Her Whole Life in a Plastic Bag

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Photo: threeoclockbears.com

 

Tamina attended first-grade in a Harlem public school. She was homeless most of that year. Her mother lost the apartment after she lost her job. Sometimes they stayed with relatives but mostly Tamina, her mother and her sister slept in shelters where they could never stay very long. They carried their belongings in thick black garbage bags, protection from the weather. Tamina used to have a teddy bear, but it got left in a shelter and her mother was ‘too tired’ to go back for it. Tamina never got it back.

Tamina had very little. Other children had a home, their own bed, place for their stuff, more stuff. So she stole. Mostly small things: erasers, crayons, hair-pins. Things she could hide in her pockets and later in her black garbage bag. If confronted, Tamina would furiously demand it “was always hers.” I suspected she often believed it and wondered if some items resembled things she once had and owning them was a link to a time when life was less overwhelming. Beyond an overall language delay, Tamina seemed confused about concepts like the difference between possessing and owning: in some shelters cots were ‘first-come-first-serve’ and while you had it, it was ‘yours’ even if it did not remain so for long. You had to ‘watch’ your stuff or have it disappear. Why could an unattended eraser not be ‘hers’?

 While children often crave things that are not theirs, Tamina’s stealing was possibly about unmet needs. Her mother was “always mad and cussing” and Tamina could not rely on her for support. Children whose ‘hungers’ are neglected seek other ways: become secretive, dissociate, numb themselves with substances, steal, hoard. These behaviors often further distance them from care and social support, when they in fact communicate confusion, loneliness, anger, loss, and shame.

[The above is an excerpt from “Communicating Trauma” Routledge, 2015]

Communicating Trauma-Yehuda

Homelessness does not necessarily mean neglect, but the realities and causes of homelessness pose many risks, especially to children. In addition to loss and grief, there are increased health and safety risks, along with reduced access to care. Children without homes suffer insecurity, and their caregivers may be too overwhelmed to attend to their emotional needs. Depression, posttraumatic stress, illness, disability, poverty, domestic violence and other life-crises are all too common among parents of homeless children. Any one of these factors can overwhelm a parent and reduce their availability, let alone when such factors combine.

Having no place to call home–in all the forms it takes–can be distressing and occupying. It leaves children anxious and unavailable for learning. Homeless children are often wary and worried, angry or withdrawn. They are three times as likely to require special-education, four times as likely to drop out of school, and almost nine times as likely to repeat grades.

Homelessness devastates. It is crucial we work together to understand it and resolve it as well as support families in crisis and address risk factors before they reach a loss of home, hearth, and heart.

 

 

Tom’s Secret

The animation video below was chosen to lead the European Day on the Protection of Children against Sexual Exploitation and Sexual Abuse which is held on November 18.

The five-minute video had been originally launched in Hebrew, and was since translated to Russian, English, and French. It guides parents, teachers, and other caregivers in ways to identify and react to cases of sexual assault and abuse in children. It has been incorporated into learning programs in Europe, Asia, and the United States.

The clip portrays with sensitivity and clarity the reactions children often have to sexual abuse: dissociation, denial, secrecy, fear, worry, shame, and more. It also shows the behaviors children might display and which should be treated as red flags: reluctance to do things or go places they might’ve enjoyed before, irritability, sadness, refusal, lack of appetite, bed-wetting, physical complaints, etc. While these may not be specific to sexual abuse, they are often representation of distress, and need attending to.

It is a fact that most children who endure sexual abuse don’t tell. At least not directly.

It is also a fact that many parents/teachers/caregivers don’t know when to ask or how to ask or what to do or say if they find out something did take place. They may not understand how a child can seem okay, even when they are internally not okay. Even those who want to help, may not know how to go about it.

This video offers a good start.

Watch it. Share it widely.

 

 

For the Hebrew version, and more information (in Hebrew) about sexual abuse of children, and ways to identify and respond to red-flags, click on the link to an article below:

http://www.ynet.co.il/articles/0,7340,L-4880054,00.html

 

Stressful Situations Simulation: A resource

Below is a good resource and simulation of stressful situations that can be immensely helpful to parents and caregivers. I especially recommend the ones involving “Family Support”: “Calm Parents, Healthy Kids” and “Building Family Bonds.” These scenario simulations inform, teach, and actively guide parents and caregivers through various scenarios of interactions with toddlers in commonly challenging situations.

The resource can be invaluable information for parents and caregivers who are inexperienced and/or may have had less than good enough parenting themselves, and who may not know how to facilitate clear, supportive interaction with their own children, especially under stress. The simulation is presented in a non-shaming, educational way, and provides the participant with an active role in choosing different ways of responding … and being able to see the possible reactions to them … It also allows the participant to ‘re-do’ situations so they can experience how better choices can bring better results …

Practicing is important for any skill, let alone for skills one needs to apply in stressful situations. The very way our brain processes information is affected when we’re stressed, so it helps to already know what to do beforehand. Also, our own stress and how we manage it gets communicated and passed onto children in our care. This makes it doubly important to learn and practice (and then be able to model) new skills when one is calm and in neutral situations–as this simulation allows one to do.

Calm, informed caregivers help raise calm, healthy, competent kids. This can help!

I highly recommend you take a look and see:

https://conversationsforhealth.org/#conversations

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Communication and Collaboration

Upcoming Webinar!

Communication and Collaboration: Multidisciplinary treatment of traumatized/dissociative children

Friday, May 20, 2016
2:00 PM – 3:30 PM Eastern Time

Registration now open! (please see disclaimer in bottom of post)

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Photo Credit: A.A.

Abstract
Treatment of traumatized and dissociative children is most often discussed in the context of psychotherapy. However, traumatized and/or dissociated children often come into contact with additional professionals. Like all youngsters, traumatized children need to manage everyday interactions with caregivers, educators, and routine childhood medical and dental care. Yet many also face clinical interactions with speech-language pathologists, occupational therapists, physical therapists, medical professionals, and more. This is because trauma places children at a high risk for developmental issues, and because children who already have developmental and/or health issues are highly vulnerable to trauma. In addition to clinical care, many traumatized children encounter legal personnel, forensic evaluators, child protective services, foster care staff, etc.

Posttraumatic and dissociative reactions are not limited to the therapist’s office. Just as communication issues aren’t segregated to speech-language pathologist’s office, asthma to the doctor’s, or sensory integration issues to occupational therapy. Various issues can complicate children’s presentation and behavior, and traumatized youngsters are often judged as difficult, aggressive, manipulative, immature, unpredictable, and inattentive. This can result in painful consequences (e.g. loss of placement, shaming, treatment failure), which further increase stress and reinforce the need for dissociative coping. In addition, caregivers routinely face challenges that can affect course of treatment, and professionals do not always ‘speak the same language’ when it comes to describing, assessing, and treating the child (and/or family). Even when professionals are trauma-aware, coordinated care is not always easy to achieve … and yet is essential for effective stabilization, minimizing compartmentalization, and carryover.

This webinar will look into the often complex realities of caring for traumatized/dissociative children and adolescents, the tapestries of clinical encounters many face, and how these may shift throughout infancy, childhood, and teen years. The challenges (and potential) of coordinated care and communication will be discussed, as would logistical and ethical limitations and suggestions for managing them. Clinical vignettes will serve as a window into ways for improving communication among child/family professionals, and will provide examples for practical solutions for increasing regulation and decreasing posttraumatic activation in all involved. The role of caregivers and the child as part of the team will also be examined.

Objectives
Upon completion of this webinar, participants will be able to:

  • Identify the connection between trauma and care utilization in children and adolescents.
  • Describe three challenges to coordinated care
  • List five strategies therapists can apply to improve communication and coordination in the multi-disciplinary treatment of traumatized/dissociative children

For more information and to register

Disclaimer: I volunteer my time and expertise for this webinar, and do not receive any financial gain from it. Registration fees are collected by ISSTD, which hosts the webinar, is responsible for all fees and/or refunds, and provides an option for CEs for attendance.

What PTSD teaches us about human frailty and resilience

The link below will lead you to one of the best interviews about PTSD I have ever seen, hands down.

The fact that Rachel Yehuda is my cousin is an added bonus–I am ever so proud of her: for the person she is, for the work she does, for the wisdom and empathy she imparts, for how she has literally changed the field of PTSD in the last 25 years.

(I recommend reading the transcript, not just viewing the snippet of video on the site)

Take a look. Take a read. You will be glad to have taken the time:

Ingenius: Rachel Yehuda

http://nautil.us/issue/31/stress/ingenious-rachel-Yehuda

 

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Kids and Screen Time: Data, Reality, and Possibility

ScreenTime

When I grew up, television was a very small part of daily life, and was the only screen in the house. Telephone conversations were usually brief (and attached to the wall through the cord in the main room of the house, they only allowed limited privacy). Most daily interactions were face-to-face. Social interaction with peers and siblings certainly were face to face.

Now most homes in developed countries have several screens in different configurations: TVs, laptops, computers, tablets, phones, game consoles, DVD players, other interactive toys that come with a screen.

Children spend a lot more time facing a screen than they ever did. What is the impact of that?

Like every tool, screen media is neither good nor bad–it is HOW you used it and HOW MUCH you used it and what it DISPLACES that matters.

In this electronic age, children have more access to more education materials in quicker and more convenient ways than ever before. Media and information are powerful, but not neutral: If not taught how to discern information on the web, children do not learn how to conduct research or pick out primary source or secondary source, how to identify fact from biased blog or a complete fallacy. They may believe everything they read online–both truth and blatant misrepresentations. They need to be taught how to use information, how to cross-check, how to learn.

Education with the use of screens has replaced some of the methods of learning that were used in not-too-long-ago times. They have benefits and limitations. They can replace some older methods of research and increase efficiency and effectiveness of learning. They can connect people from far places to work together. They can bridge over differences and stigmas. However, they can also displace the interactive collaboration of listening, analyzing other people’s opinions and views, and working together interactively in real space (rather than over the internet in shared documents or through ‘attachments’ or searching to copy other people’s reports through google …).

Outside of educational screen time (i.e. the time children spend watching screens for learning, whether formal or informal), there are also the many hours a week that children spend playing or gazing at movies or music videos, or in texting incomplete sentences in stunted spelling to their friends on social media or phones. These hours often displace actual face-to-face interactions and all that comes with them: reading social cues, body language, emotions, tone of voice. Electronic communication is a poor substitute to actual interaction. Emoticons are a very crude representation of people’s facial expressions, and while they can lend ‘color’ to a message, they are not the real deal.

Children who spend too many hours staring at screens spend too few hours interacting with others and learning skills for interpersonal communication, for reading other people’s emotions and body language, for taking turns and listening.

In an article on NPR, about “Kids and Screen time–what does the research say”, researchers found that removing screen time (and effectively, the replacing of that back with social interaction and TALKING TO EACH OTHER and engaging with others), helped children be more able to recognize facial expressions. The benefits were significant even after five days of no screen time.

While some people advocate total electronics removal … I am not an advocate of removing all electronics: we live in a time where media and internet, email and web searches are enormous tools. It would be a form of social isolation to cut children off from the ability to interact with the world. However, it can be unhelpful to have too much screen time, as it displaces other kinds of social engagement that are just as important. Children do not know what they are missing when they stare at screens instead of interact with people–it is our job and responsibility as adults to help them learn to communicate and socialize.

Infants learn how to interact, how to engage, how to interpret communication and intent–through facial expression and through immediate dyadic interaction in many different settings over many interactions. It is a learning that continues throughout childhood and into young adulthood (and some may say, throughout the lifespan). We need to be mindful of not displacing personal interaction with screen time.

It is possible to do both–though that calls for moderation and boundaries (things that children need to learn, anyway). Additionally, it needs to be not only the children … adults who spend all their times staring at a little screen are displacing time of interaction WITH their children and are becoming models for what we do not want to reinforce.

There is no one recipe that would work for everyone–the right balance is different for different people at different times. What does make sense to me, is to be mindful and be honest:

  • Do not demand of your children something you do not follow yourself …

* Create windows of time when screens are not used in your home: a ‘curfew’ time for phones, or an evening a week without any electronics, a ‘no virtual communication’ weekend day, maybe decide on no electronics in mealtimes (basic politeness, that …), or on other ways to limit screen time. For everyone.

  • Make sure that you are a good model for turning off electronics and doing more than just lifting your eyes momentarily from one …

Young children, especially, are vulnerable to not developing what they SHOULD be developing. If their little faces are stuck to a screen rather than interested in another person, and if their interactions are the brief raising of eyes (or the parent’s brief raising of eyes) from a screen to nod or follow a direction; they would not learn how to engage well, they would not know to be good communicators, or listeners, or readers of social gestures, facial expressions, body-language, and signs.

This is not an either/or. Electronics and screen time, interpersonal social time: It can be an and/and, but it needs to be mindful, lest we raise a generation of children who do not how to interact … and fail them by not providing them the opportunities they needed to learn.

To read the article: “Kids and Screen Time–what does the research say” on NPR, click on the title, or click below:

http://www.npr.org/sections/ed/2014/08/28/343735856/kids-and-screen-time-what-does-the-research-say

Nadine Burke Harris on: How Childhood Trauma Affects Health Across a Lifetime

What if there is an exposure that affects health and development dramatically and is more prevalent than HIV, cancer, and Hepatitis combined and yet most doctors do not screen for it? What if you knew of an exposure that increases the risk for heart disease, diabetes, early death, inflammatory diseases, premature birth, metabolic syndrome, depression, anxiety, suicide, and more? What if that exposure was at the base of many learning disabilities, attention issues, and behavior issues and if there was a lot to do to help reduce this risk?

Wouldn’t you want to know about it?

Wouldn’t you want it to be treated as a priority in healthcare and public interest? I know I would, and do. Nadine Burke Harris is sure, too. Listen to her amazing Ted Talk–this is a brief talk that you’ll want to pass along!

How childhood trauma could be mistaken for ADHD

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This is an immensely important article. Not because traumatized children cannot have ADHD–they can, and many do–but because children with ADHD must also be screened for trauma. They are already at a higher risk for maltreatment and overwhelm, and trauma may also lower their ability to manage stimuli and process information, exacerbating inattention.
Trauma and attention for learning are at cross purposes–this alone is a good enough reason to assess what part trauma may play in a child’s clinical presentation.
And of course–if there is trauma that is ongoing, we are all of us entrusted with doing all we can to identify it and stop it, so that children can be safe.
Until we ensure they are safe and FEELING safe, we cannot truly expect them to lower their hypervigilance or attend to what the teacher is saying in class. We cannot expect their brains to respond well to medications that are meant to treat inattention when their survival may feel as it hinges on remaining in hyper-vigilance mode and constantly scanning for danger.
I highly recommend reading this article.

ACEs Too High

Acry

[Photo credit: woodleywonderworks, Flickr]

Dr. Nicole Brown’s quest to understand her misbehaving pediatric patients began with a hunch.

Brown was completing her residency at Johns Hopkins Hospital in Baltimore, when she realized that many of her low-income patients had been diagnosed with attention deficit/hyperactivity disorder (ADHD).

These children lived in households and neighborhoods where violence and relentless stress prevailed. Their parents found them hard to manage and teachers described them as disruptive or inattentive. Brown knew these behaviors as classic symptoms of ADHD, a brain disorder characterized by impulsivity, hyperactivity, and an inability to focus.

When Brown looked closely, though, she saw something else: trauma. Hyper-vigilance and dissociation, for example, could be mistaken for inattention. Impulsivity might be brought on by a stress response in overdrive.

“Despite our best efforts in referring them to behavioral therapy and starting them on stimulants, it was hard to get the symptoms under control,”…

View original post 1,765 more words

The Childhood Adversity Narratives: Learn. Share. Educate.

ACES

How do childhood adverse events affect development? How do they impact health? How much does it cost society to have children exposed to adverse events? What are the social ramifications? How does childhood adversity reflect in mental-health? In illness? Can we prevent childhood adverse events? Why is it worth it for society to invest in prevention and treatment of childhood trauma?

And other questions: What is more harmful: second hand smoke or childhood maltreatment? How is that reflected in funds or investment in prevention or treatment? Where does asthma come in? What can we do about any of this, anyway?

To find the answers to these questions and more, check out this amazing presentation (also available in PDF and PPT on the site–see links below).

This free resource is available due to the generosity of Frank and Karen Putnam along with their colleagues, who created this presentation in the hope that it will be widely disseminated and that it be used as an education resource for the public as well as for researchers and clinicians. The presentation details the prevalence, impact, treatment, and importance (it is highly possible!) of prevention of child abuse and neglect. The authors encourage everyone to use the presentation and share it.

The slides are available on the website http://www.canarratives.org/

To view the Power Point Show: CAN_Narrative_4-26-15-v2L4

To download the pdf: http://static1.squarespace.com/static/552ec6c7e4b0b098cbafba75/t/553e3673e4b09e094f914b8f/1430140531869/CAN_Narrative_4-26-15-v2L4.pdf