Parenting a Child with Behavioral/Mental Health Concerns: Trauma and PTSD

Dear Families and Adoption/Foster Care Professionals:

Parenting an adopted child, to many experts, means parenting a child who has suffered trauma.  Even an infant, placed in an adoptive family at the hospital, experiences trauma.  The separation of a primary attachment figure.  There is much debate about how this effects a person, but reality is that it does.  However, for many adoptive families, you are adopting an older child who has experienced many forms of trauma.  It is the reality and there is no denying that fact.  All children adopted internationally or through foster care have a trauma history.  There is ongoing research showing that trauma effects a person’s mental, emotional , and biological health.  The ACES Study is worth exploring for families.  As it shows how early childhood experience effect a person throughout their life span.

That being said, in my last article I addressed the issues of anxiety and post-traumatic stress disorder.  Many kids who suffer trauma have PTSD, but trauma can also effect a child in many other areas.  Trauma can effect learning, attachment, social interaction and feelings of safety security and well-being.  As a parent, you need to first acknowledge that your child has suffered trauma and that perhaps their behaviors are a direct result of this trauma.  One of my favorite articles on parenting a child after trauma was published by the American Academy of Pediatrics.  You can find the publication at http://www.aap.org/en-us/advocacy-and-policy/aap-health-initiatives/healthy-foster-care-america/Documents/FamilyHandout.pdf .  This article has some amazing simple tips for parents and I think you should all read it.

Children are resilient, some more than others, but it is very important to know there are things you can do to help.  Providing your children with a loving, nurturing, and supportive home environment is a great place to start.  Creating a predictable routine with clear rules and structure (stability) can help lesson fears and anxieties that often come with traumatized kids. Children who are provide grace and empathy as they struggle through their healing can thrive. 

The following are some things to consider:

Have you had your child seen by a physician?  What level of neglect or physical trauma did they suffer?  Could they have a brain injury from trauma, whether it be blunt force trauma or even exposure to led or other toxic chemicals (post birth or prior).  It is really important to consider have they child evaluated by an Adoption Specialist Physician—we have two amazing resources here in the Pacific Northwest.  The University of Washington Center for Adoption Medicine (http://adoptmed.org/ ) and the Oregon Health Science University Adoption Health Services (http://www.ohsu.edu/xd/health/services/family-medicine/specialized-services/adoption-health-services.cfm) . Both programs will do pre-placement/matching evaluations of a potential adopted child by reviewing medical, mental health, and academic paperwork for a fee.

How does your personal past trauma effect parenting a child who has suffered trauma? Do some self-reflection: Does your child’s behaviors or trauma history trigger you? Is it possible that maybe you might need some help in dealing with your past (remember childhood trauma effects you for the rest of your life)?  I have found for many parents reaching out for help for yourself can make you more present and aware for your own kids.  It can help you be the best possible parent your child can have.  Do they not deserve that?

How do you know if trauma is the root cause of your child’s behaviors? There is no way to be 100% certain of the cause of a child’s behaviors, but professionals can make some pretty clear assessments by learning about your child’s history, past experiences and through behavior observation.  Some common symptoms of behaviors caused by trauma are:

·         Avoiding bedtime/going to sleep/sleep disturbance-night time fears are quite common for many abused and neglected children.  The dark is when repeat trauma could have taken place or it is the place where kids remember.  Their past can cause them to have nightmares or night terrors. This can cause the children to be tired in the morning or throughout the day.

·         Eating issues-controlling food, not wanting to eat certain foods, food avoidance, eating disorders (anorexia, bulimia, or gorging.)-food can be a comfort to some kids while for others it can be a trigger.  Textures can effect some kids differently.  Not having their food touch on their plate or they won’t eat it.  Once again, trying to take control in a chaotic world.

·         Seeking attention/affection of strangers—kids who started life not knowing who to trust or children who were abused by someone that was supposed to protect them, need to learn how to protect themselves and find comfort.  They often don’t know who to trust and can either completely avoid adult interaction for comfort completely or be indiscriminate in their affection.  This can be really alarming to adoptive parent.

·         Difficulties regulating their emotional response to situations. Kids who have a trauma history may be completely unpredictable in their behavior and you may not understand why your child is acting a certain way, examples of this are hitting, biting, kicking or yelling for no apparent reason.  This can be inconsistently or maybe even always.  At school they may do these things to get a toy or to hurt another child who has been receiving attention from a cared for adult.  This can be very alarming to parents, but it is not uncommon.

·         Difficulties in school including school refusal (not wanting to go to school), learning challenges, and behavioral problems. Many kids who have trauma are not even able to focus on school or have not had an opportunity to learn prior to this.  Perhaps their behaviors and the schools response may impact a child’s academic success even though they have the intellectual capacity to learn.

·         Poor social interaction-including isolation from peers (no friends when age appropriate), poor peer interactions (trying to control play, hitting, biting, yelling, etc...), or hanging out with the "wrong" crowd.

Seeking Help:  See my blog from last week.  There are so great guidelines for what to look for in treatment.  However, a couple of the best forms of treatment are Trauma Focused Cognitive Behavioral Therapy (TFCBT http://tfcbt.musc.edu/) or ADOPTS (Addressing Post-Traumatic Stress in Adopted Children http://www.bethany.org/main/adopts-program) or Karyn Purvis and her team at Empower to Connect has a great curriculum for parents on parenting an adopted child who has suffered trauma (http://empoweredtoconnect.org/). This is a resource many of our families have loved and is worth exploring.  There are some great videos on the site.

The National Child Traumatic Stress Network has a great guide on finding treatment providers-I see no reason to recreate the wheel. http://www.nctsnet.org/about-us/about-this-web-site

Individual Queries for Clinical Guidance

 If someone's life is in danger, call 911 or your local emergency number.

The National Child Traumatic Stress Network provides information on its website and through its publications as a public service. We cannot respond to specific questions regarding personal situations, appropriate diagnosis or treatment, professional resources available in your area, or otherwise provide any clinical opinions. We understand, however, that people may have arrived at NCTSN.org because they are looking for such help. Please consider the following.

If you believe you might benefit from the services of a mental health professional, consider using these resources to locate the services you need:

• Get Help Now. This section of our website lists hotlines and websites for people in crisis and information about victim assistance programs.
• The nearest NCTSN member for a referral: Click here for a list of all NCTSN-affiliated centers by state.
• SAMHSA's Mental Health Services Locator for information about mental health resources and services.
• Your Primary Care Physician (PCP): If you are part of an HMO or other managed care insurance plan, your primary physician can refer you to a specialist or therapist.
• Your insurance provider: Contact your insurance company or "behavioral health care organization" for a list of mental health care providers included in your insurance plan.
• District branches of the American Psychiatric Association (APA) for names of APA members in your area: Click here to find your APA district branch online.
• The psychiatry or psychology department at a teaching hospital or medical school in your community.
• National Association of Social Workers' Register of Clinical Social Workers.
• American Psychological Association (APA) for a list of psychologists in your area: Call 1-800-964-2000 or access APA's list online.
• American Academy of Pediatrics (AAP) for a list of pediatricians in your area. Click here to access AAP's "Find a Pediatrician" referral service.
• Mental Health America (MHA) for links to local affiliates around the country and their resources for finding treatment
• American Academy of Child & Adolescent Psychiatry (AACAP) for general information for families and their Child and Adolescent Psychiatrist Finder.

Paulette Caswell, LICSW
Branch Director of Pacific Northwest
Bethany Christian Services Of Washington 

1501 N. 200^th St. Ste. 103 Shoreline, WA 98133  
O - 206.367.4604  F - 206.367.1860 Direct (616) 254-7719

www.bethany.org/washington

True devotion, the kind that is pure and faultless before God the Father, is this: to care for orphans and widows in their difficulties and to keep the world from contaminating us. James 1:27

Resources:

Video:

Child & Adolescent PTSD https://www.youtube.com/watch?v=thhz9sGqffI Powerful video on trauma.

Children, Violence & Trauma: Treatments that work:  https://www.youtube.com/watch?v=3EyvaEk0K-k 

           

What is PTSD https://www.youtube.com/watch?v=YMC2jt_QVEE&feature=youtu.be     more direct at adults, but great!

Websites:

           

ADOPTS (Addressing Post-Traumatic Stress in Adopted Children http://www.bethany.org/main/adopts-program)

American Academy of Pediatric article on parenting a traumatized child:  http://www.aap.org/en-us/advocacy-and-policy/aap-health-initiatives/healthy-foster-care-america/Documents/FamilyHandout.pdf

Australian Center for Post Traumatic Mental Health: Helping my Children after Trauma – A Guide for Parents Includes: What is a traumatic event? / Common problems / What is PTSD? / Treatment for PTSD / How do I get help for my child?  http://www.acpmh.unimelb.edu.au/resources/resources-community.html           

           

Empower to Connect has a great curriculum for parents on parenting an adopted child who has suffered trauma http://empoweredtoconnect.org         

           

National Child Traumatic Stress Network http://www.NCTSN.org 

           

The International Society for traumatic stress studies http://istss.org

           

Trauma Focused Cognitive Behavioral Therapy TFCBThttp://tfcbt.musc.edu/