Trauma and Behavior – Laura Phipps (UNCFCRP)

See below for full transcripts of four short fantastic clips developed by the Family & Childrens Resource Program, at the UNC School of Social Work. You can find the four videos on the UNCFCRP Youtube Channel.

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Trauma and Behavior Part 1: “How Trauma Affects the Brain”

Laura Phipps, MSW, Clinical Instructor at Family and Children’s Resource Program (FCRP)

It’s a very complicated subject, there’s lots of research on the topic.  But I think really, it’s important to think about three big things. And the first of those is how trauma affects cognitive development and the development of the structures of the brain.  So, in the most basic terms, when children are experiencing trauma, there is a release of stress hormones. For all of us, when anyone is experiencing any kind of trauma, or fear, we have that fight-or-flight response.  When children are having repeated traumatic events, there is an overabundance of that stress hormone in the brain, and we know that that causes actual damage to the development of the structures of the brain. What that also does, is creates this “always on” state of alert, where there is an overabundance of the cortisol, that’s the hormone in the brain, and children are always in that hypervigilant state to protect themselves.  What that does as far as brain development, is that creates a situation where the other neuropathways are not able to develop as well as they should or in a timely manner in those critical periods. So, the parts of our brain that regulate decision-making, emotional regulation, judgment, all of that higher order thinking, is less developed when kids are experiencing repeated traumatic events. What that means for behavior, is that we have actual cognitive delays for kids with a trauma history.  They can have lower IQ, problems with language development. They can have problems with judgment and decision-making. So, in terms of behavior, if you think about how that disruptive brain development impacts behavior, so much of the way we interact with the world is through language when we’re giving instructions to kids, we often use a lot of more words than we should. We also expect that kids can make good choices. So, when we give choices, we think that they understand what those choices are.  But, if you have cognitive impairment, and if you’re having difficulty understanding language, you’re going to have difficulty understanding what you’re supposed to be doing in those situations. And the typical strategies that we might use with kids who don’t have that kind of impairment, are not going to be as effective. So that’s one big area that it affects behavior.

        The second thing we really need to think about is the issue of attachment.  And again, we could have an entire class on attachment, but the basic, most simple level, we know that secure attachment is the foundation of all further development.  That we need to have that secure attachment during those early years. Children who have been traumatized, particularly from their primary caregiver, have really disorganized attachment, because the person from whom they’re going to go to feel safe, to learn trust, to learn that the world is a predictable and loving place, is also the person that is perpetrating this scary and traumatic event on them.  And that is incredibly confusing. In order to understand the world, that doesn’t make a lot of sense. And so, these children don’t know how to trust the world around them, they feel like they don’t know how to get their needs met. And so, that foundation for future relationships is very much impaired. So again, if you think about so much of what we have to do in the world to be successful is to interact with others, to read social cues, to understand what the interaction is between us and other people.  If you have that disorganized attachment as a foundation of understanding the world, you’re going to have a lot of difficulty with that. So many behaviors that we see from children with a trauma history, are a result of just not having that secure attachment.

        And then the third thing, that is very important, especially when you have a child in your home who has a trauma history, is understanding trauma triggers.  What that means is that there are going to be things that remind the child of the trauma, but they might not be readily apparent to everyone around them. So, if you think about your own memories, things that trigger memories, smells, sights, sounds, all those things can immediately take you back to a positive moment in your childhood.  With children who have a traumatic history, where that’s been the majority of their experience, those exact same triggers, take them back to this very scary place. But, they may not be evident to us. It might seem like a normal transition from going to bed time, but something about that event, i.e. the lighting, the location, triggers a traumatic memory, and the child is going to react as if that’s happening at that time.  Those reactions are behaviors that children developed in order to stay safe. So, they were very adaptive behaviors. However, we might see them as bad behaviors, or negative behaviors. So, it’s really important to understand that those reactions are important, they help the child survive, they help the child get through a very difficult experience and it’s going to take a while to unravel that. So, it’s important to try to understand as much as possible of the child’s history, so that we can start to look at these trauma triggers and help them move past them.

Trauma and Behavior Part 2: “Why Does the Cookbook Approach Not Work for Many Behavior Problems?”

Laura Phipps, MSW, Clinical Instructor at Family and Children’s Resource Program (FCRP)

Well, we often say that, you know, if there was a single book, where you could just look up, “OK, here is the behavior and here’s what you do,” if we could create that, we would make a million dollars.  And people really want that. It’s completely understandable why we want it. Because difficult behavior is exhausting and it’s confusing because it changes. You think you’ve mastered it, but then it changes again.  So, there’s lots and lots of resources out there that you’ll find, that will say, “If you have this behavior, you should try this strategy. If you have this behavior, you should try that strategy.” Sort of like you have a recipe, and here’s the answer.  It’s not to say that those are not helpful or effective, but they won’t be every time. And I think that’s where they get to be very frustrating. So, for all children, but especially for children with trauma history, we have to remember that we’re human beings and we’re all different and we’ve all had different experiences.  So, we cannot take the outward appearance of a behavior that might look the same in two kids and treat it the same way, because that behavior might serve two completely different needs.

So, what we talk about when we think about how to manage behavior is this idea that we’ve got to understand the need behind the behavior.  Every behavior that we engage in as humans is meeting some need. It’s not always entirely clear or it’s not always the best thing for us, but it is meeting a need that we’re trying to reach.  So, “I need attention. I feel like I don’t have secure relationships, so I’m going to throw a lot of stuff and yell and scream because you’re going to come over and tell me to calm down.” And that’s a relationship.  It’s not the greatest relationship, but it is a relationship. And, on the most basic level, I think people understand that. That that behavior is doing something.

With children with trauma history, as we were saying earlier about trauma triggers, it can’t always be clear what it is they’re trying to get met because the behavior doesn’t necessarily make sense.  It’s not so much of a direct connection between the behavior and the outcome. There’s a lot of internal processes happening as part of getting those needs met that we don’t necessarily understand from viewing that behavior from the outside.  So, what we have to learn to do is to really- we talk about becoming a behavior detective- is to really analyze and understand the pattern. One of the wonderful things about working in behavior for so long, is that, you know, I really believe, if you take the time, all behavior operates in a pattern.  We tend to repeat these loops we get into because they work to a certain extent. And we do them over and over and over again. So, if you’re good, if you learn how to find the clues to that pattern, then you have the ability to unravel the pattern and to sort of, help them learn a new pattern. But because each child is different, and because the way that pattern has been developed is different, we cannot apply the same strategy to every single child, even if what they’re doing is the same.  So, an example of that, is you could have two children who are withdrawing, isolating themselves, not wanting to be with the family. One child is doing that, because they really want people to come seek them out. And so, when people do seek them out, they realize that withdrawing is getting that need met. The other child could be doing it, because they are really rejecting, they’re scared of relationships. That’s a scary feeling of connecting with other people so they really don’t want people to connect with them.  So, if people come to them, they’re behavior is going to get worse. Outwardly behavior looks exactly the same. The approach would have to be completely different. And we can only know that by analyzing that pattern over time.

Trauma and Behavior Part 3: “The Importance of Relationship”

Laura Phipps, MSW, Clinical Instructor at Family and Children’s Resource Program (FCRP)

        Well, I think all of us understand that relationships are sort of the foundation of the way that we do anything.  We all want to have positive relationships with our caregivers. In order to change behavior, there has to be a lot of trust.  The child, particularly children who have trauma background, they have developed these series of behaviors that have kept them self.  If they are going to engage in a process with you to change those behaviors, they’ve got to really trust that you’re not taking those away from them and that’s going to make them unsafe all of the sudden.  So, it’s even more important that that initial trust is laid before we start engaging in a process of modifying behavior. And modifying behavior is a process. It takes a long time. You’re slowly having to sort of undo patterns that have been established for long periods and you want the child to be with you in that process, rather than it’s something that is being done to them.  You want them to engage in that. And if they don’t feel that you really genuinely have their best interest at heart and you genuinely care about them as a person, they’re not going to be able to engage in that process as easily.

        I think the other thing that’s really important is that many children who have developed these behaviors that the outward world sees as negative, are very used to connecting those behaviors with who they are as a person.  So, they see themselves as bad people and that the world around them is just going to label them as bad. And they start to believe that in an internal process. Like, “these things must have happened to me, because it’s my fault,” “I’m a bad person,” “I act badly, people react to me badly, therefore, I’m a bad person.”  And so, in order to begin to undo that, we’ve got to really help children make connections between “I care about you for who you are, regardless of what you do.” Because they don’t believe that. Many children who have had history of trauma, those things are completely mixed up. “What I do and who I am are exactly the same thing.”  So, that foundation of building trust and building a relationship is part of the process of disconnecting those things. That you are a good person. Good people can make bad choices. Even when we make bad choices, we are still good people. And they’ve got to really believe that on a genuine level. We can’t just sort of give them that lip service if they’re going to start in that process of really making a change.

       

How can you build a relationship with a child who has a hard time trusting adults?

        Well, I think we have to sort of think more strategically about what trust is.  You know, we talk a lot about we got to build trust, but we do not give people a script for what that is.  So, there are some basic things that are part of trust. Honesty. Like, really being able to say transparency, “this is what I believe, this is what I think.”  Being able to tell them when you make mistakes. Because, as parents and as caregivers we make mistakes all the time. Even if you’re all the best intentions, we have bad days.  And so, when kids hear people say, “You know, I raised my voice and that really wasn’t a good choice and I’m sorry,” they’re getting that role model. Number one of like, “Oh people can make mistakes and they’re still OK.”  But, they’re also seeing that it’s important enough to you to go them and sort of make those amends.

        I think that predictability, reliability, is incredibly important for trust.  Particularly because kids who have had a lot of trauma and have had a lot of moves, don’t know what’s coming next, that contributes to that feeling of needing to be always on alert.  So, the more that we can be consistent, predictable, tell kids in advance what’s coming next as much as we possibly can. Or, even if we don’t know what’s coming next, telling them what some of the options might be, like “this or this could happen,” also will help build that connection that you’re taking the time to make sure that they understand what’s going to happen to them.  So yes, predictability, honesty, empathy.

        I mean, real empathy.  Genuine caring for who they are as a person.  And I think really trying to find those strengths.  And not just in a sort of a surface way, like, “Oh, she has a nice smile.”  But in sort of like, what are the skills that this child has that are positive that we can build on.  So many behaviors that we label as negative, we can find actual skill sets in there. So, if you have a kid who people say is manipulative, well they obviously can read people and they’re smart and they are able to get- they know what their needs are and they can get their needs met.  So, they have a skill set involved in this behavior that we consider bad. So, if we can help kids pull those out and say, “Well, how can we use these same skills to their advantage?” they start to feel like you value who they are and what they bring to the table.

        So, I think it’s just a matter of it’s slow.  I think many times as caregivers we think, “Well, if I just give them a lot of love, they’re going to trust me.” And that’s certainly a part of it, but we’ve also got to think really strategically about our day to day interactions.  Because, children who have trauma are coming at the world in a very defensive stance and it’s going to take more effort on our part to build that trust.

Trauma and Behavior Part 4: “Advice for Struggling Caregivers”

Laura Phipps, MSW, Clinical Instructor at Family and Children’s Resource Program (FCRP)

        Well, if I was going to talk to a foster parent or a biological parent or any caregiver that’s working with a child who has challenging behavior, I would say first of all, that it is hard.  And you need to accept that and you know, it’s OK to admit that it’s hard and that you can’t necessarily do it alone. I think we tend to think, “if I can just muster up the strength, I’m going to be able to fix this.”  The challenging behavior has developed over long periods of time, it’s complicated, it probably happens in a variety of settings and you’re going to need help. And you’re going to need other people to support you in this process.  So, it’s important to know that and it’s OK to ask for that help.

        I think the other thing that I would say, is that many challenging behaviors feel very personal.  They feel like it’s something the child is doing to you. And many times, the things they say will be aimed at you, they will be very specific the things that you are sensitive about.  And it can be very hard to separate out in those moments that what they’re doing is not who they are because you feel understandably, very upset by the behaviors that children are expressing.  So, I think it’s really important to remember that behavior’s expressing a need. And, in any way possible that you can remind yourself of that, is incredibly important, especially in the moment when those behaviors are happening because often not reacting in a negative way is the first step, partially to building trust, but also to changing the pattern.  And it’s very hard to do that when someone has just called you a bad parent or told you they hate you, or a million things that kids can say in an effort to reject you. So, trying to really keep in mind this is not about me. This behavior is not aimed at me. It’s not about who I am, it’s the way this child knows how to interact with the world.

        And I think also I would say that it takes time.  That, we want to look for progressive, slow change in the direction we want to go and sometimes that might not be easy to see.  But, if you are looking for a magic overnight change, it’s not going to happen. But, you will see change with consistent efforts that are just going to be slower and over time.  And so, in order to get through that, you’re going to need that support and you’re going to need some people who can take the burden off of you and share it with you and give you breaks because it’s a really hard task to change behavior and you’ve got to be committed to that, you know, consistent process.  You’re going to have ups and downs. Behavior is not linear. It doesn’t sort of move in one direction and only in one direction. So, things may get worse, they may get better. You may have to change approaches and there’s nothing wrong with that. That doesn’t mean you’re doing anything wrong. It’s just the natural way that humans interact with each other.  And if you stick with it, you really can make a difference in a kid’s experience and how they are successful in the world.