to work on it from both sides - physical (neurofeedback and somatic therapy) and emotional (attachment therapy and providing a safe, structured, nurturing environment).  

g.  PTSD/ Complex PTSD/ Hypervigilence
Kids of trauma are often easily triggered, extremely sensitive to emotions, unable to regulate their emotions... causing them to react as if they are in a warzone.  You can't learn and attach if you don't feel safe and you're living in a war zone!  Hypervigilance (obsessively monitoring the environment) is super common among kids with PTSD.  It relaxes when they start to feel safe, but probably doesn’t ever really go away.  

Children of  trauma NEED structure and caring support to feel safe and start to heal.   This feeling of safety is often not based in reality – it is a perceived feeling of safety.  You can think of it as a learned defense mechanism that they need help getting rid of now that they are in a safe environment. 

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