Fostering Attachment

Quotes from Time Magazine about Overmedication of Foster Youth

2011-11-29T16:28:00.000-08:00

Source: Szalavitz, Maia. Why Are So Many Foster Care Children Taking Antipsychotics?
Time Magazine, November 29, 2011.

"The influence of pharmaceutical company marketing cannot be overlooked. Ninety-nine percent of youth receiving anti-psychotic medications in the study were given atypical anti-psychotics — the newer generation of these drugs, which are expensive and mostly unavailable in generic form and have been heavily advertised.

"All of the major manufacturers of these drugs have been fined by the Food and Drug Administration for illegal marketing practices — in part, for marketing the drugs for unapproved use in children — with some convicted of criminal charges.

"The main condition that antipsychotics are approved to treat —schizophrenia — is extremely rare in children. The rate of schizophrenia in children under 12 is an estimated 2 cases per 1 million children; it affects fewer than 1% of older teens. Anti-psychotics are also approved to treat bipolar disorder, a diagnosis that is highly controversial in children. Some studies suggest that it affects 0.2% to 0.4 % of children, and up to 1% of adolescents.

And yet, between 1994 and 2003, rates of bipolar diagnoses in youth under 19 rose by a factor of more than 40, according to the National Institute on Mental Health. It seems unlikely to be a coincidence that this rise occurred during the period when atypical anti-psychotics were being illegally marketed for children."

"Indeed, most of the anti-psychotics used in foster-care youth were for conditions that the drugs were not approved to treat. Fifty-three percent of prescriptions were written for attention deficit/hyperactivity disorder (ADHD), a condition that is ordinarily managed with drugs that have the opposite pharmacological effects as anti-psychotics. The stimulant medications like Adderall and Ritalin, widely used for ADHD, tend to increase levels of dopamine, while anti-psychotics tend to decrease it."

"This study confirms the need for developmentally and trauma-informed practices in the vulnerable foster-care population," says Dr. Bruce Perry, founder of the ChildTrauma Academy. "Misunderstanding the pervasive effects of abuse and neglect leads to the mislabeling of behavioral and emotional symptoms in these children and then to overmedication."

Overmedication of foster youth continues....

2011-11-29T15:56:00.000-08:00

A new study, Antipsychotic Treatment Among Youth in Foster Care, examined concomitant antipsychotic use among Medicaid-enrolled youth in foster care, compared with disabled or low-income Medicaid-enrolled youth.

They found that:

More than a third of youth in foster care without disabilities had multiple anit-psychotic prescriptions lasting longer than 90 days
Children who were not adopted had the highest rates of prescriptions, representing 38 out of every 100 children in foster care.

In comparison, 26 out of every 100 children who were on public assistance but not in foster care had more than one antipsychotic prescription.

In recent years, doctors and policy makers have grown concerned about high rates of overall psychiatric drug use in the foster care system. Previous studies have found that children in foster care receive psychiatric medications at about twice the rate among children outside the system.

In 2008, the House Ways and Means Subcommittee on Income Security and Family Support held a hearing on the utilization of psychotropic medication for children in foster care.

In 2010, Senator Daniel Akaka (D-HI) asked the Government Accountability Office (GAO) to investigate the prevalence of prescribed psychotropic medications for children in foster care.

Valuing and Asserting Personal Worth vs. Maintaining Abusive Relationships

2011-11-28T11:45:00.000-08:00

"Describing how the brain changes in response to a child's experience, Bruce Perry wrote, 'Children are not resilient, children are malleable.' Trauma, neglect and abuse influence how synapses develop pathways, how neurons fire, how we translate incoming information...

"The baby learns how the caretaker will respond to his emotional needs, and from this, the baby begins generalizing his experiences and defines the world.

"The failure to consistently meet the infant's needs (emotional or biological) impacts the child's sense of self long before the pain influences her perception of the outside world. 'Unfortunately, the child will interpret this as a product of its own inadequacy,' J. Konrad Stettbacher notes.

"Dependent upon others for survival, the child believes that the cause of pain is his own self and he tries to adapt (they must be right; therefore, he is wrong). In response, he minimizes or relabels his own pain: 'It's not so bad.' Pain is always a signal that something has to change - how we respond to that pain reflects what we've learned early on.

"Similarly, the victim of emotional abuse things, 'If I were better, they wouldn't do this to me,' rather than, 'This other person is causing me pain and if she doesn't stop, she has to exit my life.'

"No infant has the ability to make that distinction - they blame themselves in order to hopefully fit the caregiver, alleviate the pain, and preserve that bond.

"Acknowledging pain is the vital first step in any self-defense. Acknowledging what 'hurts' identifies the boundaries that define each one of us... If a victim can decide whom to trust and then act on this decisions, (he or she will have) the resiliency to emotionally to defend himself...

"Resiliency acknowledges that there will be a cost. The former victim may lose a 'friend...'

"Doing so lifts the burden the victim assigned himself, but also presents a hard decision. To define one's self, there is a cost."

~ Heart Transplant by Andrew Vachss and Frank Caruso

New Federal Requirements for States re: Foster Children, Trauma and Monitoring Medications

2011-10-09T15:40:00.000-07:00

President Obama recently signed the Child and Family Services Improvement and Innovation Act (H.R. 2883) into law.

Among other stipulations, this new law:

Requires States to address emotional trauma in foster children, adopt protocols for using and monitoring psychotropic medications, and describe how they both address the developmental needs of young children in the child welfare system and reduce their length of stay in foster care.

National Clearinghouse on Families and Youth

2011-09-15T10:27:00.000-07:00

The National Clearinghouse on Families and Youth recognizes that most homeless youth have experienced multiple traumatic events both before becoming homeless and once on the street. This underscores the importance of trauma-informed practice:

They suggest that several homeless shelters might need a trauma-informed transformation, considering such details as the need to put a lock on the shower door at a shelter in order to ensure physical safety and emotional security.

Youth workers need to provide trauma-informed care, seeking to understand each young person’s emotional triggers, build supportive relationships, and give youth opportunities to rebuild control in their lives.

Individuals who have experienced homeless express the need for expectations and empowerment, and hope that staff members are willing to look beyond external behavior, and recognize the underlying trauma beneath.

Federal Partners Committee on Women and Trauma

2011-08-01T11:33:00.000-07:00

According to a recently released report by Federal Partners Committee on Women and Trauma:

Due to the spiraling number of people impacted and the wide range of consequences, trauma is now believed to be a public health crisis.

Violence is gendered: While men are most likely to experience violence from strangers, women and girls are most likely to be hurt by people they know intimately: For women in the military, the greatest risk of harm is from fellow soldiers; for an adolescent girl, it is from a person whom she loves.

One in five girls and one in ten boys are sexually abused before adulthood. Adolescent girls between the ages of 16-19 are four times more likely than boys to be a victim of rape, attempted rape, or sexual assault.

Women are twice as likely as men to experience depression, and 54% of depression in women can be attributed to childhood abuse.

Not surprisingly, according the SAMSA's 1998-2003 research study on women and violence:

"The most effective interventions are gender-responsive – they reflect an understanding of the realities of the lives of women and girls, respond to their strengths and challenges, and use knowledge about female socialization and development to guide all aspects of program and system design."

Helping Foster Children Handle Transitions

2011-07-06T09:39:00.000-07:00

The Indiana University School of Medicine has developed a one-page tip sheet for Helping Your Child in Foster Care Handle Transitions.

Helping Children Who Have Experienced Traumatic Events

2011-05-21T11:23:00.000-07:00

In conjunction with Children’s Mental Health Awareness Day, The Substance Abuse and Mental Health Services Administration (SAMHSA) released their 2011 Short Report on Helping Children and Youth Who Have Experienced Traumatic Events.

and

American Humane Association — along with Zero to Three, the Center for the Study of Social Policy, the Child Welfare League of America and the Children's Defense Fund — recently released A Call to Action On Behalf of Maltreated Infants and Toddlers.

Community System of Care Improves Behavioral Health of Children Affected by Trauma

2011-05-14T12:54:00.000-07:00

"Childhood exposure to traumatic events is a major public health problem in the United States. Traumatic events can include witnessing or experiencing physical or sexual abuse, violence in families and communities, loss of a loved one, refugee and war experiences, living with a family member whose caregiving ability is impaired, and having a life-threatening injury or illness. It is estimated that 26% of children in the United States will witness or experience a traumatic event before the age of 4 years."

Children and youth affected by traumatic events improve their functioning when they can access effective community-based programs and supports, according to a study by the Substance Abuse and Mental Health Services Administration (SAMHSA).

This report shows that after 12 months of accessing services within a community-based system of care, 44 percent of children and youth improved their school attendance, 41 percent improved their grades, and youth suicide attempts fell by 64 percent. In addition, the number of youth reporting arrests in the past 6 months fell by 36 percent.

Similarly the report shows that children and youth receiving trauma specific services experienced a 20 percent drop in the number experiencing problems at school, a 59 percent drop in the number with problems with suicidality, and a 57 percent drop in number of children engaging in delinquent behavior after 6 months of service.

Stay tuned for future blog entry on "Hidden Rules"

2011-05-05T17:49:00.000-07:00

Free Training on Trauma in Children and Families

2011-05-03T13:40:00.000-07:00

Recognizing and Addressing Trauma in Infants, Young Children, and Their Families is an online tutorial for professionals who work with young children that explains the developmental context of trauma in early childhood, and expands professionals' knowledge for intervention through consultation. The tutorial also provides valuable links to a range of resources for further learning and exploration, and includes concrete take home messages.

Those who complete the tutorial will be able to:

Define trauma, describe two types of trauma, and list common yet diverse types of traumatic experiences

Describe the impact of trauma on infants, toddlers, and young children from a developmental perspective

Identify trauma signs and symptoms in infants, toddlers, and young children

Recognize and understand the role of the consultant in addressing trauma in the early care and education setting

The free tutorial takes between 30 and 40 minutes to complete. It is the sixth in a series for mental health consultants and was funded by the Office of Head Start and developed by the Center for Early Childhood Mental Health Consultation (ECMHC).

The entire series of tutorials are housed on the ECMHC website: www.ecmhc.org/tutorials/trauma/index.html

Trauma and Immigrant Families in the Child Welfare System

2010-11-17T14:50:00.000-08:00

A Social Worker's Tool Kit for Working With Immigrant Families – Healing the Damage: Trauma and Immigrant Families in the Child Welfare System (September 2010)

Written by the Migration and Child Welfare National Network, this tool kit provides guidelines for integrating child welfare practice with trauma-informed care and trauma-specific services. The tool kit contains answers to frequently asked questions illustrated by case examples, as well as website links and other resources.

Direct link: http://www.americanhumane.org/protecting-children/programs/child-welfare-migration/tool-kits.html

Trauma and Homeless Youth

2010-11-02T10:00:00.000-07:00

Visit the National Child Traumatic Stress Network for more resources on homeless youth.

Trauma and the Juvenile Justice System

2010-11-01T14:47:00.000-07:00

Trauma and Justice:

Traumatic victimization often results in negative behaviors that bring both youth and adults into the criminal justice system.

Studies of people in jail and prison reveal high rates of mental and substance use disorders and personal histories of trauma.

Adapting CBITS and SSET to Support Foster Care Youth

2010-09-23T06:48:00.000-07:00

Toolkit for Adapting Cognitive Behavioral Intervention for Trauma in Schools (CBITS) or Supporting Students Exposed to Trauma (SSET) for Implementation with Youth in Foster Care (Dana Schultz, Dionne Barnes-Proby, Anita Chandra, Lisa H. Jaycox, Erin Maher, Peter Pecora)

The purpose of this toolkit is to assist school-based mental health professionals, school personnel, and child welfare social workers in adapting these interventions for use with youth aged 10-15 who are in foster care:

CBITS was developed for use by school-based mental health professionals for any student with symptoms of distress following exposure to trauma.
SSET was adapted from CBITS for use by any school personnel with the time and interest to work with students affected by trauma.

The authors note that delivering a school-based mental health program to youth in foster care has many challenges, including collaboration between the child welfare and education systems, confidentiality and information sharing policies regarding youth in foster care, and identification of these youth.

The toolkit was designed to help understand these challenges and provide strategies for addressing them. It is made up of three parts:

Background Section
Overview of CBITS and SSET
Step-By-Step Guide to Implementing and Adapting CBITS/SSET for Foster Care Youth

Healing Invisible Wounds: Why Investing in Trauma-Informed Care for Children Makes Sense

2010-08-04T06:33:00.000-07:00

The Justice Policy Institute has issued a brief examining the relationship between childhood trauma and youth justice system involvement.

The brief, Healing Invisible Wounds: Why Investing in Trauma-Informed Care for Children Makes Sense, notes that of the more than 93,000 children who are currently incarcerated nationwide, between 75 percent and 93 percent have experienced at least one traumatic experience, including sexual abuse, war, community violence, neglect, and maltreatment, which can have long-term effects such as emotional problems and negative impacts on youth brain development.

According to the brief, the U.S. justice system does not meet the needs of traumatized youth and may in fact increase trauma through its use of incarceration. Youth who receive treatment in their communities have better outcomes than those placed in correctional facilities, which indicates the need for trauma exposure to be considered in youth placement decisions.

When Helping You Is Hurting Me

2010-07-05T08:23:00.001-07:00

When helping you is hurting me

View more presentations from Lisa Dickson.

Rewriting the scripts in a child's life

2010-06-10T10:59:00.001-07:00

What the movie Martian Child teaches about trauma and food hoarding

2010-06-10T08:23:00.001-07:00

Boy in a Box: What the movie Martian Child teaches about responding to child trauma

2010-06-10T08:07:00.000-07:00

Foster Care Youth and Chosen Family

2010-05-19T06:02:00.000-07:00

"Family isn't whose blood you carry,

it's who you love and who loves you"

~ Jackie Chan as Bob Ho from The Spy Next Door

Stress Hormones Predict Trouble for Kids Left in Abusive Homes

2010-05-12T15:41:00.000-07:00

Stress Hormones Predict Trouble for Kids Left in Abusive Homes'
Business Week, May 5, 2010.

Specific hormonal pattern tied to later psychological problems, researchers say...

Children who live with their parents after local child protective services agency enters their lives have worrying levels of a stress hormone compared to those who end up in foster care.

Researchers at the University of Delaware at Newark studied 339 children aged 3 months to 31 months, 155 of whom lived with their birth parents and 184 who landed in foster care, all after child protective services became involved with the families.

The researchers analyzed levels of the hormone cortisol in the children for two days, and found that those who remained with their parents had flatter slopes.

"A blunted pattern of cortisol production appears to confer risk for later psychiatric disorders, most especially psychopathy and substance abuse problems," study author Kristin Bernard and her colleagues wrote. "Although it is premature to suggest specific implications for neglected children, the findings are concerning."

The authors concluded that "foster care may have a regulating influence on children's cortisol among children who have experienced maltreatment."

The findings were published May 3 in the Archives of Pediatrics and Adolescent Medicine.

Youth-Centered Approach to Achieving Permanency

2010-05-04T15:38:00.000-07:00

In 2005, the Children's Bureau funded nine demonstration projects through an Adoption Opportunities grant.

Interviews with youth shed light on their feelings about family and permanency:

The level of commitment an adult brings to the relationship with a youth is what constitutes family—not blood.

Permanency is a process of building trust, and finding a family is almost always worth the risk.

Permanency work is not just about finding a home but includes restoring family connections that have been lost. Sibling relationships have been significant to older youth in the project.

Youth are proud of their self-reliance and their ability to overcome adversity.

For more information about the Dumisha Jamaa Project, visit the National Resource Center for Adoption website.

Understanding the Effects of Maltreatment on Brain Development

2010-04-27T11:24:00.000-07:00

Another tool for understanding the emotional, mental, and behavioral impact of early abuse and neglect in children who come to the attention of the child welfare system:

This Child Welfare Information Gateway brief provides basic information for professionals on brain development and the effects of abuse and neglect on that development.

SAMHSA Evidence-Based Practice Kits

2010-04-27T09:39:00.000-07:00

The Substance Abuse and Mental Health Services Administration (SAMHSA) is offering a new series of Evidence-Based Practice KITs. The KITs were developed to help move the latest information available on effective behavioral health practices into community-based service delivery.

The KITs contain information sheets, introductory videos, practice demonstration videos, and training manuals.

Currently, five KITs are available:

These new KITs are available online and in CD-ROM/DVD format.

Reaching Out to Connect Teens and Young Adults With Resources

2010-04-27T06:21:00.000-07:00

REACHOUT.com is an information and support service using evidence based principles and technology to help teens and young adults facing tough times and struggling with mental health, substance abuse and other issues.

All content is written by teens and young adults, for teens and young adults, to meet them where they are, and help them recognize their own strengths and use those strengths to overcome their difficulties and/or seek help if necessary.

NAMI Launches Social Networking Site for Young Adults

2010-04-16T06:15:00.000-07:00

The National Alliance on Mental Illness (NAMI) has launched StrengthofUs.org, a new online community where young adults living with mental health concerns can provide mutual support in navigating unique challenges and opportunities during the critical transition years from ages 18 to 25.

Developed by young adults, StrengthofUs.org is a user-driven social networking community where members can connect with peers, share personal stories, creativity and helpful resources by writing and responding to blog entries, engaging in discussion groups and sharing videos, photos and other news.

The site offers resources on issues important to young adults, including:

Healthy relationships
Family and friends
Campus life
Independent living
Finances
Employment
Housing
Mental health issues

"Young adulthood is an exciting challenge, but also a confusing and stressful time for anyone," said Michael Fitzpatrick, NAMI executive director. "Life can throw things at you fast."

"Mental illness affects everyone. StrengthofUs.org is intended not just for young adults who have a mental illness, but for anyone entering adulthood that has a friend, parent or other family member facing a mental health problem."

"Most of all, StrengthofUs.org is an interactive, fun space where young adults can share experiences and other information to empower each other, build relationships and offer peer support."

Resiliency Ohio Recently Launched

2010-04-14T10:28:00.000-07:00

The website http://www.resiliencyohio.org/ is designed to help children and youth with mental and emotional health challenges and their families learn about and embrace resiliency.

The concepts, and website materials were developed by Resiliency Leadership Ohio, which is comprised of youth experiencing mental health issues and their family members.

Resiliency is defined as an inner capacity that when nurtured, facilitated, and supported by others empowers children, youth, and families to successfully meet life's challenges with a sense of self-determination, mastery, hope, and well-being.

The website includes a video of Ohio youth and families speaking about the role of resiliency in their lives and the importance of having a resiliency perspective for mental wellness.

Whose Permanency Is It, Anyway?

2009-12-01T08:47:00.000-08:00

Voices From the 2008 National Convening on Youth Permanence

More than 30 youth and alumni from foster care attending the 2008 National Convening on Youth Permanence participated in an impromptu session facilitated by the Annie E. Casey Foundation's Family to Family Youth Engagement Team. Participants shared their experiences and provided recommendations about improving the foster care system.

What concerned these young people the most were issues of trust; they felt unable to trust the concept and the process of permanency planning. Most youth also reported that they had not been included in the process of identifying permanent connections for themselves.

Youth recommended the following important steps in developing a trusting partnership:

Redefine permanence to include emotional connections.
Address the disparities in permanency outcomes for older youth and youth of color.
Continue the permanency search beyond emancipation.
Involve youth in planning for future Convenings.

To read the full Recommendations of Youth and Young Adults From the 2008 National Convening on Youth Permanence, please visit:

www.youthpermanence.org/_pdf/materials/mat_2008/recommendations-of-youth.pdf

The California Permanency for Youth Project (CPYP) emphasizes the importance of (1) involving youth in their own permanency planning and (2) using technology to help youth find family connections.

They work with California counties to ensure that youth leave foster care with some kind of permanent connection with a caring adult.

The Emancipated Youth Connections Project involved 20 young adults (ages 17-39) who had exited foster care with no permanent connections. Services were provided to help them make those connections.

To learn more, read the Emancipated Youth Connections Project Final Report/Toolkit, available at:

www.cpyp.org/Files/EYCP-ReportToolkit.pdf

The August 2008 Destination Future: National Youth Leadership Development Conference brought together youth leaders in foster care or formerly in care from around the country to discuss their experiences in foster care and their hopes for the future. This conference was sponsored by the National Child Welfare Resource Center for Youth Development (NRCYD) and supported by the Children's Bureau.

The 94 youth and 74 adults in attendance were divided among eight groups, each with a focus topic for discussion:

Engaging youth in the National Youth in Transition Database (NYTD) implementation
Extending the Federal foster care program payments to age 21
Ensuring youths' success in their academic endeavors
Meeting youths' cultural needs while in foster care
Involving youth in the court case review process
Developing and maintaining youths' connections to family members
Ensuring that youth who do not go to college can still find a good-paying job
Ensuring that youths' mental health services needs are met

The conference slogan "Nothing about us without us" reflects the desires of foster youth to take an active role in the decisions that affect their lives and develop ways to influence programs and policies. This theme was raised in all of the small-group discussions.

To read the full report of the conference, Destination Future: National Youth Leadership Conference Report, by Jacqueline Smollar, please visit:

www.nrcys.ou.edu/yd/resources/publications/pdfs/df08rep_w.pdf

Mental Health Practices Toolkit

2009-11-25T06:29:00.000-08:00

The REACH Institute, Casey Family Programs and the Annie E. Casey Foundation have worked together to develop a Mental Health Practices in Child Welfare Guidelines Toolkit.

It covers:
* Screening and assessment
* Interventions
* Medication
* Parent support
* Youth empowerment

This toolkit provides suggestions and resources for putting the guidelines into action in child welfare agencies.

Question for Readers: What Do You Think of This Model?

2009-11-20T08:48:00.000-08:00

This is new to me...

The Intergenerational Trauma Treatment Model is "a revolutionary trauma treatment for 3-18 year olds and their adult caregivers. It consists of a comprehensive and robust, 21-session manualized program that is informed by trauma theory, attachment theory and advanced CBT techniques. ITTM effectively trains practitioners across all professional designations."

WHAT: The ITTM is a model that works to resolve the impact of trauma on a child through the caregiver.

HOW: The ITTM heals unresolved impact in the caregiver's history first and then re-positions the caregiver in treatment sessions to be the primary impact healer for the child.

WHO: The ITTM empowers caregivers to retain and regain their position as their child's most important and influential support.

For more information on the Intergenerational Trauma Treatment Model, please visit www.theittm.com

Foster Care and PTSD

2009-11-12T05:48:00.000-08:00

Mental Health Needs of Foster Children and Children At-Risk for Removal

2009-10-01T15:50:00.000-07:00

A recent issue of Virginia Child Protection Newsletter focused on the mental health needs of children entering foster care and children at risk to enter care.

The article explores:
- The range of mental health needs
- Ways to address those needs using evidence-based practices
- Ways to work with the children
- Methods for parent and foster parent training

http://psychweb.cisat.jmu.edu/graysojh/volume%2085.pdf

Emotional Resiliency Resources while pursuing Higher Ed

2009-08-17T13:16:00.000-07:00

Addressing the Mental Health Needs of Former Foster Youth in Campus Support Programs,

December 2, 2008.

Download the PowerPoint presentation

California College Pathways conducted a web seminar to provide ongoing learning opportunities and resources for professionals working with current and former foster youth. Mental health experts from Cal State Fullerton and UC Riverside discussed the relationship between mental health support and educational attainment for foster youth in higher education. They shared their evidence-based approach to addressing the mental health needs of former foster youth on campus.

Information provided in the training included:
- Issues foster youth present when transitioning into college.
- Strategies for working with foster care with mental health needs (e.g. medication management, therapy).
- Signs and symptoms of depression and anxiety.
- How to refer a student psychological services.
- Types of counseling and support resources are available on college campuses

A sense of home in exile

2009-08-04T00:25:00.000-07:00

Quote from the article A Sense of Home in Exile by Sandra Dudley:

"Materializing exile"

Displacement inevitably complicates and changes people's relationships with objects and places, as well as with each other. In order to live as 'normally' as possible within a new place, Karenni refugees seek to make it familiar in material ways...

-They are attempting to connect two points in space and time.

-They affirm their connections through the ritual of food, clothing and everyday activities.

-They are re-creating a sense of home.

Thoughts on Easter 2009

2009-04-12T07:04:00.000-07:00

“Our scars have the power to remind us that the past was real.” – Red Dragon

2009-03-31T18:27:00.000-07:00

Thoughts on the shift from victim to survivor

2009-03-22T05:40:00.000-07:00

"The 'big click' for survivors comes after seeing a purpose for the pain, and a venue to help others. When pain seems meaningless, folks fall into despair."

~ Lisa Dickson

After Abuse, Changes in the Brain

2009-03-06T11:15:00.000-08:00

After Abuse, Changes in the Brain
By Benedict Carey, NY Times, Feb. 23, 2009.

For years, psychiatrists have known that children who are abused or neglected run a high risk of developing mental problems later in life, from anxiety and depression to substance abuse and suicide.

The connection is not surprising, but it raises a crucial scientific question: Does the abuse cause biological changes that may increase the risk for these problems?

Over the past decade or so, researchers at McGill University in Montreal, led by Michael Meaney, have shown that affectionate mothering alters the expression of genes in animals, allowing them to dampen their physiological response to stress. These biological buffers are then passed on to the next generation: rodents and nonhuman primates biologically primed to handle stress tend to be more nurturing to their own offspring, Dr. Meaney and other researchers have found.

Now, for the first time, they have direct evidence that the same system is at work in humans. In a study of people who committed suicide published Sunday in the journal Nature Neuroscience, researchers in Montreal report that people who were abused or neglected as children showed genetic alterations that likely made them more biologically sensitive to stress.

The findings help clarify the biology behind the wounds of a difficult childhood and hint at what constitutes resilience in those able to shake off such wounds.

The study “extends the animal work on the regulation of stress to humans in a dramatic way,” Jaak Panksepp, an adjunct professor at Washington State University who was not involved in the research, wrote in an e-mail message.

He added that the study “suggests pathways that have promoted the psychic pain that makes life intolerable,” and continued, “It’s a wonderful example of how the study of animal models of emotional resilience can lead the way to understanding human vicissitudes.”

In the study, scientists at McGill and the Singapore Institute for Clinical Sciences compared the brains of 12 people who had committed suicide and who had had difficult childhoods with 12 people who had committed suicide and who had not suffered abuse or neglect as children.

The scientists determined the nature of the subjects’ upbringing by doing extensive interviews with next of kin, as well as investigating medical records. The brains are preserved at Douglas Hospital in Montreal as part of the Quebec Suicide Brain Bank, a program founded by McGill researchers to promote suicide studies that receives brain donations from around the province.

When people are under stress, the hormone cortisol circulates widely, putting the body on high alert. One way the brain reduces this physical anxiety is to make receptors on brain cells that help clear the cortisol, inhibiting the distress and protecting neurons from extended exposure to the hormone, which can be damaging.

The researchers found that the genes that code for these receptors were about 40 percent less active in people who had been abused as children than in those who had not. The scientists found the same striking differences between the abused group and the brains of 12 control subjects, who had not been abused and who died from causes other than suicide. “It is good evidence that the same systems are at work in humans that we have seen in other animals,” said Patrick McGowan, a postdoctoral fellow in Dr. Meaney’s lab at McGill and the lead author of the study.

His co-authors, along with Dr. Meaney, were Aya Sasaki, Ana C. D’Alessio, Sergiy Dymov, Benoît Labonté and Moshe Szyf, all of McGill, and Dr. Gustavo Turecki, a McGill researcher who leads the Brain Bank.

Because of individual differences in the genetic machinery that regulates stress response, experts say, many people manage their distress despite awful childhoods. Others may find solace in other people, which helps them regulate the inevitable pain of living a full life.

“The bottom line is that this is a terrific line of work, but there is a very long way to go either to understand the effects of early experience or the causes of mental disorders,” Dr. Steven Hyman, a professor of neurobiology at Harvard, wrote in an e-mail message.

Self Verification

2008-12-10T12:36:00.000-08:00

Developed by William Swann, the theory of Self Verification is that once individuals develop firmly held beliefs about themselves, they come to prefer that other people see them as they see themselves - even if their self-views are negative.

Replace traumatic memories with positive ones

2008-05-13T12:15:00.000-07:00

Emotional memories engage different brain structures than do normal memories, and are stored in a particularly powerful and lasting way by the brain.

There is evidence for a self-reinforcing "memory loop" whereby the brain's emotional center triggers the memory center, which in turn further enhances activity in the emotional center.

Because of this, traumatic memories can have a powerful effect on human behavior – including placing restrictions in the way that people go about their daily lives.

Survivors may avoid places, smells or objects that remind them of the traumatic experience, because they may trigger severe anxieties.

Learned knowledge may dissipate, but emotional memories still remain.

According to researcher Karsten Baumgärtel, “It is entirely possible for facts to vanish completely from the memory, whereas in extreme cases emotional recollections remain stored for a whole lifetime.”

Isabelle Mansuy, Professor of Cellular Neurobiology explains that, “Emotional memories are not simply erased. Oppressive negative memories need to be actively replaced by positive memories.”

How are you replacing the negative experiences in your life?

Marriage as crucible

2008-05-07T06:56:00.000-07:00

My husband's prediction about a mutual friend: "All the issues that she thought were dealt with will come springing back up out of her once she gets that ring on her finger..."

Children, foster care and PTSD

2008-04-20T05:44:00.001-07:00

Link to articles about how to help and treat children who have PTSD as a result of abuse: http://hubpages.com/profile/krillco

Child Welfare Trauma Training Toolkit

2008-04-03T19:21:00.001-07:00

http://www.nctsnet.org/nccts/nav.do?pid=ctr_cwtool

Some of the many insights available in this valuable resource:
"Trauma can change children’s world views, their sense of safety, and how they interpret the meaning of the behavior of others—including people who are trying to help them...

"Children often have multidimensional trauma histories, and adults should not assume that they know what was most traumatic for the child. The event(s) thatled to child welfare involvement may not be the child’s most significant trauma experience...

"There is a difference between physical safety and psychological safety. Child welfare workers should not only aim to keep a child physically safe but should also provide a psychologically safe setting for children and families when inquiring about emotionally painful and difficult experiences...

"System-Induced Trauma: (def).Traumatic removal from the home, traumatic foster placement, sibling separation, or multiple placements in a short amount of time."

At the Root of Addiction

2008-03-28T11:58:00.000-07:00

"Addiction is never really about fun...
It's always about pain."

- A Field of Darkness by Cornelia Read

Psychosocial Trauma and Restitution

2008-03-24T16:51:00.000-07:00

Searching for Life: The Grandmothers of the Plaza de Mayo and the Disappeared Children of Argentina

"The concept of “psychosocial trauma” developed by Ignacio Martin-Baro can help us understand the restitution process. He believed that when an injury that affects people has been produced, nourished, and maintained through a certain set of social relations, then individual solutions are not effective.

"The social context responsible for the injury has to be taken into account. A new “social contract” to heal the trauma is needed, incorporating individual and socio-political factors into the equation.

"In the case of the disappeared children, their loss of identity represents a trauma affecting not only their individual lives but also their relationship with society. For this relationship to be restored, the social distortions that took place need to be exposed.

"Restitution brings into focus the trauma’s social dimension, as it provides the wider context for each individual story. Truth and justice must be part of the picture, if the children are to construct a meaningful future for themselves as individuals and as members of society."

This statement makes no sense

2008-03-23T07:31:00.000-07:00

Quote from Erick Nicklas, associate commissioner of the Family Permanency Division: "The whole idea of foster care is not to disrupt children's lives."

Foster Care Alumni and Relational Permanence

2008-03-20T10:43:00.000-07:00

http://www.chapinhall.org/article_abstract.aspx?ar=1466

Gina Miranda Samuels interviewed 29 young adults who aged out of foster care in order to understand their existing support networks and how they learned to cope with people coming in and out of their lives.

Wearing a Mask to Face the World

2008-03-17T09:37:00.000-07:00

http://translucence.multiply.com/journal/item/284/Masks_Repost

"We all wear masks, and the time comes when we cannot remove them without removing some of our own skin.”
- Andre Berthiaume

Abuse, Females and Testosterone Levels

2008-02-19T08:54:00.000-08:00

“Trauma, at any age, produces anatomical changes in the brain, and even if those changes do not have an obvious effect on behavior, they can still shape our deepest responses to anxiety.

“A NIMH study (discovered that) abused girls were found to have abnormally high levels of testosterone, increases in immune system abnormalities and abnormal changes in the regulation of heart rate under stress.”

Source: Lui, Aimee. Gaining: The Truth About Life After Eating Disorders.

Feeling like a "failed anorexic"

2008-02-19T08:53:00.000-08:00

Recovery from anorexia comes with a deep sense of shame, because it feels somehow like a failure. Caroline Knapp has referred to this as “the post-anorexic riddle of identity, a sense of wild shapelessness.”

Aimee Lui writes accurately that;
“Eating disorders sabotage identity… You’ve failed to reduce yourself to a perfect object…

“For years you’ll move along just fine, gaining weight, gaining confidence, gaining all the trappings of a thriving life, and then, unexpectedly, a shadow of your past will resurface in the face of a long-lost friend or a moment on revived anxiety, and your bright new self will cringe, yearning for that old mask of perfection.”

Sheila Reindl has valuable insight into this area as well:
“We all have to integrate the light with the dark… the noble and ignoble aspects of ourselves. That’s a normal developmental task. It’s just harder for people with eating disorders.”

Source: Lui, Aimee. Gaining: The Truth About Life After Eating Disorders.

Anorexia and Bulemia

2008-02-19T08:51:00.000-08:00

According to Shelia Reindl, “With anorexia, the act of losing weight serves as a metaphor for feeling that one is emotionally invisible… (it’s a) disciplined emptiness. So, for her, the message is that you don’t have to be perfect to be loved.

“The bulimic, on the other hand, binges and purges in secret – hiding the beast she knows is in there. The issues of shame are stronger. I think that’s why, when anorexics hit a bulimic patch in recovery or difficulties later in life, they often want to go back to the anorexia. It feels cleaner and tidier – they didn’t have to deal with all these messy feelings and conflicts.”

Reindl’s research has demonstrated that the most enduring obstacle to healing in the aftermath of anorexia and bulimia is vulnerability to a sense of not being enough, not having enough, feeling empty, unlovable, unworthy.”

Lui, Aimee. Gaining: The Truth About Life After Eating Disorders.

Can You Inherit Anorexia?

2008-02-19T08:50:00.000-08:00

“Researchers often say that genetics load the gun of eating disorders, and environment pulls the trigger.”

Aimee Lui believes that genetics make the gun, environment loads it, and that an experience of unbearable trauma is what actually pulls the trigger.

Source: Lui, Aimee. Gaining: The Truth About Life After Eating Disorders.

Childhood trauma and emotional maturity

2008-02-03T06:10:00.001-08:00

Adults often underestimate what children experience, the extent of their reactions and what they need to know.

Childhood trauma can disrupt child or adolescent development, interfering with the growth of emotional maturity. Repeated exposure to trauma can affect a child's brain and nervous system.

Children suffer a dual response:
- The impact of the trauma on themselves
- The emotional distress of a child's caregiver

Adult support is a strong protective factor. Impacted adults may make at-risk children more vulnerable.

Common trauma responses in children include impaired concentration, difficulty in learning new things, aggression, recklessness, reduced inhibitions, somatic complaints and school refusal.

It is normal for a child who has experienced trauma to:
- Be hypervigilant and constantly alert
- Be jumpy and startled easily by loud sounds and sudden noises
- Feel exhausted
- Have a worsening of chronic medical problems
- Have difficulty concentrating
- Exhibit poor judgment
- Exhibit denial of emotions or lack memory of events

Sometimes children revert to a younger developmental stage (bed-wetting, thumb-sucking, clinging). Teenagers might respond by taking on the role of a parent, acting as an adult and taking charge of the situation. Or, the teen might try to escape in sex, drugs and alcohol.

Children who are traumatized can develop depression, anxiety, mood disorders and/or behavior disorders.

Source: Traumatic Stress in Children, NRCFCPPP, January 8, 2008

To forgive is not to forget

2008-01-18T13:24:00.000-08:00

From E.R. Bird's book review of 'I Am Not Joey Pigza' by Jack Gantos:

"I think the important thing about this book is that it makes it clear that forgiveness is different from stupidity. You can forgive someone and remember what they put you through. Forgiveness is not the same as memory loss."

Results of Casey Field Office Mental Health Study

2008-01-16T15:48:00.000-08:00

http://www.casey.org/Resources/Publications/CFOMH.htm

The aftermath of child traumatic stress

2008-01-09T13:03:00.000-08:00

Child traumatic stress occurs when children and adolescents are exposed to traumatic events or situations, and this exposure overwhelms their ability to cope with what they have experienced.

Traumatic events can include physical and/or sexual abuse, assault, serious accidents or illnesses and the loss of important relationships or caregivers.

The issue of trauma has only recently received attention within the juvenile justice department, and children’s services in general. For this reason, very few agencies routinely screen for trauma or offer trauma-specific treatment interventions for youth in their care.

Severe and/or long-term trauma has a chemical effect on the body which changes the body’s normal stress response into an alarm response.

As a result, young people might internalize their feelings through depression and anxiety, or act out their feelings in the form of aggression, conduct problems and oppositional/defiant behavior.

Young people are faced with the task of dealing with past trauma, recognizing its current impact and learning ways to manage or overcome the emotional and behavioral problems caused by PTSD.

Effective strategies are those that:
- Educate survivors about biochemical reactions associated with PTSD
- Empower survivors with strategies to self-regulate their response to triggers
- Encourage survivors by giving them a safe place to share their story in an atmosphere of acceptance

Source: Ford, J., et al, Trauma among youth in the juvenile justice system. National Center for Mental Health and Juvenile Justice, Research and Program Brief, June 2007.

What do you think?

2008-01-09T11:50:00.001-08:00

According to preventative psychologist JoAnn Derek, females are predisposed to experience higher levels of fear and anxiety, and remember painful experiences in greater detail than males.

Source: Keeling, Libby. Writer applies brain research to child development. Sept. 3, 2007.

Stress, Trauma and Support in Child Welfare Practice

2007-12-15T18:01:00.000-08:00

This study from the University of Toronto measured the extent to which exposure to stress and trauma impacted social workers.

Results suggested that child welfare workers are exposed to a significant amount of traumatic stimuli and exhibit high levels of post-traumatic stress.

Mental Health First Aid Guidelines Project for Traumatic Events

2007-11-22T06:45:00.000-08:00

I have been privileged by the University of Melbourne by being invited to share my insights as an expert panel member for a project titled the Mental Health First Aid Guidelines Project for Traumatic Events.

Panel members are mental health professionals and researchers, people who have experienced traumatic events in the past and who work to help others with handling trauma as part of their careers.

Eating your feelings

2007-11-13T10:51:00.000-08:00

"There is not enough fried chicken on the planet to soothe a broken woman."

"I would eat so I didn't have to talk, drink so I didn't have to feel, smoke so I didn't have to be close to another soul."

"Nothing is better for numbing your soul than the sheer, unbridled love of the carbohydrate."

"You can eat your life into submission, or drink it down with so many bottles of wine, or smoke it away on a patio. You can look for love and respect in the eyes of another, and it still will not fill you up. This I have finally learned. Nothing will ever make you whole except you."

- Laurie Perry, Drunk, Divorced and Covered in Cat Hair

Unfinished business

2007-10-23T06:34:00.000-07:00

"Once in a while, a piece of old business surfaces; some item on life's agenda you thought you'd dealt with years ago.

"Suddenly, it's there again at the top of the page, competing for your attention, despite the fact that you're completely unprepared for it."

- Sue Grafton, O is for Outlaw

Wise words from an Ohio foster care alumna

2007-10-08T16:15:00.000-07:00

"If I'm ever gonna get over it,
first, I've got to get it out."

Kudos to the courage of this young person facing her past and working through difficulties!

Quotes from Torey Hayden book "Twilight Children"

2007-10-05T15:09:00.000-07:00

A friend of mine was sexually abused as a child, and she has never talked about it. She doesn't want anyone to know. She has been reunified with her mother after a stint in foster care, but doesn't trust her mother to be able to handle the knowledge.

Her counselor is ready, willing and able to help her -- but she finds it difficult to open up her mouth and speak about what happened.

After a traumatic experience, when you discuss these things, it is painful, because you find yourself reliving it all over again. The violation. The fear. The feelings of powerless.

This is because traumatic experiences encode themselves in the brain via images and emotions, not words. We remember the taste, the touch, the sight, the sound...

But it is by giving them words, verbalizing the experience, that we are able to lasso these huge, powerful, scary experiences and get them under control.

After our phone conversation, I sent this young woman the following quote by Torey Hayden, from her book Twilight Children. Torey is talking with a young girl named Cassandra, and she says:

"What's wrong with you is inside of you. So, wherever you go, your trouble goes inside of you...

"Some really awful things have happened to you. Things children shouldn't have to experience... (Now) you are just trying to protect that troubled place inside of you, because it hurts so much, and you don't want it to get hurt again."

Torey continues:

"Unfortunately, there is a really big problem in doing this. And the problem is: You've protected your troubled place so well that you've ended up taking its side."

"Our minds are kind of funny things. When something big happens to us, it tends to stay really big in our minds and won't become a proper memory unless we talk about it. Our minds, on our own, don't seem to be able to get big events sorted out enough to squish them down to size with our other memories. We need to talk about it.

"Talking helps our minds to organize what happened... It lets us put away things that have happened to us, so they aren't in the way every time we are thinking.

"We talk about them until our mind gets organized about what happened. Then, they're not such a big deal anymore. Finally, they start to feel like ordinary memories and we can stop thinking about them all the time.

"We don't forget them, (but) they stop taking up all our thinking... (so) we can get on with what's happening now in our lives and not worry any more about it."

"BUT just the opposite happens if we have to keep something big a secret. First of all, we have to create a special place in our minds to keep it... chock full of all the stuff we can't tell...

"You have to lock it up really tight, so even you can't get there very easily. And if you don't, then you don't have any room in your mind for other thinking."

"When you first do it, first create a Troubled Place and manage to get it locked up, it's easy to think you've made it go away.

"But the fact is... just the opposite is true... Everything you put in there, it keeps really fresh, like its just happened. So, if you accidentally crack open the door... everything will hurt horribly all over again."

"What happened to you... didn't happen to you because you are a bad person. It didn't make you a bad person because it happened. It just happened.

"And now it's time for it to be OVER. It's time to open the door on the troubled place and clean all that junk out. Not to throw it away, because those memories are a part of your memories, part of what makes you 'you.'

"But it's time to make them ordinary. To talk about them until you understand how you felt, what you feel did, what other people did.

"To talk about them until there aren't any secrets left in your Troubled Place to stay fresh and scary, to talk until you're bored with them. That will turn them into ordinary memories, like all the rest of memories in your life."

Men and fear of intimacy

2007-09-27T05:12:00.001-07:00

"She prefers the senseless pain that we inflict on each other to the pain that we might otherwise inflict upon ourselves."

- William Hurt, Altered States

"Too many women mistake a man's hostility for wit and his silence for depth."

- Sue Grafton, L is for Lawless

The aftermath of rape

2007-09-19T07:24:00.001-07:00

http://www.backinskinnyjeans.com/2006/01/the_last_time_i.html

More Quotes from The Unsayable

2007-09-02T18:58:00.000-07:00

- "At first, words are babbling stream of sound. And though very young children play with words and sounds in turn-taking rhythms with others, they don't use language with the purpose of communicating.

"But as a child begins to see that words can make things happen, can call forth specific response from others, she is able to make what Lacan calls 'a demand.' This is a request for recognition of what she means and for a response that affirms she is loved."

- "Provided with food and warmth, yet without recognition or any evidence of love, a child will become lethargic, stop growing and even die. The capacity to ask for something, and make herself understood, is crucial to a child's sense of being loved. But making a demand requires a risk; the other person may not understand, or may understand and say no."

Source: The Unsayable by Annie G. Rogers, PhD

Quotes from The Unsayable

2007-09-02T18:47:00.000-07:00

"Although some see me as an 'expert' on trauma, I'm not. Trauma is bigger than expertise of any sort - it's in our midst, in our language, our wars, even the ways we try to love, repeating, repeating. No one is an expert on trauma."

"Even then I had a reputation for reaching 'unreachable' children... If a child is suffering, in that quiet invisible way that children really do suffer, I am drawn to find that child and make contact. Maybe I am going back to myself as a child... I simply won't be turned away."

"In my practice I want to hear children in a way that invites them to say more, to find words for the unsayable - and this necessarily means listening to the unconscious."

"I gradually learned that trauma follows a different logic, a condensed psychological logic that is associative, layered, nonlinear, and highly metaphoric."

"Trauma is a letter written on the body in vanishing ink.... a message emerges that demands to be read, to be known."

Source: The Unsayable by Annie G. Rogers, PhD

The Myth of Child Resiliency

2007-08-19T04:41:00.001-07:00

Bruce Perry has made it his life's work to understand how trauma affects children, and to develop innovative ways to help them cope with it. In 1996, he founded the Child Trauma Academy, since research demonstrates that the impact of PTSD is far greater on on children than it is on adults.

Children can recover from unspeakable trauma -- but adults' responses to children during and after traumatic events can greatly affect their chances of recovery.

Quotes from The Boy Who Was Raised As A Dog:

- "It's hard to imagine today, but when I was in medical school in the early 1980's, researchers didn't pay much attention to the lasting damage that psychological trauma can produce. Even less consideration was given to how trauma mgiht harm children. It wasn't considered relevant. Children were believed to be naturally "resilient" with an innate ability to "bounce back."

- "The brain is a historical organ. It stores our personal narrative. Our life experiences shape who we become by creating our brain's catalog of template memories, which guide our behavior, sometimes in ways we can consciously recognize, more often via processes beyond our awareness."

- "if anything, children are more vulnerable to trauma than adults... Resilient children are made, not born. The developing brain is most malleable and sensitive to experiences - both good and bad - early in life."

- "Children become resilient as a result of the patterns of stress and nurturing that they experience early on in life... we are rapidly and easily transformed by trauma when we are young. Though its effects may not always be visible to the untrained eye, when you know what trauma can do to children, sadly, you begin to see its aftermath everywhere."

- "Ultimately, what determines how children survive trauma, physically, emotionally , or psychologically, is whether the people around them - particularly the adults they should be able to trust and rely upon - stand by them with love, support and encouragement."

The story in this book that most deeply affected me as a reader was one about a three-year-old girl named Sandy who witnessed her mother's murder, and almost died herself.

Yet, her CPS caseworker did not believe that she needed to see a mental health professional. For nine months, Sandy was moved from foster home to foster home, with no counseling whatsoever -- and the details of her life were not shared with any of her foster parents because she was in hiding from the murderer.

No Man's Woman; Nobody's Child

2007-08-10T14:54:00.000-07:00

"I could see in a flash the extreme pleasure I'd taken in being related to no one.

"I'd actually managed to feel superior about my isolation, I was subtle about it but I could see that I'd turned it into a form of self-congratulation.

"I wasn't the common product of the middle class. I wasn't a party to any convoluted drama. The feuds, the unspoken alliances, secret agreements and petty tyrannies.

"Of course, I wasn't a party to the good stuff either."

- Sue Grafton, J is for Judgment

2007-07-17T14:11:00.000-07:00

"Pain and sadness are homeless beggars in my life, displaced feelings that come and go, plopping down for their own reasons, sleeping in any corner of my brain. They wear at me with a constant tiredness that I have to chase out.

"Sometimes, though, a trigger pulls inside me, and the pain goes off, getting bad. It isn't like I know all the triggers, but school newness is a definite."

- Clinton, Cathryn. The Eyes of Van Gogh.

Strategies for Coping With Panic

2007-07-15T07:54:00.000-07:00

1. Remember that although your feelings and symptoms are very frightening, they are not dangerous or harmful.

2. Understand that what you are experiencing is just an exaggeration of your normal bodily reactions to stress.

3. Do not fight your feelings or try to wish them away. The more you are willing to face them, the less intense they will become.

4. Do not add to your panic by thinking about what "might" happen. If you find yourself asking "What if?" tell yourself "So what!"

5. Stay in the present. Notice what is really happening to you as opposed to what you think might happen.

6. Label your fear level from zero to ten and watch it go up and down. Notice that it does not stay at a very high level for more than a few seconds.

7. When you find yourself thinking about the fear, change your "what if" thinking. Focus on and carry out a simple and manageable task such as counting backward from from 100 by 3's or snapping a rubber band on your wrist.

8. Notice that when you stop adding frightening thoughts to your fear, it begins to fade.

9. When the fear comes, expect and accept it. Wait and give it time to pass without running away from it.

10. Be proud of yourself for your progress thus far, and think about how good you will feel when you succeed this time.

Source:
Jerilyn Ross, M.A., L.I.C.S.W., The Ross Center for Anxiety and Related Disorders, Disorders, Inc., Washington, DC. Adapted from Mathews et al., 1981.

PMS and PTSD: A bad combination

2007-07-15T06:43:00.000-07:00

The reason that PTSD survivors are affected differently from others when faced with the same stressful situation is that person carries a different emotional history inside our bodies. The external event may reawaken the lingering memories of similar events from the past, memories that carry their own set of anxieties.

The residue of emotional trauma from earlier in life can be held deep inside the body where it influences the way we live our lives, and disrupts normal bodily functioning. When an event occurs that is similar to the originating event, it can aggravate the hidden emotions and cause them to flare up, worsening our behavior and exacerbating our physical problems.

Post-traumatic stress disorder (PTSD) is an anxiety disorder that can develop after exposure to a terrifying event or ordeal in which grave physical harm occurred or was threatened.

Many people with PTSD repeatedly re-experience the ordeal in the form of flashback episodes, memories, nightmares, or frightening thoughts, especially when they are exposed to events or objects reminiscent of the trauma. Anniversaries of the event can also trigger symptoms.

Emotional symptoms can include:
■ Hypervigilence
■ Exaggerated startle response
■ Irritability or outbursts of anger
■ Heart-stopping terror
■ Emotional numbness
■ Depression, anxiety
■ Feelings of intense guilt
■ Sleep disturbances such as nightmares and recurring dreams of the event

People with PTSD tend to have abnormal levels of key hormones involved in response to stress. Fear, an emotion that evolved to deal with danger, causes an automatic, rapid protective response in many systems of the body. For people with PTSD, the "fight or flight" response becomes inappropriately aroused.

PMS: Pre-Menstrual Syndrome
Emotional symptoms can include:
■ Mood swings
■ Fear, nervous tension
■ Feeling overwhelmed, powerless, out of control
■ Depression, anxiety, suicidal thoughts
■ Phobias, feelings of suspicion
■ Sleep disturbances

The words used to describe panic disorders are often frightening. But there is great hope: Treatment can benefit virtually everyone who has this condition.

Several types of medication, particularly the selective serotonin reuptake inhibitors and other antidepressants, can help relieve the symptoms of both PMS and PTSD.

Additional treatment options:
■ Breathing exercises: Control breathing to avoid hyperventilation
■ Replace alarmist thoughts with calmer ones
■ Approach fearful situations gradually
■ Join a support group

Source:
National Institute of Mental Health
Toll-Free: 1-88-88-ANXIETY (1-888-826-9438)
E-mail: nimhinfo@nih.gov
NIMH Web site: http://www.nimh.nih.gov/

Recent research on PTSD

2007-07-15T06:20:00.000-07:00

According to the National Institute of Mental Health:

■ In brain imaging studies, researchers have found that the hippocampus—a part of the brain critical to emotion—appears to be different in cases of PTSD. Scientists are investigating whether this is related to short-term memory problems. Changes in the hippocampus are thought to be responsible for intrusive memories and flashbacks that occur in people with this disorder.

■ People with PTSD tend to have abnormal levels of key hormones involved in response to stress. Some studies have shown that cortisol levels are lower than normal and epinephrine and norepinephrine are higher than normal.

■ When people are in danger, they produce high levels of natural opiates, which can temporarily mask pain. Scientists have found that people with PTSD continue to produce those higher levels even after the danger has passed; this may lead to the blunted emotions associated with the condition.

For more information:
National Center for PTSD: http://www.ncptsd.org/

Source:
National Institute of Mental Health
Toll-Free: 1-88-88-ANXIETY (1-888-826-9438)
E-mail: nimhinfo@nih.gov
NIMH Web site: http://www.nimh.nih.gov/

2007-07-07T06:50:00.000-07:00

Helping Traumatized Children Learn

The Massachusetts Advocates for Children has released a report and policy agenda to help ensure that children traumatized by family violence succeed in school.

The report sets forth an education and policy agenda to help schools become more supportive environments where traumatized children can focus, behave appropriately, and learn.

http://www.massadvocates.org/helping_traumatized_children_learn

MICKY: POST - TRAUMATIC STRESS DISORDER

2007-07-04T17:02:00.000-07:00

MICKY: POST - TRAUMATIC STRESS DISORDER

Another survivor of the system shares statistics and information about PTSD...

Intimacy can bring emotional damage to the surface

2007-07-01T08:11:00.000-07:00

Whatever the surface appearances, most human beings come equipped with convoluted emotional machinery... With intimacy, the wreckage starts to show.

- Sue Grafton, D is for Deadbeat

Postcard Project on the Culture of Foster Care

2007-06-14T19:49:00.000-07:00

Link to "Without A Tribe"

2007-05-31T20:39:00.001-07:00

http://withoutatribe.blogspot.com/2007/05/session-with-betty-throwing-yourself.html

Triggers and Vietnam War veterans

2007-04-14T06:55:00.000-07:00

Some veterans from the Vietnam War were so traumatized that any loud noise similar to the sound of gunshot triggered flashbacks of the war.

Grown men rolled into a gutter in order to 'take cover' from the sound of a car backfiring. The sound triggered a full-body reenactment of the war experience.

This experience of post-traumatic stress disorder was not under the veteran's concious control. It was an automatic response when the neural network associated with the trauma of war was triggered.

Again, take note that a Harvard/Casey study has proven that foster care alumni experience post-traumatic stress disorder at a rate twice that of Vietnam War veterans.

Source:
McGraw, Patricia. It's not your fault: How healing relationships change your brain and can help you overcome a painful past. IL: Bahaii Publishing, 2004.

Learning to disconnect from thoughts, feelings and behavior

2007-04-14T06:10:00.000-07:00

Behavior doesn't come out of a vacuum. Underneath the surface, there are deep roots from which that behaviour has grown.

When babies are born, as part of the imprinting process, a baby experiences their parents' emotions as if they were his/her own. It's an emotional merger, wherein the parent and child are meant to "attune" to one another's experience.

Ideally, the environment would be stable and safe.
Ideally, the growing child will be given words to describe his/her emotions.

In this ideal situation, a child would be secure and ensured of protection and love. This child would learn to identify feelings when experiencing them, and think about how to respond to that emotion.

But what if a child's safety and well-being are seriously threatened?
What is there is an external threat that seems frightening and insurmountable?
What if the first relationships of a child's life are broken?

Foster care creates repeated trauma. Children learn to disconnect with thoughts and feelings in order to survive.

Trauma can also create a disconnection with personal behavior: If you, or someone that you know, are involved in self-destructive behavior, over and over, examine their pasts for imprints of relationship patterns in which that type of behavior was born.

Consider a child who was sexually molested -- and ends up exploiting his/herself through unhealthy relationships or becoming a stripper or prostitute. In a sense, what this person is doing is reenacting the abuse from their past in order to make sense of it.

Numbing out: Victims of trauma often try to escape their emotional pain. They try to numb out by sexualizing events, eating emotions, drinking to dull the event, smoking to feel the buzz of nicotine or using drugs to make the situation temporarily 'disappear.'

These are survival techniques. In the face of danger, memories become fragmented, mental processes shut down and the only focus is on survival.

But emotions are basic to survival. When a person's outer life and inner life are disconnected, that person cannot heal.

It takes courage to seek help.
It takes courage to stop running and look yourself in the eye.
Even after the healing process has begun, there will be moments of uncertainty.

In post-traumatic stress disorder, fear from the past raises its ugly head and causes the body to react with fight-or-flight or freeze responses. This experience can be very unpredictable and confusing.

Here are the stages of healing, according to Dr. McGraw:

1.) Attunement to self: Take time to be aware of your emotions, including physical symptoms such as increased heart-rate. Journal about the emotions and bodily sensations that you are experiencing, as well as the thoughts and memories that emerge.

You need this time to remind yourself that your physical state and emotions are important.

Learn what your 'triggers' are... To be triggered is to reexperience an event from the past in the present. You will experience the bodily sensations and emotions of a terrifying event that happened long ago.

2.) Strengthening and stabilization: Create safe and stable life circumstances for yourself. Inasmuch as it is in your power, keep your everyday life free of crisis and chaos. Do not participate in behaviors that you have been using to avoid or act out traumatic experiences.

You need this time to give yourself a base of happier memories and safe experiences.

3.) Working through traumatic experiences: After having a base of happier memories, adults find that they are better able to deal with the past.

-This stage should not be rushed. Rushing this process can be damaging and counterproductive.

-Simply talking about a problem will not heal it. The actual events are less important than their emotional impact.

-Pace yourself. Take baby steps. If a conversation becomes too painful, end it. Revisit the problem later, when the emotional intensity has subsided.

Shocking, surprising or overwhelming yourself with emotional experiences that you are not prepared to handle will not help you heal.

4.) Acceptance and service: This is characterized by:

-No longer hiding from yourself, your past or your true feelings. See yourself within your own story with compassion and empathy. Be the hero of your own story.

-Being aware of your triggers and not letting your emotions take you hostage. Creating a strategy for coping and recovering when triggers occur.

-Building the capacity to develop warm, loving relationships with others. Avoid or discard harmful relationships. Seek to build new, positive connections.

-Establish a goal and direction for your life. What unique abilities do you have to offer the world?

Source:
McGraw, Patricia. It's not your fault: How healing relationships change your brain and can help you overcome a painful past. IL: Bahaii Publishing, 2004.

Poem about empty promises

2007-04-02T13:35:00.000-07:00

He leaves
and comes back

He leaves
1 week
2 weeks
6 months
2 years

Every time it gets worse
he comes home
and with no thought of how I feel
he leaves

When he first gets home he promises
“I won’t be back in there”
as he complains to us
about the thick metal bars
foul food
and nothing to do
later I wake up and
he leaves

With no info of:
when he’ll be back
what he did
or why
he just
leaves

We communicate slightly
only through phone
his picture is a dusty memory in my mind

He says “I miss you boy”
and I say “I miss you too”
but do I really mean it
do I really miss him

“I wish you would come see me” he says
but do I want to?

so I can walk through the metal door
and see his orange suit
scruffy face
sad eyes

so now you see?
let him leave

-Shawn Hanning

Wired for survival

2007-03-27T07:36:00.000-07:00

"Brain development begins soon after conception and continues after birth. The changes that take place in the brain in the early years of life ensure that an infant becomes highly attuned to the environment into which she was born.

"An infant raised in perilous surroundings will develop brain connections and chemical responses that are highly sensitive to signs of danger.

"Early development is for the long-term. It assumes the environment into which an infant is born will not change significantly over the span of her lifetime.

"Hence the brain connections or chemical tendencies laid down in a dangerous environment at the beginnings of life become entrenched even if an individual finds herself in a safe and secure environment in her adult years, her brain is likely to stay on constant lookout for the slightest signs of danger."

- Early Years 2: Putting Science into Action by Hon. Margaret Norris McCain, J. Fraser Mustard and Dr. Stuart Shanker

Free online classes through Child Trauma Academy

2007-03-04T18:20:00.000-08:00

Research and study at the University of Chicago and the Baylor College of Medicine has revealed the complexities and multi-dimensional nature of the problems of childhood abuse and neglect.

The Child Trauma Academy started out as a university-based, medical model working group, but then evolved into an independent, not-for-profit "community of practice."

Their online university offers free online courses.

Right now, the courses they are offering are:
1.) "The Amazing Human Brain and Human Development"
2.) "Surviving Childhood: An Introduction to the Impact of Trauma"
3.) "The Cost of Caring: Secondary Traumatic Stress and the Impact of Working With High-Risk Children and Families"
4.) "Bonding and Attachment in Maltreated Children"

For more information, please visit:
http://childtraumaacademy.org/

Life stories to address attachment issues

2007-03-01T13:28:00.000-08:00

Child protection: serious business.: Scrapbook Life Story Work with Kids in Foster Care.

Trauma-related beliefs and resilience

2007-02-25T19:23:00.000-08:00

In the general public, physical abuse is likely to occur twice as often as sexual abuse.

Within the foster care system, however, the rate of substantiated allegations of sexual abuse is higher than that of physical abuse.

While there are no significant differences regarding physical abuse or neglect for boys vs. girls in foster care, studies have demonstrated that girls are at greater risk for sexual abuse within the foster care system.

Girls with a history of sexual abuse:
-Experience twice as many placement changes than girls with no history of sexual abuse
-Are more likely to be housed in a group home or residential placement

Trauma-related beliefs related to sexual abuse:
- Self-blame/stigmatization
- Betrayal
- Powerlessness
- Traumatic sexualization

84 women between the ages of 18 - 25 years old participated in a study supported by the Orphan Foundation of America.

65% of participants reported a history of sexual abuse.

Where sexual abuse takes place:
1.) Prior to entering foster care
2.) While in foster care (35% of participants)
3.) In both settings (highest rate of self blame/stigmatization)

Tool utilized in study: Trauma-Related Beliefs Scale, which has been shown to be a reliable measure of beliefs for sexual abuse survivors.

Powerlessness was found to make the most significant impact on the resiliency of foster care alumna. Recovery from sexual abuse is aided by having an internal locus of control. (See previous blog entry on attribution theory).

Source:
Breno, Anjey and Galupo, M. Paz. Sexual abuse histories of young women in the U.S. child welfare system: A focus on trauma-related beliefs and resilience, Towson University.

Traumatic stress as experienced by children in the child welfare system

2007-02-01T16:19:00.000-08:00

Here is a link to the current issue of Focal Point, which focuses on traumatic stress and children within the child welfare system: http://www.rtc.pdx.edu/pgFPW07TOC.php

Articles include the following:

Traumatic Stress and the Child Welfare System

Walker, J. S., & Weaver, A. This article defines child traumatic stress, describes some events that can cause traumatic stress, and summarizes the effects it has on children, youth, and society.

Complex Trauma in Children and Adolescents

Cook, A., et al. This article provides a core background for understanding the psychological and physiological effects of multiple traumatic stress experiences on the developing brain. Steps for assessment and treatment are also discussed.

A Real Mother's Embrace: Reflections on Abuse and Recovery

Weaver, A. The guest editor of this issue of Focal Point gives a poignant first-person account of his childhood abuse and subsequent recovery. A strong theme of Aaron’s story is the enduring support and love offered by his foster family.

Evidence-Based Treatment for Children in Child Welfare

Stambaugh, L., Burns, B. J., Landsverk, J., & Rolls-Reutz, J. This article reviews several treatment programs for children in the child welfare system who have experienced traumatic stress. The article focuses on treatments for which there is the best evidence of effectiveness.

Early Intervention as Prevention: Addressing Trauma in Young Children

Groves, B. This article focuses on the need for early intervention to address child traumatic stress in young children. The article also describes the characteristics of effective intervention.

Adapting Evidence-Based Treatments for Use with American Indian and Native Alaskan Children and Youth

Bigfoot, D. S., & Braden, J. This article describes the adaptation of several evidence-based treatments (EBTs) for child traumatic stress for use in Native American communities. The EBTs that are discussed attend to the broad cultural, historical, and intergenerational traumas that are part of the life experience of many Native American youth.

Creating a Trauma-Informed Child Welfare System

Igelman, R., Conradi, L., & Ryan, B. One role of the child welfare system is to remove children from abusive or neglectful home environments. However, the system itself can be a source of trauma. This article provides steps for reducing trauma within the child welfare system.

Child Trauma: The Role of Public Policy

Gerrity, E. This article discusses the impact that federal, state, and local government policies have in promoting increased understanding of and effective response to child traumatic stress. Analysis of current policy issues and areas for improvement is included.

Survey on Personal Boundaries

2007-01-30T17:37:00.000-08:00

How many of these questions would you say "yes" to?

1.) I can't make up my mind.
2.) I have difficulty saying "no" to people.
3.) I feel as if my happiness depends on other people.
4.) It's hard for me to look a person in the eyes.
5.) I find myself getting involved with people who end up hurting me.
6.) I trust others.
7.) I would rather attend to others than attend to myself.
8.) People take or use my things without asking.
9.) I have difficulty asking for what I want or what I need.
10.) Some people I lend money to don't ever pay me back.
11.) I feel ashamed.
12.) I feel bad for being so "different" from other people.
13.) I feel anxious, scared or afraid.
14.) I spend my time and energy helping others so much that I neglect my own feelings and wants.
15.) I find myself getting involved with people who end up being bad for me.
15.) I feel as if my happiness depends on circumstances outside of me.
16.) I tend to take on the moods of people close to me.
17.) I am overly sensitive to criticism.
18.) I tend to get caught up in the middle of other people's problems.
19.) I feel responsible for other people's feelings.
20.) I put more into relationships than I get out of them.

*Source: Boundaries and Relationships by Charles Whitfield

Boundaries and Core Issues

2007-01-30T17:26:00.000-08:00

Healing often occurs within community
To work through whatever core issues are most important to you, it helps to be in the company of safe people who support what you are trying to accomplish.

Early experience(s) of abandonment can lead to feelings of self-doubt and shame.
Sometimes this creates layers of problems, including compulsions and addictions.

As an adult, it's important for us to create safe boundaries in our lives, especially if as a child, those boundaries were broken. We don't want those boundaries to be too rigid, keeping love and safe relationships out of our lives. But, we don't want to allow our need for love to cause us to put up with abusive behavior either.

As adults, we can choose the that we surround ourselves with, and with whom we share our personal information. (Please note that foster care alumni often have an all-or-nothing tendency to overshare or undershare).

Recovery happens in stages

2007-01-30T17:01:00.000-08:00

Recovery issues might include:

1.) Grieving
- Stage 1: Identifying our losses
- Stage 2: Learning to grieve
- Stage 3: Grieving past losses
- Sign of recovering: Grieving current losses

2.) Neglecting our own needs
- Stage 1: Recognize that we have needs
- Stage 2: Identify what those needs are
- Stage 3: Begin to get our needs met
- Sign of recovering: Getting our needs met on a regular basis

3.) Being over-responsible for others
- Stage 1: Identifying boundaries
- Stage 2: Clarifying what our personal boundaries are
- Stage 3: Learning to set limits
- Sign of recovering: Being responsible for self, with clear boundaries

4.) Control issues
- Stage 1: Recognize what the control issues are
- Stage 2: Sort through what you can and cannot control
- Stage 3: Let go of some things, take responsibility for others
- Sign of recovering: Achieving more of a balance

5.) All-or-nothing thinking
- Stage 1: Recognize that it's there, and that it is a problem
- Stage 2: Consider possibilities of middle ground

6.) Trust issues
- Stage 1: Realize the importance of trusting
- Stage 2: Trusting selectively
- Stage 3: Learning to trust safe people
- Sign of recovering: Trusting appropriately

7.) High tolerance for inappropriate behavior
(often linked with dependence issues)
- Stage 1: Question what is appropriate and what is not
- Stage 2: Define what you will and will not put up with
- Stage 3: Learn to set limits
- Sign of recovering: Being able to set boundaries with others

8.) Fear of abandonment
- Stage 1: Acknowledge that we have been neglected or abandoned
- Stage 2: Talk through those emotions with a safe, trustworthy person
- Stage 3: Work through emotions and learn safe attachment within a caring community
- Sign of recovering: Willing to take the risk to open your heart to another person

9.) Difficulty handling and resolving conflict
- Stage 1: Define the conflict; put it into words
- Stage 2: List the roadblocks to conflict resolution
- Stage 3: Attempt conflict resolution
- Sign of recovering: Conflict resolution, or agreeing to disagree

*Source: Boundaries and Relationships: Knowing, Protecting and Enjoying the Self by Charles Whitfield, M. D.
http://www.markstivers.com/cartoons/

Former Foster Children and Post Traumatic Stress Disorder

2007-01-15T10:58:00.000-08:00

Comic from Cyanide and Happiness at http://www.explosm.net/comics/archive/

According to An April 6, 2005 study, former foster children in Washington and Oregon suffer post-traumatic stress disorder at twice the rate of U.S. War veterans.
http://www.casey.org/MediaCenter/PressReleasesAndAnnouncements/NWAlumniStudy.htm

The definition of PSD is "a condition in which victims of overwhelming and uncontrollable experiences are subsequently psychologically affected by feelings of intense fear, loss of safety, loss of control, helplessness and extreme vulnerability. In children, the disorder involves disorganized and agitated behavior."

After having suffered a traumatic event, children believe that if they are vigilent enough, they will recognize the warning signs and avoid future traumas.

Researchers from Harvard Medical School, the University of Michigan and Casey Family Programs reviewed case files of 659 adults, ages 20 to 33, who had lived in foster care between 1988 and 1998. They interviewed 479 of them.

It was the first significant study of how former foster children fared over a long period of time. Most of those studied entered foster care because they had been abused or neglected. More than half reported clinical levels of mental illness, compared with less than a quarter of the general population.

Foster children, the study said, are especially vulnerable to post-traumatic stress disorder.

Peter Pecora, director of research for Casey Family Programs, said a fourth of those studied reported symptoms of the disorder -- twice the rate of U.S. war veterans. "It is a dramatic finding," he said, adding that national studies show that 12 percent to 13 percent of Iraq war veterans and 15 percent of Vietnam war veterans suffer from the disorder.

Post-traumatic stress disorder occurs in some people who experience or witness life-threatening events, such as violent personal assaults, military combat or serious accidents. They often relive the trauma through nightmares and flashbacks, and feel detached or estranged.

Identity development and self-protection among group home residents

2007-01-12T17:19:00.000-08:00

Author's premise:
'Although it is a given that children come into foster care with multiple, complex problems that stem from traumatic experiences such as physical abuse, sexual abuse, neglect, parental substance abuse and mental illness, there is little evidence that foster care ameliorates those problems.' (Definition of ameliorate: To make a situation better or more tolerable).

I love this quote from the research study: "There is a dearth of foster care research to elicit the perspective of the child."

In studies that did interview foster youth:
-Very few were able to articulate the reason for their placmment or plans for their future
-Most articulated high levels of insecurity about the permanency of their current placements

Sample:
-Teenagers from ages 15-19 who had been in foster care between 2-11 years
-This sample was drawn from group home settings

Group homes are structured residential settings, housing several foster youth. The use of group care for teenagers is high for many reasons, including a lack of available foster homes for adolescents. Group settings are often chosen for teenagers in order to facilitate their preparation for independent living.

Identity development, according to Erikson, is the process by which a teenager develops a concept of his/herself. It includes the recognition of personal capabilities and limitations.

This process involves:
-Coming to terms with past experiences
-Accepting a realistic self-definition
-Manifesting a future direction (*educational disruptions don't help)

Self-identity is socially bound: A person's sense of self emerges, in part, through their interactions with others. Therefore the social context of living in a group home has a critical influence on the residents' developmental process.

Group home residents experienced:
1.) Development of a stigmatized self-identity (*culture of foster care)
2.) Self-protection

--Institutionalized: Group foster care was described by residents as being 'like an institution.' Despite being based on a familylike philosophy of care, group homes were perceived to be overly restrictive and to lack individual consideration or respect.

--Pathologized: Furthermore, caregivers interpreted normal teenage behavior, when expressed by group home residents, as psychopathological or devient.

--Stigmatized: Entering group care conferred a new status on the child. Being labeled a 'foster child' or a 'group home kid' was experienced as a diminished social status. Other people assumed that the teenager was delinquent or disturbed.

Impersonal treatment and disrespect: These assumptions were communicated to group home residents in everyday social interactions, and, in effect, devalued their personal worth.

Negative stereotypes followed them in both their living situations and their larger social world, and were widely held by adults and peers in their neighborhood and school environment. This resulted in biased assumptions and behavioral expectations.

Internalizing the stereotype: In time, the negative views that other people held and communicated through interactions with the teenager were interalized into the teenager's self-view. This led to self isolation and limited future aspirations (lowering the bar of self-expectations).

Process of self-protection
When a child in foster care endures recurring assaults on his or her developing identity, defenses must be developed in order to prevent additional harm. Foster care is rife with uncertainty.

Self-protection is the process by which a child develops those defenses and strategies to protect self from further disappointment, rejection, loss or trauma. This process may begin prior to foster care placement, when a child experiences major losses, neglect or ongoing abuse.

The self-protective process is often accentuated in foster care due to:
-Multiple placement transitions
-Unstable caregiving
-Further episodes of mistreatment within foster placements

1.) The illusion of normality: Upon first entry into foster care, many children are given the illusion that they will be placed in a 'homelike' setting, that they will be safe, and that the people will be like a family. For many of us, this turns into broken promises.

2.) The unpredictability of foster placements is that they so often involve many transitions. Children are often left without a stable core of caregivers. The faces change, at school, in the foster placement. Even permanent foster homes end when a teenager is emancipated, which "terminates" the placement.

Each time you move, it's harder to get close to people: Trust diminishes. Most participants in the study could idenify at least one previous caregiver to whom they have felt close. The loss of that individual had been disappointing and painful. The repeated transitions underscored the original losses or rejections that had caused the young person to enter foster care.

3.) Personal loss and disconnectedness: Quote from participant in the study, "When you move, you always leave a little something behind that was yours"
-Multiple moves
-Difficulty maintaining relationships with siblings, relatives and friends
-Learning how to live without those relational connections

Strategies for self protection
1.) Creating a fictional self to conceal their foster child status: Forethought and selectivity before sharing personal information with another person. First measuring the risks of disclosure, trustworthiness of the person and potential changes in the relationship.

2.) Maintaining a defensive posture about foster care status: Apathy, "I don't care who knows" or defiance, "If they don't like it, it's their problem!" Might involve setting up fronts or barriers to avoid involvement with others or distancing themselves through antisocial behavior.

Quote from participant: "I keep my problems to myself and I solve them in my own mind. That's the way I handle things."

3.) Keeping relationships superficial: Nearly all the study participants reported making a conscious decision not to get too close or make attachments to other people.

One participant said, "I'm not really close to anyone that lives here (the group home). Oh, I'm nice to them, like when I need to borrow something. So I basically just use this place like a motel."

Underlying themes for self-protective strategies:
-"I can and must take care of myself"
-"Others can hurt you"
-"I don't need anyone"

The key defense was a veneer of self-reliance, giving the appearance of self-confidence, competance and independence. This is accomplished by using one's internal resources to combat or cope with external conditions that have a real or potential impact on the self.

It's basically a barrier to protect self from further harm.

Source:
Kools, Susan. Self-protection in adolescents in foster care. Journal of Child and Adolescent Psychiatric Nursing, Vol. 12, No. 2, pp. 139-152.

Does foster care affect boys differently than girls?

2007-01-09T15:42:00.000-08:00

*External locus of control: An individual believes that his/her behaviour is guided by fate, luck, or other external circumstances.

*Internal locus of control: An individual believes that his/her behaviour is guided by his/her personal decisions and efforts.

The sample:
56 foster children from a public metropolitan social service area and 56 nonfoster children from the same community completed an external/internal locus of control scale and a brief demographic questionnaire. The male-female ratio of both groups was 28 boys and 28 girls.

The tool:
The Nowicki Strickland Internal-External Locus of Control Scale

The results:
Results indicated that female foster children experience a significantly higher external locus of control orientation. This difference was present regardless of the number of years in foster care.

Relationship between achievement and locus of control:
Other studies have demonstrated that high achievers are significantly more internal in their locus of control than comparison groups.

Please note that internal locus of control, or belief in one's one effectiveness can co-exist with low self esteem.

Speaking personally:
I have a high internal locus of control.

Speaking collectively:
Reading this research study made me concerned for other female alumni of foster care, who might think that their lives are governed by fate or chance, and because of that belief, sit idly rather than working proactively to make their lives better.

Sources:
Jackson, Sonia. Reducing risk and promoting resilience in vulnerable children. IUC Journal of Social Work, 2001/2002.
Wiehe, Vernon (2001). Locus of control in foster and nonfoster children. Journal of Genetic Psychology, 148(2), pp. 183-187.

Cognitive Effects of Trauma and PTSD

2006-12-21T08:35:00.000-08:00

Typical cognitive effects after a traumatic experience:
-Recurring intrusive thoughts
-Flashbacks
-Memory lapses
-Difficulty with focus, concentration and sustained attention

It is difficult for a person who is traumatized to learn new things. There is a sense of being scattered, distracted and unable to focus on work or daily activities. Making even simple decisions might seem overwelming.

Feeling overwhelmed: It can be difficult to sort out relevant matters from the daily bombardment of information.

Negative perceptions: The world seems threatening after a traumatizing experience. Partly this is due to flashbacks and environmental triggers. There is also a bias toward noticing things that are worrisome or frightening.

Recurring memories and nightmares replay the same experience, over and over again. Research by Bessel van der Kolk observed that the content of the nightmares of veterans with PTSD stayed the same for 15 years.

Unlike normal, narrative memories, which fade over time, traumatic memories remain fixed, timeless and contemporary, delivering the same dramatic punch every time.

Why do our brains work this way? The flood of hormones in response to trauma both gives us the energy to fight/flee danger and imprints the memory of that trauma in order to create a once-and-forver learning experience. It is a survival mechanism, so that if a similar danger comes again, we will be wired to instantly react.

Traumatic memories are processed and stored differently than memories of ordinary events. "Normal" memories are encoded verbally, and thereby can be verbally communicated to others afterwards. But traumatic memories are experienced as emotions, sensations and physical states.

The trauma survivor faces an odd contradiction. The memories are so vivid, rich with emotional and sensory details. Yet it's difficult to put words to these experiences, to make cognitive sense out of them.

The phrase "speechless terror" is not a hyperbole; people literally cannot talk when affected in this way. PET scans demonstrate the physiological basis of this phenomenon: during flashbacks, oxygen levels and the verbal centers of the brain are affected.

Source:
Naparstek, Belleruth. Invisible Heroes. NY: Bantam Bell, 2004.

Physical effects of PTSD

2006-12-20T09:07:00.000-08:00

In post-traumatic stress disorder, the cycling back between fight/flight and freezing continues and becames a self-sustaining feedback circuit. The cycle takes on a life of its own.

This pattern becomes imprinted in the neural networks, initially underground but eventually as a self-perpetuating system. If left unchecked, symptoms become increasingly entrenched, and often worsen.

PTSD can be immediately triggered by:
-Spontaneous memories
-Flashbacks
-Nightmares

PSTD might become activated from even vaguely related cues of the initial threat, such as a loud noise, a reminiscent smell, a movement from the corner of the eye, a familiar building or the shadow of a person approaching from behind.

Constant activation of the body's alarm system can lead to several physical complaints. Because these conditions are generated in the brain stem, peripheral forms of treatment provide only temporary relief.

This is why, for the PTSD victim, it's difficult to distinguish between physical compaints and their psychological underpinnings.

Source:
Naparstek, Belleruth. Invisible Heroes. NY: Bantam Bell, 2004.

Physical Effects of Trauma

2006-12-19T08:59:00.000-08:00

Bear with me here... In my next series of blog entries, I will explore the physical, cognitive, emotional and behavioral effects of trauma and PTSD, one by one. Then, I will share some helpful techniques.

Physical effects of trauma:
1.) Immediate response: Restlessness, hypervigilance, sleep issues, generalized anxiety, inability to relax, shallow breathing, fatigue and an exaggerated startle response at trigger events, sudden noises and/or unexpected touch.

Can also include headaches, backaches, TMJ, skin complaints such as itching or rashes and unintentional weigh loss.

2.) Weeks following a traumatic experience: Body remains on alert, reacting to neutral cues in the environment as if they are dire warnings, threats of annihilation.

3.) If chronic post-traumatic stress sets in: Survivors often manifest functional diseases such as chronic fatigue syndrome, irritable bowel syndrome, fibromyalgia, interstitial cystitis, and myofacial, lower back and pelvic pain.

What happens to the body during a traumatic event?
1.) Blasted by biochemicals: The body has a built-in reaction to physical threat.

A small structure within the brain called the amygdala is the storehouse of emotional memory, and it is instantly activated when we sense danger. Interestingly enough, laboratory rats with surgically-removed amygdala are fearless. They are also vulnerable and reckless, with very short life spans.

The amygdala does not wait for instructions from the conscious, thinking portions of the brain to act. It has an enormous capacity to commander our brains, and override the neocortex (which is designed to analyze detailed information and formulate an apporopriate response).

The amygdala jolts the hypthalmus, which produces a hormone called CRF, which signals the pituitary and adrenal glands to flood the bloodstream with stress hormones: epinephrine, norepinephrine and cortisol.

This results in hyperalertness, a flood of energy and the "fight or flight response."

Endorphins are released as well. These are our body's pain-killing neurotransmitters. They ensure our physical survival by making sure that pain doesn't interfere with our ability to act immediately.

2.) Freeze response: This is the immobility response. When an animal is overtaken in the wild, fight-or-flight seems pointless and there is nothing proactive that can be done to save the day. So, the animal collapses and becomes limp, even before it is seized.

At this point, the body receives even more pain-killing endorphins to inhibit wound-licking and other behaviors that could interfere with one last-ditch, life-saving effort on the animal's part.

The body has rebounded from the tension of alarm to its polar opposite: the state of near-paralysis. Tense muscles relax, blood pressure takes a step dive and the racing heart slows down to a crawl.

In the wild, this can help the animal by "playing possum" or by preventing a painful death. If the animal (or person) survives, this biochemical overload has an aftereffect. Almost all animals start to shudder and tremble, to perspire for several minutes and then to take a series of short deep breaths.

Rabbits can do this several times in one day, and shake it off afterwards. People differ from animals in that we don't automatically discharge the biochemicals. It's been hypothesized that we humans don't shake, perspire or take enough deep breaths afterward.

3.) Disassociation: When people freeze, they also disassociate. They "flee the scene" psychically by becoming emotionally disconnected from what is happening.

Afterwards, people tend to blame themselves for their detachment, and assign a negative meaning to it.

Source:
Naparstek, Belleruth. Invisible Heroes. NY: Bantam Bell, 2004.

Lack of predictability and loss of control

2006-12-16T09:03:00.000-08:00

We all structure our lives based on certain assumptions. When children enter foster care, this creates a sense of loss of safety, where "nothing makes sense anymore."

Consciously or unconsciously, a child might cling to ideas like, "If I do A, then B will happen." For me, it was, "If I am smart enough, pretty enough, talented enough, then maybe my father will come back for me."

This makes sense, because our self esteem is bound up in our belief that we can impact the world. Watch an 18-month old child knock over a tower of blocks; he will be compelled to do it again and again, because he's discovering that he is prime mover; he can make things happen.

Because it is built into our hard wiring to love ourselves for being able to make things happen, the converse is also true; we lose self-regard when things happen that are out of our control.

Rational or not, we can't help but feel it's a reflection on our worthiness when a terrifying event comes, and we are unable to prevent it, escape it or fix it. If the trauma is somehow our fault, then the world still makes sense. As a result, we feel guilty and ashamed.

Trauma creates a sense of helplessness, powerlessness and inadequacy.

Left unchecked, that sense of inadequacy can haunt a person (off and on, at intervals) for the rest of their lives.

Sources
Naparstek, Belleruth. Invisible Heroes: Survivors of Trauma and How They Heal. NY: Bantam Bell, 2004.

Restorative Relationships for Foster Care Alumni

2006-11-27T17:40:00.000-08:00

As adults, it is possible to restructure negative relational patterns laid down in childhood.

The adult brain is able to adapt and improve its functioning under the right conditions. It has plasticity, which means that existing neurons are capable of taking on new jobs in order to help individuals adapt to changing circumstances.

Although early structural and chemical patterns might predispose a person towards anger anxiety or depression, the human brain is capable of adapting psychologically to new situations.

Restorative relationships
Relationships can be destructive -- but they can also be restorative. Problems that were created through damaging relationships can be resolved through healing relationships.

At one time, certain responses helped you to survive. Now, those same unconscious reactions undermine your ability to maintain intimate relationships.

You basically have to create a new pathway in your brain. New behaviors will lead to new brainwave patterns -- but these connections will only become stronger if they are frequently used.

Reroute old reactions into a new response:
-If your habitual response is emotional secrecy, you might have to "build the habit" of putting emotions into words.

-If your habitual response is anxiety, you'll need to identify what triggers anxiety, and try to put into words what triggers that anxiety: What are you thinking about that triggers those emotions?

Source:
Hendrix, Harville and Helen LaKelly Hunt. Receiving love: Transform your relationship by letting yourself be loved. Atria Books, 2004.

It seems familiar, but it isn't really...

2006-11-26T13:22:00.000-08:00

The battle is over, but self-vigilance is still constantly enforced...

Three features of post-traumatic stress disorder are particularly damaging to intimacy:

1.) Avoidance: Feelings of detachment and estrangement from others can lead to self-imposed isolation. I am different from others / I can only trust myself.

2.) Hyperarousal: An overdose of adrenaline can lead to increased irritability and outbursts of anger. I must protect myself; I am in danger.

3.) Re-experiencing: Intrusive recollections of past trauma tend to occur even after true danger has receded. They may be an attempt to process the experience. Suddenly, I find myself back where it all began... Can I never escape from this type of experience?

Self-isolation can be motivated by a desire for safety - but in fact, often makes a person more vulnerable. Without a support network, a person has less physical and emotional resources. Also, it is easier for human predators to take advantage of isolated individuals.

A moment of personal disclosure:
When I first married my husband, there were moments when I felt threatened to my very core. The first year of marriage is often the most difficult, and I became fully aware during our honeymoon that I had married a fallible person, who might possibly hurt me.

In my mind, the first half of my life was checkered with events that had made me feel powerless and out of control. It was only after entering college and being legally emancipated, that I had taken control of my life and created an atmosphere of stability and safety.

In college, graduate school and the workplace, I'd established a circle of friends. But, I had always tried not to be overly emotionally dependent upon them. Whereas, in marriage, by yoking myself to another person, I had allowed myself to become vulnerable.

This was an incredibly scary realization for me.

I wish that I had been better prepared for the experience. However, since we can't undo the past, and my husband and I are still happily married, my goal is for other people who age out of foster care to feel better prepared to navigate what they might experience in terms of their fear of dependence on someone.

Think about it:
If the very first emotional / physical support systems of your life disappoint you, the logical response might very well be to depend upon yourself.

This will often get you through the short-term, and ensure your physical survival.

But, if at some point, you want to commit to another person, to love and be loved by them, that might be hard. Because, in loving them, you are vulnerable to them... and that means that they can hurt you.

Since they are human, there will undoubtedly be moments when they disappoint you. And at those times, having them fail you might bring to the surface the memories of every other time that someone from your past has failed you.

But something is different... can you guess what it is?

Impact of Trauma on Intimacy

2006-11-25T15:43:00.000-08:00

My previous blog entry referred to foster care alumna, and how they (we) experience post-traumatic stress disorder at a rate twice that of Vietnam war veterans.

Research also indicates that the ability to relate to other people is altered by personal exposure to trauma.

Truama often causes the "wires" of human interaction to become crossed. This impact is felt most deeply in intimate relationships -- but also has a "ripple effect" which affects every other relationship in that person's life.

In that sense, the trauma continues to harm the person, and infect/affect every person in their life who tries to love them.

Trauma can be a singular event, or the build-up of multiple experiences. Singular events tend to create an immediately obvious reaction, while multiple traumatic exposures can accumulate over several years before revealing themselves. Studies have shown that natural disasters generate less of an emotional impact than interpersonal trauma.

Common features found in traumatic events include:
-Sudden, dangerous, and often life-threatening turn of events
-Feelings of helplessness and loss of control
-Disruption of personal routine; loss of what was familiar
-Unresolved uncertainty over the future

I would argue that, for most of us, foster care created an accumulation of multiple interpersonal traumas.

As an aftermath of sexual abuse, victims often avoid intimacy and trust. Feelings of guilt, shame and inadequacy become linked with sexuality, tainting it and robbing it of beauty or joy.

Problems with intimacy can be caused/exacerbated by traumatic events of a nonsexual nature. Studies reveal that combat veterans often become secretive and emotionally withdrawn.

Although the circumstances of traumatic events differ, the impact on survivors and their partners and the damage to their level of intimacy are similar. This includes accident victims and parents who lose a young child.

Source:
Mills, Bo and Gordon Turnbull. Broken hearts and mending bodies: The impact of trauma on intimacy. Sexual and Relationship Therapy, Vol. 19, No. 3, August 2004.
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