(NOTE: This is the printable version of Lesson Two only. Please go to first page of Lesson One and Lesson Three to download the printable version of those chapters.)
It is the pervasiveness of neglect that causes a great impact on child development.-- Dee Wilson
Some people think neglect is not as damaging to a child as physical or sexual abuse. But that is not necessarily true. Chronic neglect can strongly impact a child's health and development.
According to research, neglect is the type of child maltreatment most likely to re-occur in a family even after child protective services intervention. Research also finds that the more chronic or recurring neglect is in a family, the more likely that children in that family have been physically abused or sexually abused as well. Neglected children are more likely to show up in the juvenile justice system during adolescent years and are less likely than physically abused or sexually abused children to receive services for their developmental delays. Children in the foster care system because of neglect tend to be younger than other maltreated children in out-of-home care.(See Dee Wilson.)
Below is a list of effects that can are often found in children who have been neglected. As you read through the list, think about how many have you seen in the children you have cared for throughout the years.
Pregnancy and the first three years of life are the most active periods of brain development in our lives. The following paragraphs are taken from the work of Dr. Bruce Perry, a pioneer in the work of brain development in children and the impact of maltreatment and trauma.
Huge portions of the human brain are devoted to social functions and communication including establishing and maintaining eye contact, reading faces, judgments and more. When a baby is born, his brain houses over one hundred billion neurons that will chart paths and make connections based on the social experiences they encounter. By the age of two and a half, approximately 85 percent of the baby's neurological growth is complete, meaning the foundation of their brain's capacity is in place. By age three, the child's brain is 90 percent of its completed adult size.
In a remarkable cycle of stimulus and response, the budding brain builds itself using chemical signals generated by vision, smell, touch, hearing and taste to activate and organize the neural cells that make up its tissue and determine the brain's capacity to process, retain and respond to information.
Think of it in terms of nutrition. If a baby is not fed consistent, predictable messages of love and communication, then those areas of the brain shut down and the child's capacity to function later in life is compromised.
- Dr. Bruce Perry
The brain is born with billions of neurons, but it is the experience of social interaction and communication that wires the brain to either its full potential or a compromised state. Neglect means that the brain may not be being "fed" enough to help it grow its best.
Dr. Perry has researched how the brain develops in response to trauma. To understand his results, let's review how a healthy brain develops.
Think of the brain as a upside down pyramid. At the bottom and developing first is the BRAINSTEM which monitors basic responses such as breathing and heartbeat. The next to develop is the MIDBRAIN which focuses on survival functions such as safety and responses to threats. Farther up this upside down pyramid is the LIMBIC system which controls feelings and emotions. The largest and the part of the brain last to develop are the CORTICAL functions which include our frontal lobes and parts of the brain that control executive functions such as reasoning, planning, anticipating, and predicting. The executive functions develop most rapidly during adolescence and early adulthood. Below is what a healthy, well-balanced brain should look like from bottom to top.
Normal development results in a healthy brain that is proportioned about 2 to 1. That means the combined Cortical and Limbic systems should be about twice as big as the combined Midbrain and Brainstem system. This proportion of brain development allows the Limbic and Cortical functions (higher reasoning skills) to modulate and control and balance the Brainstem and Midbrain functions (reactive and reflexive functions). When we try to teach children think before you act, we are asking them to use one part of their brain to help them assess and control what another part of the brain wants to do out of instinct.
What Dr. Perry found in his research is that when young children experience severe trauma, the Brainstem/Midbrain portion of the brain seems to overdevelop, meaning children will have overdeveloped safety and stress responses and act more impulsively, even though the Thinking/Feeling part of the brain (the Cortical/Limbic systems) may be normally sized.
When children experienced neglect, they often did not develop the Thinking/Feeling parts of the brain resulting in an underdevelopment of the higher reasoning parts of the brain. The worst combination of maltreatment Dr. Perry found was when children experienced both neglect and trauma. That resulted in overdevelopment of the Brainstem/Midbrain functions ( resulting in anxiety, impulsivity, poor affect regulation, motor hyperactivity) and underdevelopment of Limbic/Cortical functions (which affected empathy and problem solving skills). The result looks like this.
Neglect during infancy, including nutritional deficits during pregnancy, can impact a child’s development of brain capacity and size. When neglect is combined with trauma, a child’s brain develops in a survival style to help him stay safe. This may result in a child being initially “wired” for survival—being impulsive, anxious, acting from instinct instead of reason, and not able to understand or identify his feelings easily.
Foster and adoptive parents need to know that children bring their developed survival skills into the home because they have been wired that way. It will take a strong experience of safety and nurturing for children to again begin the process of growing. Love alone is not enough. Safety, a good structured environment, and knowledgeable parenting is also necessary.
A major developmental goal during the first three years of life is to develop an attachment with a caregiver, usually a parent. This attachment forms a blueprint for future relationships. Physical contact, eye contact, and responding to signals of distress of need such as feeding or comforting, are the primary ways that a bond is formed between a parent and a child. Children neglected in the early years often do not have an opportunity to develop a good attachment with a caregiver. When neglect is combined with abuse, a child's ability to develop healthy relationships may be compromised even further.
Neglected children who come into the foster care system may have trouble with their relationships to their new caregivers. These attachment difficulties may also become issues during the adoption process when children may struggle with forming and trusting new attachments with new parents.
What specific problems can I expect to see in maltreated children with attachment problems?
The specific problems that you may see will vary depending upon the nature, intensity, duration and timing of the neglect and abuse. They may also differ from child to child. Some children will have profound and obvious problems, while some will have very subtle problems that you may not realize are related to early life neglect. Sometimes, these children do not appear affected by their experiences. However, it is important to remember the reason you are working with the children and that they have been exposed to terrible things. There are some clues that experienced clinicians consider when working with these children.
Developmental delays : Children experiencing emotional neglect in early childhood often have developmental delays in other domains as well. The bond between the young child and caregivers provides the major vehicle for a child’s development. It is in this primary context that children learn language, social behaviors, and many other key behaviors and skills required for healthy maturation. Lack of consistent and enriched experiences in early childhood can result in lags in physical, motor, language, emotional, social, and cognitive development.
Eating: Atypical eating behaviors are common, especially in children with severe neglect and attachment problems. They will hoard food, hide food in their rooms, eat as if there will be no more meals--even if they have had years of consistent available foods. They may have failure to thrive, rumination (throwing up food), swallowing problems and, later in life, unusual eating behaviors that are often misdiagnosed as anorexia nervosa.
Soothing behavior : These children will use very primitive, immature, and seemingly bizarre soothing behaviors. For example, they may scratch or cut themselves, bite themselves, head bang, rock, or chant. These symptoms will increase during times of distress or threat.
Emotional functioning : A range of emotional problems is common among these children, including symptoms of depression and anxiety. One common behavior is “indiscriminant” attachment. All children seek safety. Keeping in mind that attachment is important for survival; children may seek attachments-- any attachments--for their safety. Non-clinicians may notice abused and neglected children are “loving” and hug virtual strangers. Children do not develop a deep emotional bond with relatively unknown people; rather, these "affectionate" behaviors are actually safety-seeking behaviors. Clinicians become concerned because these behaviors contribute to the abused child’s confusion about intimacy and are not consistent with normal social interactions. Furthermore, although the child seeks safety, these inappropriately affectionate behaviors can, ironically, put the child in very dangerous situations.
Inappropriate modeling : Children model adult behavior--even if it is abusive. They learn abusive behavior is the “right” way to interact with others. As you can see, this potentially causes problems in their social interactions with adults and other children. For children that have been sexually abused, they may become more at-risk for future victimization. Males that have been sexually abused may become sexual offenders.
Aggression : One of the major problems with neglected, poorly attached children is aggression and cruelty. This is related to two primary problems in neglected children: (1) lack of empathy and (2) poor impulse control. Empathy, or the ability to emotionally "understand" the impact of your behavior on others, is impaired in these children. They really do not understand or feel what it is like for others when they do or say something hurtful. Indeed, these children often feel compelled to lash out and hurt others-- most typically something less powerful than they are. They will hurt animals, smaller children, peers, and siblings. One of the most disturbing elements of this aggression is that it is often accompanied by a detached, cold lack of empathy. They may show regret (an intellectual response) but not remorse (an emotional response) when confronted about their aggressive or cruel behaviors.
This section is excerpted and reprinted with permission from the Child Trauma Academy. The excerpt and the course it was taken from can be found at http://www.childtraumaacademy.com/bonding_attachment/lesson03/page04.html
OPTIONAL ACTIVITY: Dr. Bruce Perry has written a whole course on effects of trauma and maltreatment on bonding and attachment. Alaska resource families can earn an additional 3.0 hours of training credit for completing this course. For more information about this additional course of study, go to the Alaska Center for Resource Families Selected Web Course "Bonding and Attachment in Maltreated Children."
A sensitive foster or adoptive home can help children begin to develop healthy attachments using three different strategies:
Provide for Basic Needs: Take care of a child's physical and emotional needs. Help anticipate what they might need and know that they may not be able to ask for it. Pay special attention to food, sleep, physical affection, attention, and health related needs. You want the child to learn to view you as a source of comfort and care, and feel safe with you and protected by you.
Promote Postive Interactions: We like to be around people who like to be around us! So include family activities, one-on-one time and story time in your every day life. Include a child in all your family activities such as camping, going to a park, going out to eat, taking part in a community activity, board games and family video nights. Make it a point to speak positively with each child every day and use praise often.
Help Child Feel Part of the Family: Include child in regular activities and chores. Have designated space for items and clothing for the child. Take a picture of the child with your family members, and help him get a picture of his birth family to have in his room. Be respectful of his attachments to his birth family but let him know you consider him part of your family, too, while he is living with you.
First and foremost, do no harm. Do not repeat abusive or neglectful or negative experiences, even though the child sometimes repeats that for himself. Catch yourself and take a time out before you hurt a child again. Avoid trying to scare a child into good behavior or compliance.
Go lower in the brain. With some children, you need to think "younger" and be more concrete and physically involved as you are with infants and toddlers. Use consistency, structure and repetition. Physically nurture the child through rocking, singing, holding and touching. Bonding and attachment first happens through physical touch and responding to a child's basic needs. Use these same principles with your older children.
Take advantage of The Most Important 8 Minutes of the Day: This idea comes from Gary Benton, a parent trainer in Washington. The first 4 minutes of the day and the last 4 minutes at night are a time to connect right before or after we separate from each other. Make those minutes count by making eye contact, maybe having some skin contact such as patting a hand, a kiss, or reading a story sitting next to each other. View the morning as a time to reconnect, and the evening as a time to let go but still let the child know you will be there.
Keep your expectations realistic. Some children may have trouble enjoying themselves and may not seem appreciative. So keep it simple, keep it small, and keep it frequent as opposed to a big trip or big event with big expectations. Keep your expectations low and don't expect a big show of gratitude. Talk about your feelings to model. "Wow! I looked forward to going to that picnic and I had fun talking with my friends and eating that great pie. What did you like doing best?"
Take Photos: Pictures are a powerful way to say "we belong" and "we care." Take a picture of your family with the child and hang it on the wall. Allow him a picture of his own family members in his room so he can feel good about that connection, too. Take pictures of children as they grow or of special occasions. If children do not stay with you, send a book of photos with them so they don't lose a history of their childhood.
Memory Chains: Realize that attachment is a journey, not a single event. Children who are moving toward adoption might have problems as they approach the legal court day. One family moving toward adopting two older children suggested the use of memory chains as a way to help children relive and learn to enjoy good memories.
"Because the boys are older," one mother wrote, " we have started a count down chain. We all got 7 pieces of paper chains, wrote down favorite family memories, and linked them together. Then we decorated the main board where the links are attached with the adoption date and pictures of us. Every night the boys take a link out and we read the attached memory and talk about said memory together. It is a fun way to see everyone’s favorite family memory and share in the excitement of counting down. I thought I would share the idea with families adopting older kiddos."
Make a Lifebook: Build a Lifebook for children whether in adoptive or foster care. Lifebooks keep a memory for children and keeps a picture and a written history of their life, even if the adult putting the book together is not the "forever parent." Lifebooks also give children an understanding and a story of what has happened to them and may also help in the next generation of parenting. One study showed that mothers who grew up in the foster care system who were able to describe and understand what happened to them early in their life, were much better be able to bond with their own children. A Lifebook can help children do that.
Look for Small Opportunities: Check out these Five Minute Bonding Activities for fun, easy to use activities to promote bonding and attachment.
Children in foster care frequently have problems in the area of eating. Children who have not been fed regularly or consistently may develop a survival mentality toward food-- feeling there isn't enough or it won't be there the next time. Understanding the reasons behind eating problems will help resource families address the problems in a helpful way, instead of turning food into a power struggle.
Some children approach food with a "vacuum" mentality-- that is, eat as much as you can as fast as you can! Some children have a survival mentality that makes them anxious around food. If they haven't been able to count on regularly or consistently being fed, many children will eat as much as they can when food is available. They may become anxious if they think others are getting more food than they are. Some children can't tell when they are full and may eat until they vomit.
Some children may hide or hoard food in the room. Sometimes this food isn't even edible, such as stale sandwiches or mushy, molding fruit. Some children may also hoard or take food secretly from cupboards that doesn't make sense, such as dried pasta or toothpaste.
Hoarding food stems from emotional anxiety or want. On some level, children may feel that they can't get enough because they have have been able to get enough. They may feel less anxious if they have stashed some food.
Children are very different in the way they eat. Some children are great eaters. Some children eat slowly, and take a long time to finish normal amounts of food.
Some children may not eat because they are unfamiliar with the food you are serving, or may be used to high fat,
high salt food, so that healthy food doesn't taste good or familiar to them. There are many reasons why a child may not want to eat. Some may be biologically based, such as a child with a physical condition that causes him to be sensitive to food with a hard texture or food that is too hot.
Children with FAS may have a very fast metabolism and may eat a lot without putting on weight. Some children may need to have food in smaller quantities, but more often. Some children have sensory issues and are very sensitive to texture, heat and spice and may reject most food. Some children have mouth pain or teeth problems and eating is painful. Very young children with eating problems may not have developed their muscles around their mouth, so have difficulty with eating and chewing.
It is critical that foster parents work with their health providers on any food issues to determine whether there is an organic problem for a child. It is also important for foster parents to monitor weight gain and development, especially in very young children and infants. Infants who are failure to thrive or don't get enough to eat or enough formula can become sick very fast. Foster parents may need to work with their health providers to learn alternative methods to get children the nutrition they need.
It is important to be sensitive to the fact that we learn the expectations and rituals about eating from our families and our environments. Children from different backgrounds and cultures learn these rituals and bring them into your home. Some families may commonly eat with fingers, or share food from plates or common bowls. Some families may eat when they are hungry and not have regular meal times. Some eating habits are not wrong, but may be different than your own family's.
In addition, when children are neglected, some of the basic niceties that you expect in your home may not be familiar to them such as using utensils, eating with your mouth closed, not eating off other people’s plates or having regular mealtimes. This may also show up in other areas such as sharing, using the toilet, hygiene, and letting parents knowing when you leave the house. In these situations, it is important to be respectful and sensitive as you teach children the basics skills that they need to know to get along in your family.
1. Offer a variety of foods and stick with simple dishes. Start with foods familiar to the child or basics to all children such as chicken fingers, mac and cheese, and peanut butter and jelly.
2. Ask the child about his favorite meals or invite him to help you choose a dish when shopping.
3. Make meal time as pleasant as you can. Keep it short and as least stressful as you can.
4. Make sure that every child gets a good physical exam by a health professional. Monitor weight and growth especially in young children and pay attention to the child’s cues of whether he is getting enough to eat.
5. Plan regular, consistent meals so children begin to develop a rhythm and a trust they will be cared for. Offer healthy snacks throughout the day. Some families have a snack drawer or shelf that they make accessible for children and fill it with snacks such as raisins, nuts, fruit, and cereal.
6. Sometimes children may want to eat just one thing day after day. For the most part, don’t worry about food jags. Offer a variety of foods and avoid turning dinner into a battle of wills. Supplement a child's meals with a multi-vitamin if appropriate.
7. Avoid power struggles. Don't force a child to eat or trick him into eating. Again, offer the food and watch the child’s health. You don’t need to turn into a short order cook, either. Some parents offer an alternative such as peanut butter sandwiches that easy to make. Other will wrap up viable leftovers for the child to reheat when he or she is feeling hungrier.
8. Don't use food as a punishment. Don’t send a child to bed without supper or deny a child food because of misbehavior. Use food and meals as a vehicle to help establish care, trust and safety for a child.
Read the following CASE EXAMPLE then answer the questions below.
You find an old, half-eaten sandwich, a bag of dried pasta, and an expired container of yogurt underneath the bed of your nine- year-old foster daughter. You’ve also found half slices of bread and pieces of breakfast muffins in her pants pockets when you do laundry.
If this was happening in your home, what would you do? Write your ideas in the space below.
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Have regular meals every day and provide a way for children to help themselves to healthy snacks without having to sneak around.
Take the child shopping. Let her pick out some non-perishable items to put into a snack box that they can go to and grab a snack when needed. Let her know what food is available to her when she feels hungry, such as a the snack box, or for example, crackers and fruit left on the counter.
Acknowledge her desire to have food with her at all times. Discuss happens when perishable food is left sitting around or is stuffed into pockets. Establish clear boundaries about food in the bedroom and work toward a solution of how she can have appropriate food in the room without having to be sneaky.
Discuss in the third person why some kids hide food and emphasize maybe not having enough in the past, not trusting adults to care for them, and all the feelings behind the behavior. Emphasize what you do in your home to keep children safe and well fed, such as providing snacks, planning meals every day, and shopping regularly for food.
REVIEW:
Let's continue to practice your problem solving skills. The best way to review this lesson is to apply what you learned. Read each example below and determine what concerns you about the child’s behavior. Then, in the space below, write your your ideas of what you might try in each situation.
EXAMPLE 1: Your five-year-old foster son has a habit of being very affectionate with adults, even people he doesn’t know. He seems to always want to be touching other people, sitting in their laps, and touching and kissing their faces. It makes other people very uncomfortable but they often don’t say anything.
WRITE YOUR SUGGESTION BELOW:
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EXAMPLE 2: Your four-year-old foster daughter doesn’t seem to know how to play with other children. She is more like a two year old, playing next to another child, but not playing with them. If she wants a toy, she’ll just grab it. When the kids start to play make believe, or dress up, she seems lost and will just watch instead of joining in.
WRITE YOUR SUGGESTIONS BELOW:
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EXAMPLE 3: You are noticing that your 13-month-old foster son is not showing any signs of pulling himself up on furniture or trying to walk. He will get himself up on his knees and rock and crawl a little bit, but seems to not have much muscle strength in his legs.
WRITE YOUR SUGGESTIONS BELOW:
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Here are some Additional Suggestions For the Example Above:
EXAMPLE 2: