Professional Education
Report
The following report was written to
assist school districts in the educational planning for children with past
histories of trauma. My name is Dr. Bryan Post and I am
writing this letter on behalf of traumatized children. The following report
contains background information and specific recommendations that are based on
my clinical knowledge of family psychodynamics combined with an expertise in
treating traumatized children generally diagnosed as attachment disordered. The
report is intended to assist school district staff in the creation of an
effective educational environment by providing a concise understanding of a
child’s psycho-emotional susceptibilities as well as recommendations that are
routinely implemented in numerous schools to help create a rewarding educational
experience for such children. The first area I shall discuss is the
emotional functioning of children with emotional histories reflective of trauma.
Exposure to traumatic experiences during early development, specifically from
conception to age three, exposes the developing neurophysiologic system to what
can be termed as arrested emotional development. The environment of calm and
consistent interaction between parent and child, necessary for successful
development of the brain/body tools associated with emotional growth and
regulation, is absent. This absence creates a state of chronic stress without
soothing. The developing child continuously experiences stress during a critical
period of growth when he should be experiencing calm regulated interaction. The
outcome is a brain system poorly equipped for tolerating and managing stressful
environments. Exposure to sufficient stress results in
the emotional state of fear. The brain and body respond to stress inwardly but
this correlates cognitively into fear, hence the fight, flight, or freeze
response. The specific receptor in the limbic system equipped for responding to
threats is the amygdala. This area of the brain responds to all manner of threat
automatically. For example, when a stress occurs, the child becomes scared
immediately. This is an amygdala reaction. However,
the hippocampus is the area of the limbic system responsible for determining how
threatening a stressful event is, acting as the fear regulator, and ultimately
the neural component responsible for effective stress regulation. This area,
along with the very important social-emotional executive control center known as
the orbito-frontal cortex, communicates to the rational area of the brain and
makes the decision to calm down, fight, freeze, or flee. Using the example of
the scared child, the hippocampus allows the child to think in the midst of the
experience: “Well maybe this is not so scary after all.” Therefore the child
calms down and is no longer frightened. The amygdala
begins the most active development in the third
trimester and continues to grow into the 18th month following birth.
The hippocampus and orbito-frontal cortex continue development through the 36th
month, the critical period of infancy. When the
environment is overly stressful during this critical period, and there is
insufficient or inconsistent external caregiver regulation, the growth of the
hippocampus stagnates, hence the term emotional arrested development. Ultimately
this leads to an amygdala that constantly signals danger, and a hippocampus that
is so poorly developed that it is unable to determine how dangerous a situation
or interaction may be. As a result, there is an escalation of stress and fear
without rational processing available to reduce it. In the words of reputed
neuropsychiatrist Bruce Perry, “You have a child that has had an amygdala
hijacking.” The amygdala reacts to stress and prompts fear in an uncontrollable
manner, and the child is essentially held hostage to his or her own
neurophysiology. In fact, research demonstrates that chronic levels of stress
will damage the hippocampii, causing an actual reduction in neural dendrites. As the child continues to grow, his
emotional system remains under arrest. This continues until an environment
conducive to constant regulation has been provided. Once such an environment is
provided, a slow tedious process of reparative stress interaction can begin. In
a highly regulated environment, the developing system can experience emotional
regulation and develop new self-regulatory neuropathways. However, stressful
interactions will rapidly send this highly sensitive system back into old
patterns of chronic intensified fear triggered from the stress reaction,
analogous to what may happen to an inmate released from jail on probation who is
successful under constant supervision and positive interaction, but without
supervision is quickly drawn into the wrong crowd, and before long is back in
jail. When a child continues to require enhanced supervision beyond three years
it becomes increasingly difficult for parents and eventually teachers and peers,
to respond positively. As a result, the arrested neural development is
maintained and the child is not provided the necessary regulated environment to
overcome the early and powerful effects of trauma (stress) exposure. In developmental terms, three age states
are defined for children: 1) chronological age, 2) cognitive age, and 3)
emotional age. Most children who reach the chronological age to start school
show comparable cognitive and emotional ages. For children with emotional
arrested development the emotional age is much younger. In this case, when
experiencing low stress and positive interactions, this same child is bright,
articulate and engaging. He functions well and his behavior is consistent with
his chronological age. However, while the child is eight chronologically and of
school age, when under stress he can quickly revert to the emotional age of a
two-year old, exhibiting many of the same behaviors. Due to an early traumatic
(stress) environment relating to adoption, family illness, multiple household
moves and caregivers, or any number of traumatic events, this child’s emotional
ability is not consistent with the appropriately functioning age of the
school-ready child. Typical characteristics of the school environment are easily
misperceived by the child’s developing system and induce stress. The constant
state of stress correlates into fear, which surfaces as hyperactivity, defiance,
anger, poor peer relations, and so on. In such an environment, a child with a
cognitive age of eight is interacting from an emotional perspective consistent
with an 18 to 36 month old child. Thus his behavior will be dependent on the
environment in which he is nurtured and guided in his development. Over time, without appropriate support,
a lack of ability to feel calm within the school environment will begin to take
its toll on all involved, parents, teachers, and peers, but most of all the
student. The thought of school itself becomes a stress-provoking event. The
child recognizes his own failures, his parents are stressed about receiving
calls and negative reports, the teachers are frustrated with this immature
child, and peers have begun bullying the child because he responds in highly
inappropriate ways to what is considered typical childhood jollying, or other
children are the recipient of the child-turned-bully due to his constant fear of
threat from others. However, the child is responding to fear exactly the way a
child of his emotional age would, with extreme ranges of sadness, anger, and
threatening behavior. In the classroom, the perceived threatening environment
will cause the child to hunker down in fear, become violent or highly
oppositional, and completely resistant to doing, or following through with any
manner of request. For success, the school and parents must
come face to face to work together as a team. In my work with students that
present such an overwhelming discrepancy between emotional and cognitive age, a
number of changes must be initiated. First, it must be stated up front that
education is the primary motive of the educational system, and is highly
applicable to cognitive ability rather than emotional growth. Emotional
learning must initiate within the family system as the family is the center of
educational and emotional development. However, emotional learning can be
greatly supported and enhanced by the school. With proper support and
encouragement from the family and teacher, the student will be better prepared
to receive the expertise offered from the educational system. The specific recommendations below for
such a child have been established to assist him in receiving the most
appropriate environment conducive to emotional development within his current
capability. It must be recognized that without sufficient support to aid in his
development of emotional regulatory ability, most school experience will be
negative. Awareness.
Perhaps the most beneficial factor that will assist this child in learning is
teacher awareness. It is imperative for his teacher to be consciously aware of
his emotional state at all times, and provide a calming influence. This would
include the teacher making a conscious and consistent effort to warmly greet the
child each morning, and to assess his emotional state. This can be enhanced by
having the parent give a brief nod as to whether it has been a morning of
anxiety or relatively regulated. From this point the teacher will be better able
to determine the needs of the child and perhaps the flexibility that might be
required that day. In this same manner, if the child is proving to have a
difficult morning it is important for the teacher charged with his care to be
proactive in creating a less threatening environment for him. This might be
achieved by taking a few minutes for special time together at key points during
the day, particularly during transitions, at the beginning of recess, walking
with him to lunch, or making the recess monitor aware of his sensitive state.
Containment.
It is important to recognize that any manner of stimulus can
be deemed a threat by this child at any time. In an effort to create an
effective environment for him, the concept of containment is most appropriate.
Containment refers to the need to keep the child in a space of more direct
proximity to the teacher than what might be needed for other students. Examples
include sitting at the front of the class as opposed to the back, sitting near
the teacher, eating lunch closer to the teacher’s table, or playing within a
certain vicinity on the playground. Structure/Routine.
School is often times associated with consistency and structure, however the
need for this is amplified when considering a child with a trauma history. Any
change in structure will create a defiant reaction in the child toward the
request. This child in particular is noted for having difficulty in making
transitions that are considered relatively mild to others. It would be
appropriate for the teacher to notify the parent, when at all possible, if there
will be a substitute teacher, or a change in routine. Time-In.
During times that the student appears to be moving into a state of dysregulation
that cannot be interrupted through a simple request or redirection, it is
recommended that the teacher invoke a “time-in.” Different than a time-out,
utilizing the time-in technique recognizes that the child is not intentionally
acting out, but rather has gone outside of his ability to control his own
behavior. This might be most effective by having the student spend five minutes
in positive rather than punitive connection with the teacher outside of the
classroom while the principal maintains the room for a brief period of time.
This technique has proven over time to be one of the most effective. Mentoring.
When at all possible it is highly recommended that at least one member of the
school outside of the teacher/student relationship, be prompted to develop an
aside relationship with the child. The individual might make an effort to greet
him in the mornings, and again in the afternoon. Also this individual could
become a regulatory figure for the child during times that he is struggling in
the classroom. In this manner he could be sent to see this individual for a
brief period of positive connection so the teacher can remain in the classroom. Phone Calls.
It will be a very beneficial practice to allow the child to make a mid-morning
or mid-afternoon phone call to his mother for a period of time as he adjusts to
the new environment. It is also recommended that parents call during the day to
talk with their child during the transition period. This practice can be
extremely settling to an anxious child and can allow for an increase in the
resonation of soothing when the parent is absent. Physical Contact.
During times that the child seems to be getting unnerved, it can be very
beneficial for the primary teacher to give him a pat on the shoulder, a hug, or
a rub on the back Any physical touch communicating warmth and affection can be
unconsciously soothing for the child thereby creating a restoration of
regulation and calm. Modified School Schedule.
In some cases a child is unable to participate in some classes because of the
over stimulation which occurs. Such classes are those that require specific
skills or have a major focus on group activities with lessened adult support and
presence. Examples may include art, music, physical education, and recess.
Special care should be taken to observe the child for a period of time to
determine his capacities to handle such activities both during and after the end
of the period. A modified school schedule can assist the child in receiving the
highest level of educational exposure within his range of emotional tolerance. A
modified schedule will keep stressors at a minimum hence providing this student
the opportunity to utilize his demonstrated cognitive skills. Reduced Peer-Interaction.
Last of all, a reduction in peer interaction for this child may perhaps prove to
be the most beneficial modification for his developmental improvement. Being
relieved of an environment in which emotional bullying can be at its worst will
allow this child to function in the least restrictive environment, without
stress stemming from emotions of fear, shame, and anger. Again, this will be an
area where monitoring is required for a period of time to determine how much the
student can tolerate both during and following the time of the event. In this
manner, the teacher can monitor the effects of the activity after the student
has returned to the classroom. It is highly important to emphasize that
some techniques often used with other children are not effective, and in fact
are detrimental, for children of trauma. Such techniques are referred to as
behavior modification, the most commonly used form of behavior control generally
utilized within the classroom. Techniques such as point charts, star charts,
carding, and “behavioral consequences” will, in a very short period of time,
alienate the student from the teacher and lead to frustration, and a very
disgruntled relationship. This child requires an understanding and awareness of
his psycho-emotional state that will permit maximum flexibility in relating to
him. Behavior modification only works to modify behavior. It does nothing to
address the emotional or physiologic state of stress in a proactive and
responsible manner. In an effort to not alienate the child from others in the
classroom if such charts are used, the charts can be maintained, but it is
critical that maximum flexibility be permitted this child in the assignment of
negative marks for his behavior. Negative behavior is a key sign of a
stressed-out and frightened child rather than a disrespectful child. In this
regard, the previous recommendations will be very therapeutic for assisting this
student to have a positive school experience. Though it may appear to the untrained
eye that such changes may further jeopardize the educational growth of this
student, this assumption is not in keeping with his need for a developmentally
appropriate learning environment. Modification to this child’s current
educational exposure will assist greatly in his ability to develop the necessary
skills that demonstrate his cognitive ability, something not possible when
placed in emotionally stressful situations. As this child experiences some
success in the least restrictive environment created for maintained emotional
regulation, he can function without the constant interference of stress
overload. In short, as the time between highly stressful events becomes longer,
his brain will be allotted an opportunity to develop. This aspect of development
within the limbic system is responsible for ultimate stress regulation and the
use of his cognitive ability. Determining such progress can be assessed through
much the same means as with other children, over time and incrementally. Such
measures would consist of constant reporting by those directly involved in the
student’s activities, the completion of required educational tasks, and
occasional comparison testing using unstructured tasks such as handwriting.
It would not be infeasible to see this
child respond positively and improve in his ability to interact and relate to
others within six months if these recommendations are implemented with close
monitoring. In other words, it generally takes six months of close monitoring
and adjustments to make the necessary changes such children require. It is an
ongoing process and one that may need to be modified or adapted when necessary.
I hope this report has been of some
assistance in clarifying the sensitive nature of educating children with trauma
histories, and some elements for what are required in helping them obtain a
meaningful education. If for some reason any points remain unclear please
contact me at your earliest convenience. Professionally submitted, B. Bryan Post, PhD, LCSW OK#2448 Diplomate, American Psychotherapy
Association
Early Exposure to Trauma
School Time Challenges
Working as a Team for Development
Techniques Not Effective for Such Children
In Summary