Nurturing Adoptions: Creating Resilience after Neglect and Trauma

by Deborah D. Gray

Adopted children who have suffered trauma and neglect have structural brain change, as well as specific developmental and emotional needs. They need particular care to build attachment and overcome trauma.This book provides professionals with the knowledge and advice they need to help adoptive families build positive relationships and help children heal. It explains how neglect, trauma and prenatal exposure to drugs or alcohol affect brain and emotional development, and explains how to recognise these effects and attachment issues in children. It also provides ways to help children settle into new families and home and school approaches that encourage children to flourish. The book also includes practical resources such as checklists, questionnaires, assessments and tools for professionals including social workers, child welfare workers and mental health workers. This book will be an invaluable resource for professionals working with adoptive families and will support them in nurturing positive family relationships and resilient, happy children. It is ideal as a child welfare text or reference book and will also be of interest to parents.

Genres: Adoption, Parenting

511 pages, Kindle Edition

First published October 6, 2009

Reviews

[Roozbeh Daneshvar · Rating 3 out of 5]

This book talks about childhood neglect and trauma, and the impacts on children and their [possibly adoptive] families. As I understand, it is geared towards professionals, but a non-professional could also learn a lot from it (as I did). The first 1/3 is more about the issues and more intimidating, while the last 2/3 is about practical approaches on addressing the past traumas and building attachments.

It was a long read and at points very unsettling (some days I couldn't read more than a couple of pages, as I needed a break). The vignettes helped with conveying the meaning and better connecting the parts of the text.

Below I am bringing a group of quotes from the book. I hope they are helpful, or at least give a feel of how this book is.

Children who lack secure attachments during the time of trauma are particularly at risk for developing traumatic stress disorders.

“The concept of trauma, which is by definition psychobiological, is a bridge between the domains of both mind and body.” Allan Schore

Neurobiologically, trauma shapes the developing brain. Early high stress is especially damaging because brain development is in such an early stage.

The quality of close relationships is the factor that most accurately predicts which people will go on to develop the long-term symptom patterns of PTSD after a trauma (van der Kolk, 2002).

It is critical to recognize that it is not just the traumatic event that needs to be addressed in treating traumatized children. It is the meaning of the event to the child’s sense of self and to the fabric of relationships in children’s lives.

Avoidance of trauma-related themes and frustrating problems is characteristic of maltreated children coming into adoptive families. They do not expect that they can go to adults in order to calm down or to get help when life exceeds their capabilities. And, even when they do go to adults, it is harder for them to calm themselves with parents since they are still learning to trust in their parents’ capabilities.

Many children who have lacked early experiences with regulation spend a lot of time at both the underaroused and overaroused area. They have diagnoses of both attention deficit disorder as well as anxiety. The parents and professionals are working with these children to expand their time in the normal range. They are trying to calm the oversensitized brain at the same time that they are helping children to focus their attention.

When children are always reading themselves for survival it is at the expense of normal processes.

CORT is always present in our systems, rising and falling throughout the day according to a circadian rhythm. Typically, CORT rises in the morning, promoting eating, learning, experience-seeking, and memory consolidation. It falls by evening, allowing us to calm and to sleep. Sensitive, interested, and committed parents who are available for attachment help children to establish normal circadian rhythms and levels of CORT.

Rather than “becoming used to it” in a way that would show resilience or coping, children who are repeatedly exposed to the stress of trauma become more sensitized to it, becoming even more dysregulated by successive traumatic events.

An important part of stress regulation includes the child’s ability to identify an internal state correctly, and an effective, sensitive response to the situation from the parents.

Children who have been neglected learn to expect that their actions will have little to do with what happens in their lives. New parents of previously neglected children must understand that. While they automatically expect their children to show initiative and hope, these expectations constitute a radical cultural change for these children.

It is equally important to process positive emotions with children as it is to process negative emotions.

The capacity to step back from events and analyze them with a sense of perspective is called reflective thought. This ability is regularly missing in children after neglect.

Unlike a daydreamer, however, children who are dissociating are not easily brought back to the present. Dissociating children often seem lost in time.

The advantage to processing traumatic information, by thinking it through and determining its relevance to your life, is that processed information feels like it is in the past rather than in the present. Processed feelings are not as vivid.

an increase in dissociation in a child is always balanced by loss of true coping. The self has mortgaged the future to survive in the present. The balloon payment will come due—usually in teen years.

Post-trauma victims tend to over-interpret life events as threatening.

The trauma experience causes more receptor sites to form in the developing brain. These extra receptor sites prejudice the brain toward interpreting new information in an extreme and paranoid manner.

Life feels a little more predictable when they think they have identified the error that caused their trauma or traumatic treatment. Part of the therapeutic process is helping children disengage from being the cause of trauma.

Good therapy helps children develop the belief that they can lay their weapons down: that they are safe.

Somatization is the term used to describe a feeling of genuine physical distress caused by psychological issues.

In spite of the complexities associated with the earliest effects of maltreatment, the rehabilitation is characterized by stark simplicity. Parents who are sensitive, who are able to model and teach calming and self-regulation, and who are given enough support to keep connecting with difficult children form the healing milieu at home.

In fact, it seems easier to grieve a secure attachment. It was more easily understood than a style in which anger, fear, shame, and a sense of failure inhibit the grief process.

Dismissing adults idealize their parents rather than viewing their relationships objectively and reflectively.

Children who have been traumatized tend to believe that they were not worth being cared for, or that they deserved abuse. Restoring hope is one of the most significant and ongoing tasks when working with children and teens after neglect. Children without hope will not even bother trying to change.

Often, giving children good background information about themselves helps them to identify a “why” for their feelings or behaviors. This suggests and aids making plans for coping with early intrinsic memories.

Parents and professionals need to mirror children’s feelings, describing them and the other person’s corresponding feelings. Use every opportunity to align with them. This is helpful in building emotional attunement and fundamental in forming meaningful relationships with others.

Make sure that children are processing and storing their positive memories. Just because they have fun with you and share important events does not mean that they will remember them later. The brain’s schema, or life pattern, acts as a filter, choosing what to remember and how it is remembered.

Unless we spend a significant amount of time talking with abused or neglected children and reflecting on positive experiences with them, these experiences will often be filtered out.

Children need to be able to share the positive parts of their lives with another who is caring, well-regulated, and positive. This sharing allows them to start changing their life schema, and, thus to hold onto positive memories. Therapists and parents need to spend time carefully working on positive events, breakthroughs, and memories so that they are stored in memory systems. Otherwise, the efficient and stressed brain deletes the positive content in favor of high-stress, negative information, which is required for survival.

The abilities to compromise and to learn how to accept disappointment constitute important attributes of emotional intelligence.

After maltreatment, children may feel anger to the point of excluding sad or lonely feelings. They may have to experience sad feelings through another’s story before they can relate to these feelings in their own lives. Use pictures and storytelling to help them “kindle” with the sad affect, then change the topic to their own story.

the verbal centers of the brain have better stress regulation, so putting things into words helps the teller lower her stress levels

Life is better for everyone when children are met where they are actually functioning instead of expecting them to function as if neglect/trauma had not interfered.

Children are placed into families so that they can learn patterns of intimacy that can only be experienced within a family.

“An important part of empathy is being able to tap into your own pain. If people deny their past, forget their past, pretend that it did not matter, or that it had a positive effect, then they are shut off to some extent from others’ pain. They do not make themselves available for empathic experiences” (Cassidy, 2006).

A stable person will have resolved and derived meaning from his life struggles. He can use these experiences to respond empathically to others, and does not become disorganized or overly emotional when recalling those struggles or losses. These key domains underlie the potential for success in any placement.

Gaps or difficulties with recalling a storyline indicate that some information is neither integrated nor resolved.

The small percentage of prospective families who should not adopt children are also the ones who take inordinate amounts of time away from the child welfare system.

Successful families are committed to the child, not just to their own emotional desires.

Really successful families need a large dose of humility.

Parents and their children are presented with the challenge of coming to know and accept each other authentically. This means that they must put aside their idealistic, wished-for parenting or parents, and love the family members as they are.

Children who have close contact with an adult can “borrow from” or regulate to that caring adult in order to organize facts and feelings about the moves—and about themselves.

Children who are moved correctly actually feel their grief when they move—but they do not feel overwhelmingly anxious, shocked, or frightened.

parents who are “in synch” at least 30% of the time—the definition of the “good enough” parent. That is the percentage that the parents need to aim for when creating an emotionally healthy environment (Fosha, 2004)

Often this step, recognizing the mixed emotions of the foster or kinship caregiver, is skipped when babies are moved. The caregiver, then, will conclude that these are the “wrong” parents. She indicates this in a variety of non-verbal ways to the baby, who squirms, resists and avoids the new parents. As a result, a placement schedule is commonly accelerated in order to avoid conflict. The baby, parents, and caregivers all lose.

Very young children are not able to hold time frames in their minds. Sequencing, and phrases like “the day after tomorrow” and “the day before yesterday” are difficult for them. Because of this, we do not prepare them weeks in advance. This preparation is too anxiety-provoking.

Sometimes the first family will offer to bring the child to the new home or deliver the possessions. While this is a nice offer, it is not as sensitive to the child. It is important for the child to say some goodbyes and see the home that he is leaving.

Limit video games. This type of activity is fun but does not build relationships.

Secure attachment patterns are best developed when children are not stressed and are instead playful, relaxed, and available for relationship building.

(Vera Fahlberg, M.D. cautions that if you want to find out if children like French fries, take them to McDonalds. If you want to find out more about this child, select other activities.)

Negotiation skills tend to be weak in children who have been abused, neglected or traumatized. Working on those skills within an accepting environment is necessary.

Watch for children who look as if they are simply proceeding with life, as this almost always indicates a delayed grief reaction.

Children do not grieve with strangers and cannot do their grief work without facts and access to the emotional strength of others

Do not be surprised if the careful explanations given about what has happened are soon forgotten or twisted. The more shock children are in, the less they integrate.

Occupational therapy is not a solution or substitution for trauma treatment. Sensory issues tend to comprise a piece of the puzzle, or part of the difficulty that children are having, rather than being the source problem.

Many children who have experienced early trauma do not remember the trauma—but they have feelings related to the trauma.

Untreated grief and trauma constantly intrude upon children’s lives. It silently shapes everyday experiences. The children who have not worked on trauma maintain trauma-contaminated core beliefs that distort their developmental perspectives of themselves and others. They either do not develop, or they lose confidence in the protective function of adults or of rules governing other areas of their lives.

Until children have some sense of safety and connection of helping adults, they do not have the emotional resources to deal with trauma.

In the order of the tasks of therapy, concentrate on attachment first, trauma second, and grief last.

Children do not have the emotional resources to grieve alone, so most children will not have progressed through the grieving process until they are attached to their parent. The child needs to have a consistent adult who can support her through her grief in order to get through the grief staging.

Neglected children are particularly helped by discussions that point out the people there to help them in every part of their daily lives, and how to get help.

Verbal memory tends to be impacted by neglect/trauma.

Chris whacked the puppet and yelled out what he was angry about and what the miscreant should have done. As he was able to express these motor gestures that had been inhibited, he would come to the end of a wave of emotion. “There,” he would say. “I’m done.” It is important to give traumatized people a chance to express these inhibited motor desires.

Children who worry want to know what is coming next. They also worry that they will not know how to do something—before they have even had a chance to learn it!

She also practiced thinking about a problem without becoming flooded by the emotions of a problem. This helped her to see challenges from a problem-solving perspective.

People are inherently driven to master situations and to solve the problems that have previously threatened them. Overcoming that which has harmed us in the past helps all people feel safer in their world. Children have an inherent desire to avoid re-experiencing the feelings and thoughts about the situations that harmed them, especially if these experiences occurred before they formed secure attachments with sensitive caregivers. They routinely try to solve this contradiction in imperatives through re-enactment.

[I] prefer not to provide the school with specific abuse information. I limit their information to conveying the child’s needs, not their background.

Sensory processing dysfunction describes the difficulty that people have in taking information through their senses and using this information in a meaningful manner.

Teach them to teach children how to organize by using methods that do not require a lot of mental classification. “First we make the bed. Then we put all the clothes in the laundry or hang them up. Then we put books and papers away. Then we put toys away. Then we take out the garbage. When you are done, I’ll look at your room. I’ll bring up the clean laundry and watch you put it away.” This beats, “Clean your room.”

Adults often get to grief through ideas and events. Children get there by feelings just as often. They may not have a lot of words.

Allow anger to surface as part of the grief process. Do not be afraid of strong feelings, Often they will express rage if they were neglected and abused. That clears the air for the grief to come through. Sometimes they have conflicted loyalties, so they do not want parents to hear some of their negative thoughts about birthparents. (This is a good time to make an appointment with a therapist.)

[Angela · Rating 3 out of 5]

Insightful and very applicable text. I enjoyed reading the real life scenarios on how to interact with children who are victims of trauma.

[Ebookwormy1 · Rating 2 out of 5]

Deborah M. Gray is a trauma counselor who shares her methods in this book targeted at therapists. These kind of books are a lot like parenting books. Each author shares the techniques that work *for them.* Their personality is a significant aspect of what works for them and replication of the expertise of a successful counselor or parent is unlikely. The best one can hope for is to find a few ideas or strategies that one can incorporate into their own counseling/ parenting.

Reading this book was more of a general exposure to the issues and concerns of children who have experienced trauma and neglect, as well as the characteristics of families in which these children are successful.

Things I learned:
1) Ms. Gray progresses from the big picture to techniques to family resilience skills. She also suggests that some learners may want to read the book in reverse. In hindsight, I think I may have benefited from the alternate path.

2) Establishing secure attachment is necessary before addressing trauma. Working through both these issues requires a slow and steady methodology that breaks the matter down into steps. These steps help the child to assimilate specific concepts/ memories/ grief/ self-control issues in a gradual manner to the point they are able to regulate their physical and emotional responses. Ms. Gray seems particularly adept at this process, but it is not something that is greatly articulated (probably because it comes naturally to her).

3) Ms. Gray links mental health with learning the ability to self-regulate and emphasizes that successful parents need to be able to self-regulate in the face of their children's outbursts or shut downs. Every parent gets overwhelmed, and when they do, they need to have strategies for how to get back to a regulated state. Ms. Gray writes in a nurturing and moderated tone, and makes suggestions for how therapists can maintain this peaceful state.

4) One of the things that bothered me is occasionally Ms Gray demonstrates a condescending or dismissive tone toward parents of the children she is attempting to help. This is, unfortunately, common among psychological professionals, and was a disappointment to me. She also criticizes other psychologists for failing to handle trauma and neglect appropriately. To me, these comments indicate this therapy is more of an art than a science and should be interpreted as such. While these lapses of negativity are not common in the 500+ page book, their departure from Ms Gray's otherwise moderate tone is noticeable.

Overall, the book made a solid contribution to a general understanding of the issue. Ms Gray's gentle and nurturing tone was easy to read. However, I did feel it was a bit long, and often seemed to be heavy on abstracts and low on concrete methods. I think it was conceptually helpful, but I'm not sure it will be concretely memorable.

For more on adoption, I recommend:
The Connected Child, Purvis, 2007
https://www.goodreads.com/review/show...

Parenting the Hurt Child, Keck & Kupecky, 2002
https://www.goodreads.com/review/show...

[ratherastory · Rating 4 out of 5]

A very informative book on how parents and clinicians alike can deal with the complexities of trauma, abuse, and neglect in adopted children. It's more theoretical than practical, but that's not necessarily a bad thing. The author was perhaps a little too critical (bordering on condescending) of other therapists and caseworkers in an effort to demonstrate what *not* to do, which was off-putting. Nonetheless, this book is going on my "to buy" list, so that I may have it as a reference later.

[Colleen · Rating 5 out of 5]

I think literally every single person looking to even have a child, birth or adopted, should read this book.

[Tara]

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