Running to a Healthy Future

The year was 1983 and the first summer of the Jasper Mountain Program. There were only six children in the Program at that time and they were out of school and ready for an active summer.  The three staff had divided up times to supervise the children and I did most of the recreation with the children.  I was a runner and when the children were in school I was able to run by myself, but now they were out of school and I had the children to supervise.  My plan was to run first thing in the morning before breakfast and sometimes one or two of the children asked to run with me and we took off along a trail that used to be the former railroad track.  As more children asked to come along, running on a trail was not ideal because the children all ran at a different pace and all had differing levels of endurance as to how far they could go.  This would go on for the next three years until we built a running track on the property.  During the fourth summer the children worked together and leveled off the ground, went to the local lumber mill and brought back many pickup truck loads of sawdust to make the running track.  The result was an ideal running surface on a level field where 17.5 laps equaled one mile.  With the track in place I could supervise the growing number of children (now up to 12) while I ran.  Although periodically a child had shown interest in running with me, I did not anticipate that many of our emotionally disturbed children would want to do something difficult like running.  So the children would sit next to the track while I ran my four miles and then we would all head to breakfast.  Partially due to their efforts to make the track and partially because they got bored just sitting there, but more and more children asked to join me for a few laps periodically running and walking.  Each morning there were more children running more laps.

My personal experience with running was not wonderful. I had found running unpleasant and very difficult and I avoided it growing up.  The first time I ran a mile without stopping was because it was required to join the football team and I found the experience horrible.  Despite being very involved in high school and college sports, I was not a runner.  I only began running grudgingly at the age of 26 when all the team sports were no longer available and I wanted to stay in good shape.  The health effects were so beneficial that I became a committed runner, but it was never fun.  With my bad attitude about the experience of running I would never have expected emotionally disturbed children to be interested or willing to do something so unpleasant.  I was wrong as it turned out.  It is not that the idea of breathing hard, enduring the pain, getting sweaty and pushing yourself beyond what you thought were your limits was all that appealing to our children over the years.  Actually I still am not certain why the children do it other than the practical aspect of the first thing in the morning running is what everyone does in the program.  They head to the track before breakfast and some walk/run and other run the whole time for 30 minutes while their laps are counted by the staff so they get credit.  We encourage the staff to run as well (a tough sell for some of them) and have found that the more participation from staff results in more participation from the children.  There are some positive aspects that encourage the children such as pride when their track shoes are moved each week up the 80 foot long mileage chart, there is some positive peer pressure to be one of the runners, and there are periodic incentives (shoes, MP3 players, running outfits, etc.).  However even today I marvel at how many of the children simply put in the effort and learn the amazing positive things that running can do for your personal health.  After all the benefits have keep me religiously doing this activity that I have never really liked for the last 39 years.

Decades of research have shown the same findings—running has consistently been found to be the most healthy single activity a person can do. The benefits are too numerous to give a complete list but the main benefits to emotionally disturbed children are:  belief in self, personal confidence, meeting a difficult goal, achieving success at a difficult task, improved respiration and circulation, improved stamina, developing coordination and muscle tone, weight loss (running helped one child last year lose 77 extra pounds), reduction in the need for numerous psychiatric medications, better sleep patterns, improved self-regulation, improved relaxation, reduced stress, enhanced stem cell development in the brain and overall improved brain health.  The list goes on and for decades it has been known that these benefits are available to everyone, but running is just difficult enough that not everyone can or is willing to do it.  Emotionally disturbed children in an intensive treatment program are the ideal population for the benefits of running.  The challenge is how to entice the children to run.  At Jasper Mountain it is the environment that does the enticing and this gradually developed over time to be what it is today.

However we have found that running can be incorporated into an existing program. When we developed a second residential treatment center at first it had no running program but through planning it was incorporated into the structure and the results were the same—the children participated.  There is no sign of the interest in running fading even after 30 years.  Just this year the children set new mileage records in both treatment centers.  The children collectively ran 3,000 miles in ten weeks.  This breaks down to an average of 1.5 miles per day for every one of the children!  Is it making a difference—without question!  We are not a track and field program not are we preparing the Olympians of the future.  Running is a small part of our treatment program, a small component with huge positive gains.  Will I personally continue to run?  Yes, just as long as I am able because of what running gives back to me.   Will our Programs continue to have a running program?  Yes, as long as the adults do their part to make running available and teach the children the benefits of healthy lifestyle decisions like aerobic activity.

Treating the Whole Child, Not Just Symptoms

By Dave Ziegler, Ph.D.

In a recent conversation with a fellow psychologist, it occurred to me that our treatment systems seldom consider all aspects of the child when treatment/service plans are developed.  An analogy with fixing a car came up.  After a serious accident with a vehicle (analogous to the wrecked lives of many clients) we receive an estimate on fixing the entire car – the engine, the frame, the windows, the exterior paint and any interior damage.  If we received the car back from the shop with some but not all of the necessary repairs the job would only be partially complete.  But consider how many children are referred to treatment to help them stop specific problem behaviors.

Treating an individual requires consideration of the whole person including any and all aspects that need healing and special attention. There are multiple advantages to taking a comprehensive orientation to treatment.  Problem behaviors are generally more complicated than they appear.  A limited intervention might produce a temporary change but may not address the causes of the problem.  People are complex and the human brain is the most complex organic structure in the universe.  All successful interventions must impact the brain.  The most lasting treatment will produce positive brain change or changing the individual from the inside out.  The more comprehensive the approach, the more impactful it is likely to have.  The interventions that are the most efficacious and cost-effective in the long run are integrated treatments.

So what does integrated treatment look like?  To start with it is treatment that acknowledges that a problem in one area, or a strength in one area, will impact other areas as well.  The whole person could be considered a combination of mind/body/spirit or 1. Mental/Neurological, 2. Physical, and 3. Spiritual/Attitudinal.  Each of these three overarching areas can be broken into any number of additional areas, but for the purposes at present I will mention ten areas under each.  As you read these areas, ask yourself how each could be addressed in a service plan for a child you are working with:

Physical

  1. Personal self-care
  2. Nutritional intake
  3. Engagement in life skills of daily living
  4. Attachment/social skills
  5. Optimal sleep
  6. Activity and exercise
  7. Communication skills
  8. Pleasure and pleasurable pursuits
  9. Relaxation/allostasis
  10. Play and playfulness

Mental/Neurological

  1. Functional internal working model
  2. Growing access to higher reasoning brain involvement
  3. Challenging mental activity/academic growth
  4. Active imagination
  5. Focused attention/meditation
  6. Coping/resiliency
  7. Perceptual clarity
  8. Developing intuition
  9. Healthy emotions
  10. Balance of past/being in the moment/future orientation

Spiritual/Attitudinal

  1. Sense of connection to something greater than self
  2. Optimism
  3. Self-reflection/contemplation/prayer
  4. Joy/personal contentment
  5. Gratitude
  6. Altruism/kindness
  7. Social connectedness
  8. Ability to forgive
  9. Respectful disposition
  10. Positive orientation

The above list at first glance may appear daunting, but effectively treating the whole child is among the most complex tasks there is.  The good news is that the thirty discrete areas are artificially separated and overlap considerably.  For example, developing a positive orientation promotes optimism, emotional health, clarity of perceptions and engaging higher reasoning centers of the brain.  There are differences with each area.  Initially, attachment and social connectedness may sound the same but there are differences in the way both can be represented.  For example, some children superficially connect or have the skills to do so, but lack the interest.

While overlapping, the above list is separated into areas as a reminder of the importance of each to overall health of mind, body and spirit.  Routine outpatient mental health treatment may involve only five to eight out of thirty areas unless other issues are brought up as problems.  Standard residential treatment may expand this to twelve to fourteen, but this is less than half of the full list.  Addressing this list of thirty areas is not to say that each area needs extensive attention or equal time.  Considering the full list can remind both the therapist and the other adults in the child’s life of the importance of some of the areas that routinely get little or no attention.  Ignoring any of the items is to diminish the chances of overall health.

Before going into an explanation of the thirty areas on the list, it may be helpful to see how the areas overlap.  Looking at a child’s overall health can help identify potential problem areas because of the substantial overlap.  If a child is obese the chances are good that a number of physical areas are deficient (self-care, nutrition, sleep, activity and play).  But this would likely not be the full picture because deficiencies in any or all of these areas may produce poor internal perceptions, a negative internal working model of self, emotional problems, lack of optimism and a barrier to connecting to others.

One way to view how the areas overlap is to consider a graphic representation of the whole child.  Some areas are somewhat distinct to one or two areas and others overlap in all three main divisions of mind, body and spirit.

 

Treating the Whole Child: Mind, Body & Spirit

 

To say that this is all too complicated and we need to simply focus on a few externalized presenting symptoms, is like getting your car back from the shop with half of the problems addressed following an accident.  If this is unacceptable with repairing a car, why should our standard be lower with a child? Treatment occurs not only in the therapist’s office but also at home and in the classroom, so some of the interventions mentioned take place in all aspects of the child’s world—thus integrated treatment.

Some descriptions and interventions can be helpful.

Physical

  1. Personal self-care – the skill and interest to take good care of oneself is critical to overall health.  Characteristics such as being selfish, egocentric or self-interested are not the same as self-love or self-care.  Excessive focus on self may indicate a negative sense of self.  Building upon self-care is fundamental to promoting health and can be accomplished with setting external standards and teaching self-care behaviors at all ages.  When adults encourage self-care it can provide dividends in self-image.
  2. Nutritional intake – the statement that we are what we eat is especially true for children who are in the system of care.  Poor early eating habits are common and they will not change without intervention from the outside.  While there are a variety of opinions as to the best healthy diet, there is general agreement about what constitutes an unhealthy diet (processed, artificial ingredients, high fructose corn syrup, and excessive calories).  Learning to cook, growing a garden, and shopping at the farmers market are all fun and learning opportunities to involve children in developing healthy nutritional habits.
  3. Engagement in life skills of daily living – engagement is a building block of happiness.  To get more out of anything one must invest more into it.  Daily living skills are important to making life more manageable and less stressful.  Competent living skills are a part of a successful life.  All children need chores to help with the household, but give them meaningful and varied chores so they learn skills and enjoy helping at the same time.
  4. Attachment/social skills – the ability to attach and bond is one of the foundations of a happy and healthy life.  Humans need others to survive and thrive.  Few children develop ideal attachment skills growing up and must work on trust, vulnerability and loss throughout life.  Social skills are a means to connection with others and are some of the most complex abilities to understand and demonstrate.  Find fun activities to do with the child to enhance attachment.
  5. Optimal sleep – from brain research we know that sleep is not for the lazy, it is for the smart.  The role that sleep plays in a healthy lifestyle is only recently becoming clear.  Deep sleep (REM) repairs the brain, consolidates memories, and recharges alertness and attention.  Short periods of sleep during the day have been shown to have multiple advantages to energy level, stress reduction, better mood and attention span.  The optimal amount of sleep varies by individual, but at least 8 hours for adults and 10-12 for children are recommended.  Have an evening ritual before bed, for example, lower the lights, reduce stimulation (turn off the TV), have some quiet time reading in bed then lights off.
  6. Activity and exercise – this is one of the least acknowledged paths to health and one of the most accessible.  Physical activity is not only good for everyone, it is fun and has many advantages including weight control, coordination, developing motor skills and many more.  Aerobic exercise could be considered the “fountain of youth” at any age because of the many health effects such as heart health, respiratory capacity, bone and joint repair and has been found to be the single most important path to brain health.  Pick a physical activity a child might enjoy and then do it together, such as a family walk/jog, hike or bike ride.
  7. Communication Skills – the ability to communicate with others through language, signs, and written forms set humans apart from all other living creatures.  To be fully healthy requires social participation and communication is the primary vehicle.  Human communication is extremely complex and we must grow throughout our lives in our understanding of all the ways communication can be effectively utilized.  Teach communication skills, have family discussions on topics and have a weekly family meeting where everyone interacts and can give opinions.
  8. Pleasure and pleasurable pursuits – somehow pleasure has received a negative reputation, perhaps because moderation is difficult when something provides pleasure.  Pleasure is one of the primary ingredients of happiness and improves motivation, laughter (very healthy in its own right) and stress release.  It is a principle of health that the brain pursues pleasure and avoids pain.  Find something fun to do with your child such as rent a movie everyone can enjoy and make some snacks to make it special.
  9. Relaxation/allostasis – managing stress through relaxation has long been recognized as a key to emotional and physical health.  The ability of the body to have a broad range of physical and emotional activation as well as deactivation (allostasis) is a key aspect of self-regulation and emotional management in a stressful world.  Begin to see tantrums as a great time to help a child learn to achieve calm and self-soothing.  It will take a while, but can give results that last.
  10. Play/playfulness/humor – play can benefit mind, body and spirit.  Losing oneself in a playful activity is rightfully called “re-creation” or an important way the person builds and creates the conditions of health. Healthy play is not stressful, intensely competitive or driven, but it is characterized by enjoyment, connecting actively with the surroundings and has no particular goal other than fun.  One of the best indications a child is at play is a smile on the child’s face.  If a child is playing to win something then a smile will often be absent.  Laughter is a major stress reliever and should be encouraged with children.  The family home must be a place to have fun; plan a family fun night with games, treats and let children plan the activities.

Mental/Neurological

  1. Functional internal working model – how we perceive the world determines a great deal about our experience.  Our mental model tells us what is happening, what to expect and how to understand and feel about it.  Developed early in life, this internal model can be problematic after a difficult childhood but can be changed with repeated positive experiences.  Determine what you believe the child’s model of self is and what you would like it to be.  You have a better chance to get there if you know where you want to go.
  2. Growing access to higher reasoning brain involvement – the amazing capability of the brain is only as good as putting it to use.  The upper frontal region of the brain is where many of the most important higher reasoning areas are found.  Teaching children to self-regulate, delay gratification, control emotions, consider options and plan their actions are all ways to exercise higher reasoning centers and promote growth in this important brain area.  Play some music and ask the child to describe the feelings that come up, show a movie and discuss it afterword.
  3. Challenging mental activity/academic growth – since we now know that our brain’s change throughout life, we also have learned that like other parts of the body we need to exercise our brain for maximum performance and health.  One of the main ways the brain grows and changes is to be challenged, with the most beneficial activities being difficult mental challenges that are different from any previous activities.  School is one place but not the only source of academic growth.  Have your child teach you something they know a lot about, we learn the most when we teach a topic to others.
  4. Active imagination – the human brain, particularly of a child, does not like inactivity.  Early abuse or neglect can harm the ability of a child to dream and imagine positive thoughts.  Imagination can be encouraged by play, reading stories, fantasy movies and encouraging the young person to tell stories.  Imagination is a mental activity that helps exercise the healthy brain.   Be sure to reinforce times your child uses imagination.
  5. Focused attention/meditation – bringing the considerable resources of the brain into a unified focus takes practice and, at times, instruction; but it has been found to be one of the key ways to encourage brain health.  Focused attention has many names, but it is the state of relaxation of the body with activation of the brain on something specific.  This activity helps with coordinating regions of the brain and developing neuro-networks.  Have the child show you a video game that they can play well to demonstrate focused attention, then play some soft music and teach the child to listen quietly with eyes closed and imagination engaged and then discuss the result.
  6. Coping/resiliency – stress is a part of living but it is the ability to effectively work with stress that separates health from disease (“dis-ease”).  Coping is the ability to handle stress in a healthy way and often comes with positive experience in overcoming stress.  Resiliency is the ability to bounce back after a difficult experience.  Fortunately, it is not how difficult the life experience is but the ability to handle it that determines coping with future stress effectively.  Point out how your child has overcome small and large challenges.  Catch the child coping and reinforce this.
  7. Perceptual clarity – our experience of the world begins with our perception of the situation.  Based upon what we perceive, we develop an emotional response and the combination of perceptions and emotions results in observable behavior.  If we want better behavior, we need to go back to square one and have accurate perceptions of situations, other people and of the self.  Initially you must provide clear perceptions for the child, you may think the child is not listening but the brain does listen and new neuro-networks are formed by your input.
  8. Developing intuition – the brain will naturally make judgments particularly when it comes to safety and to promoting self-interest.  Young children quickly learn how to get special attention from a parent by doing something cute.  Intuition goes the next step to pull together sensory input, combine it with past experiences, develop judgments and consider the motivations of others.  All these steps help promote an active brain with integrated internal communication.  Read a story and ask the child to consider what the person in the story was thinking.
  9. Healthy emotions – emotions are often characterized on a continuum from positive to negative.  Everyone would prefer the positive, but being healthy begins with the ability to experience the broadest range of emotional expression and to be on the positive end of the continuum most of the time.  Our emotions are influenced by our surroundings, but even more so by our perception of our surroundings.  Expression is how emotions self-heal after negative experiences.  Allow emotional expression and teach your child how expression is self-healing.
  10. Balance of past/being in the moment/future orientation – humans may be the only member of the animal kingdom who can live in the past, present and future.  However it requires practice to develop a balance of each.  It is important not to excessively brood over the past or have anxiety about the future that prevents the person being in the present.  Too much living in the moment can cause its own issues, so the goal is a balance.  Determine which of the three your child lacks and encourage more focus in that area.

Spiritual/Attitudinal

  1. Sense of connection to something greater than self – connection with others is synonymous with health because people are social animals.  Living with a sense of connection enhances health and a connection of spirit adds an overarching sense of meaning and purpose to living.  Model spiritual connection by sharing your beliefs with your child and encourage discussions and letting the child express opinions about principles of living.
  2. Optimism/positive orientation – because our outlook determines our experience, optimism is a pillar of a positive, proactive stance in life.   Finding the positive in any situation improves mood, outlook and even how effectively the physical body functions.  A positive attitude often equates to a healthy disposition.  Model optimism and reinforce signs of optimism in your child.
  3. Self-reflection/contemplation/prayer – there is much to discover in the stillness of our internal thoughts, but first a state of relaxation must calm down the racing mind of living in a busy world.  In the stillness of one’s thoughts can be found the origins of self and a personal guidance system that can make corrections to stay on course.  Most people use this calm state to connect with a higher power that helps guide the choices they make in life.  Turn off the TV and radio and have times during the day for the family to be internally still, together or separate.  This can establish a mental memory for the years into the future.
  4. Joy/personal contentment – joy is the state of being brought on by appreciation, gratitude and happiness.  Joy requires that we focus on what is valued and held in esteem while letting in the emotions of being surrounded by what we value and love.  Personal contentment is the continuous state of experiencing happiness.   First you must have personal contentment, then share this with your child.  You may be the only model the child has to plant this seed.
  5. Gratitude – being thankful for what one has is one of the most effective ways to counter the stress that comes from what one does not have.  An attitude of gratitude has been found in research to be directly associated with personal contentment and happiness.  A grateful, happy person is also a spiritually healthy person.  Encourage children to think about what they have, they think about what they don’t have with no encouragement.
  6. Altruism/kindness/empathy – consideration for others is essential to social success, but thinking of others must be put into practice in acts of kindness.  People who help others are healthier and happier and have longer lifespans.  Acts of kindness are health providing to both receiver and giver.  Teach your child to give to others in time and resources.  Volunteer with your child, teach your child how it feels to give to others.
  7. Social connectedness – people need other people to work, to play, to pray and to grieve.  The greater our connectedness to others, the healthier we are if these connections are characterized by engagement, honesty and respect.  The quality of the connection with others is important, just being in the company of others may not be connection.  Encourage participation in sports, scouts, camps, church groups and other opportunities to connect and learn social skills.
  8. Ability to forgive – in a society so focused on fairness and punishment, the role forgiveness plays in our health is seldom acknowledged.  Everyone has unfortunate experiences and it is a part of the human condition to be hurt by others.  Research has shown that forgiveness is actually an experience of power and resiliency.  Children need to be taught to forgive and the best method is by the modeling of adults demonstrating forgiveness.  Forgiveness does not come naturally so teach your child how to go about forgiving starting with small matters.
  9. Respectful disposition – respect is the language of health, we must respect our bodies, our families, our peers and respecting nature is an expansion of giving consideration to all that is around us.  Respectful acts are behaviors, but a respectful disposition is an orientation to the others and the world we live in.  Children must experience respect from adults to return respect.  Teach respect of adults, peers, strangers, and those we may disagree with.
  10. Self-Respect/self-love – the golden rule actually starts with self-love because treating others as we want to be treated assumes that we want to be treated with respect.  To respect and to care for others requires self-respect.  This fundamental basis for a healthy, happy life cannot be forgotten.  Catch your child reflecting self-regard and self-respect.  We get more of what we focus on from children, be sure to focus on positive qualities more than negative ones.

Interventions

Normally what is expected when interventions are mentioned are specific behavioral steps to modify or extinguish a problem behavior by a child.  However, the principle of integrated treatment is that behaviors are symptoms and manifestations of a deeper level of concern that may not be addressed by targeting the symptom.  To give one example, fire-setting behavior by children is most often an indication of a need of the child that has nothing to do with fire.  Our treatment systems have moved in the direction of treating symptoms and even encouraging this approach.  Several treatments have been popular for a number of years that generally fit into a short-term, solution focused, managed care orientation that typically promise some level of symptom relief.  However, if the symptom is an indication of a deeper intractable problem, it may be necessary to provide more integrated treatment.  How will you know?  If short-term approaches fail to produce the desired result then consideration of a more integrated approach is indicated.

Integrated interventions are best accomplished by impacting every aspect of the client’s life.  For this reason intensive alcohol/drug treatment is generally an inpatient setting, and residential treatment for serious habitual behavior has distinct advantages.  Addressing all aspects of the child’s world may be easier in a residential setting but it can be done in an outpatient setting as well, it takes all the adults in the child’s life being on the same team.

Because mind, body and spirit overlap and impact each other, so do the best interventions for troubled children and adults.  An effective intervention can have multiple positive impacts.  However, the principle of synergy works both ways; trouble in one area often produces a cascade of problems.  Because of this it is difficult to get effective results if a child is treated only in one role or part of the child’s life.  An intervention at home will generally have better results if implemented at school as well.  Teaching respect at Sunday School will have more impact if the lessons carry over to the home.

The first step to developing interventions that take an integrated approach is to focus on the right problem.  This often means to take a more comprehensive view of the issue.  If a child has significant problems with transitions at school, the issue might be handling the stress that changes produce.  An integrated intervention would help the child with handling stress in multiple areas and not just transitions at school.  Here are a few examples of interventions that use an integrated approach:

Example 1.  Symptom – frequent emotional outbursts.  Deeper problem – Handling Stress.  Many problem behaviors have the root cause in the inability to self-regulate.  A variety of stressful experiences in childhood can produce a serious deficiency in self-management, in part due to a lack of development of the frontal regions of the brain.  An integrated intervention would focus on building the brain’s capacity to override reactive primitive brain regions to enable self-control and self-regulation.  It sounds complicated but this can be done by teaching the child to relax.  It is important to practice relaxation because repetition is what trains the brain, and it is important to practice when the child is not in a state of high stress.  There are many ways to teach relaxation: sitting quietly, biofeedback activities, meditation, and many more.  Link a reward with practice because like practicing playing the piano, children give up easily if they are not good at a task.  Teach the child an internal signal to remember like a “Step 1, 2, 3 Plan,” #1 Stop and take a deep breath, #2 consider a bad and a good way to handle the situation, and #3 pick the good way when you are ready.

Example 2.  Symptom – demanding behavior with a lack of empathy for others.  Deeper problem – egocentricity caused by past negative experiences.  It is not just children who are egocentric and care mostly about their own needs; many adults have never fully learned reciprocity or the fundamental aspect of a relationship being a two-way street.  Children must be provided with everything when they are very young, but gradually they must be expected to give back more for what they receive.  This does not include basic needs, but it does include most everything else.  Reciprocity does not come naturally and must be taught and expected as an important life lesson.  Some adults struggle with expecting something in return from children, but giving the child a message that little is expected for what they receive could actually hinder the child in the long run.  Reciprocity is best taught by including it in all aspects of the child life: home, school, relatives, etc.  Reciprocity could mean that a ride to soccer practice might be preceded by giving Mom a hand with a family chore.  It might also mean getting a requested expensive name brand clothing item would expect a financial contribution by the young person.  The message of giving as well as receiving in relationships is a very important lesson to be learned as early in life as possible.

Example 3.  Symptom – breaking rules and/or not telling the truth and not taking responsibility.  Deeper problem – poor moral reasoning starting with the need to learn responsibility.  This is another area that does not come naturally with children and must be taught and expected as the child matures.  Young people rise to the expectations of the adults around them and holding high expectations for responsible speech and behavior is recommended.  Children learn best by example and one of the best ways to teach responsibility is by providing a consistent example of responsible behavior.  When a child falls below expectations, it is important to separate the child from the behavior and correct the behavior by discipline rather than by punishment.  To discipline means to teach a more appropriate response.  An excellent way to teach a behavior is through reinforcing approximations and find aspects of the behavior that can be reinforced rather than focus on what is not yet meeting the expected standard.  When a child misses the mark with a behavior, the adult should expect that the child take responsibility and do better.  Find some aspect of the child’s response that is acceptable and praise the child for this and expect the same effort in other areas and keep the expectations high.  The earlier the training in responsibility is implemented, the faster responsible behavior becomes a habit rather than irresponsible behavior.

Summary

Although it seems fashionable to focus on short-term, symptom targeted interventions, it may be wiser to consider the long-term through integrated interventions that target the overall child.  When done effectively, not only can there be symptom reduction but there are other gains that can be realized.  Integrated interventions acknowledge that individuals are complex and multiple factors interact with any problem, and solutions should address multiple dimensions of the individual to be most effective.  It may be cheaper and quicker to simply focus on external symptoms (like repairing the rearview mirror after an accident), but the benefits of integrated treatment can be shown in the short- and long-run to have the greatest impact in helping a child function with successful thoughts, emotions and behaviors as a child setting the stage for a more positive future.

Where to get more information on treating the whole child

Neurological Reparative Therapy, a Roadmap to Healing, Resiliency and Well Being.  (2011). D.L. Ziegler, Jasper Mountain, Oregon.

Traumatic Experience and the Brain, A Handbook for Understanding and Treating Those Traumatized as Children, Second Edition.  (2011). D.L. Ziegler, Acacia Publishing, Phoenix.

Beyond Healing:  The Path to Personal Contentment after Trauma.  (2009). D.L.Ziegler, Acacia Publishing, Phoenix.

Achieving Success with Impossible Children:  How to Win the Battle of Wills.  (2005). D.L. Ziegler, Acacia Publishing, Phoenix.

Raising Children Who Refuse to be Raised, Parenting Skills and Therapy Interventions for the Most Difficult Children.  (2002).  D.L. Ziegler, Acacia Publishing, Phoenix.

Impacting the Brain of the Traumatized Child

By Dave Ziegler, PhD

There is now sufficient information available from research on brain development and brain functioning, as well as the effects of trauma, to know that impacting the brain is the key to success in helping traumatized children.  We owe a debt of gratitude to technology and medical science for what we now understand in this area.  We now have the information knowledge, but what is currently needed is to turn this knowledge into practical tools that parents can readily understand and use to help their children.  In this pursuit there is little need for sophisticated medical equipment, complex treatment systems, and expensive trainings to put into practice how to impact the brain.  We must start with a basic understanding of a few principles and then invest energy into interventions that are not as complicated as one would think, or as some would have you believe.

There is no question that the short and long-term effects of traumatic experience can be devastating and can have life-long negative consequences for those unlucky enough to be abused and traumatized, particularly during early childhood years.  A simple definition of traumatic experience is any event that overrides the ability of the individual to cope with the situation.  When our ability to internally cope with an event is exceeded, a cascade of events take place in the brain that nearly always has strong and predictable results.

Short-term consequences of a traumatic experience can include mental, emotional and behavioral problems.  When faced with an event that the individual is unable to cope with, the brain goes into a survival pattern of “fight or flight” response.  The themes of fight or flight carry over to emotional and behavioral reactions.  Which direction the individual goes on this continuum can depend on factors such as age, gender, physical size, and what strategy the individual perceives will best produce survival.  For example, more young children and more females tend to internalize their response by getting away or dissociating (getting away mentally).  Older children and more males tend to externalize their response by fighting back.  However, fighting back for a child facing insurmountable odds is seldom effective and infrequently implemented.  Other short-term effects of trauma can include: emotional instability and a heightened need for support and comfort or a heightened state of fear.

As difficult as the short-term results of trauma can be, long-term problems are generally much worse, due to how long they continue and how pervasively they can affect every aspect of the child’s life.  Long-term consequences of traumatic experience affect not only the emotions and behavior of the individual but alter the brain and its development in profound ways.  Long-term effects of trauma can include the inability of the child to self-regulate both emotions and behavior.  This impact can include heightened states of arousal, hyper-sensitivity to any situation that is a reminder of the traumatic event, and a significant barrier to trusting others.  In turn these impacts can produce the following ongoing patterns: anger, violence, hyperactivity, difficulties in concentration, an inability or resistance to trust anyone, and a lack of empathy and selfish thought patterns.  These results of trauma then produce social difficulties at home, at school and in the community, as well as serve to cut the child off from family, friends and any type of support system.  When this process continues without disruption, the child starts down what can be a life-long road of isolation and a pattern of pushing away anyone who is capable of providing support and care.  A support system is a key factor in healing from abuse and coping with the stresses of life.  Without support the future can be very dark for the child.  The above long-term impacts of trauma make every period of life much more difficult starting with early childhood.  As these individuals mature they do not seize life, but instead, life seizes them.

The understanding of brain development that is now available has also pointed out the tragic truth that the most devastating long-term problems from trauma are caused by chronic neglect.  This reality is tragic because neglect is most often at the hands of the most important person in the child’s world (his or her mother) and because neglect is the most frequent type of abuse.  Neglect is nearly always a continuing pattern of substandard care rather than a one-time event.  The chronic nature of neglect has significant detrimental impacts on the region of the brain that controls emotional stability.  Each of these factors can produce an unfortunate dynamic of a personality that reacts continually and has a heightened state of fear and dread due to a lack of belief that basic needs will be recognized and met at every turn in life.

There is little mystery as to why the above short and long-term problems become engrained in the response patterns as well as in the very personality of the child.  Because trauma overrides the ability of the child to cope, the brain understands such an event as a threat to survival.  Survival threats are perceived by the brain as ultra-important events and the brain is designed to insure all such events are remembered regardless of how young the child is.  In fact, the younger the child, the more indelible the memory of the traumatic event becomes.  Because survival requires the child to learn quickly where threats exist, traumatic memory is stored in the middle of the brain in what is called the limbic system.  Trauma memory is different than factual memory and is an automatic brain response that the individual may not even be aware is happening.  The immediate brain responses are the short-term problems listed above. When these problems are not disrupted, the consequences become the long-term problems also described above.

There are many other reasons that the brain acutely remembers traumatic experiences, but most of these have to do with brain development.  The regions of the brain that are the first complex areas to develop are also the regions that are most negatively affected by trauma.  These regions (right frontal lobes) are responsible for functions such as forming attachments with primary care providers, and proximity seeking drives to help reduce stress.  These areas are needed for self-regulation coping abilities.  When a young child experiences trauma rather than stress reducing comfort and nurture, the brain’s development is damaged with predictable results that are all too commonly observed in traumatized children—inability to handle stress, emotional problems, inability to relax, loss of the ability to play or be child-like, and the significant absence of empathy.

Understanding the Brain

A brief overview of the human brain can be helpful in understanding how we can help children after traumatic experiences have occurred.  The brain is the most complex organic structure in the known universe.  The most sophisticated super computers pale in comparison to the complex structures and abilities of the human brain.  The brain can be described as having four primary components.  The brainstem is the most primitive section and one we share with most living organisms.  The brainstem runs our moment-to-moment survival functions including respiration, temperature regulation, and circulation.  Next in complexity is the section known as the diencephalon.  This part of the brain regulates motor functions, arousal, and sleep patterns among others—functions that are somewhat more complex than those controlled by the brainstem.  The final two sections are the most complex parts of the brain known as the limbic system and the neocortex.  The limbic system regulates attachment, sexuality, and plays a major role in emotions and trauma memory.  It can be said that a traumatized child functions primarily from the limbic region of the brain, a section of the brain that is primarily reactive in nature.  The neocortex is by far the most complex part of the brain and controls much of what we consider to be our reasoning and thought processes.  These components include language, abstract and concrete thought, and the most advanced mental functions collectively referred to as executive functions—planning, goal setting, cause and effect understanding, moral reasoning, delaying gratification, sequential thought, and most of the mental functions that separate Homo sapiens from the rest of the animal kingdom.

From the above descriptions it can be quickly observed that traumatized children primarily use their reactive limbic system and do not properly use their higher reasoning centers in the neocortex.  After trauma, children often have difficulties with stress management, they overreact frequently, they do not seem to learn from past experiences, and they come up short in nearly all areas of executive functioning.  Therefore the brief way to state the solution to the problems created by trauma is to change the child’s brain by teaching the child to learn how to regulate or control the limbic reactivity and learn to use the executive brain functions.  Of course this is much easier said than done, but it is very doable.

Strategies to Alter the Child’s Brain      

There are parts of the brain that we do not want to alter.  All of the functions of the brainstem and nearly all functions of the diencephalon cannot be altered.  We need these functions to keep us alive.  The other two areas of the brain, the limbic and neocortical regions are a very different matter.  These areas adapt to experiences and will be the target of interventions designed to help traumatized children, and adults traumatized at a young age.

The general goal of interventions that alter the limbic system of the brain is to help the child react less and consciously act more.  There are many ways to help the child do this including some mentioned here.  For the most part these methods are low tech and yet very effective:

  • Get on the same page with the child.  The challenge in this intervention is to have your neocortex connect with the child’s limbic system.  To the degree you are able, do what you can to let the child know you that you understand the struggle he or she has, and that you have a plan to help.  Actually if this is successful, you have taken a huge step forward in bypassing the limbic region entirely and connecting with the child’s higher reasoning centers.  You can let the child know you understand by explaining to the child why it is so difficult to handle stress, but be sure to do this when the child is calm.  You can develop a stress plan (explained later) that you outline and have the child explain back to you that can be implemented in times of reactivity and stress.  How you do this communication depends on the relationship you have with your child but step one is to connect with the child and work to have both of you on the same page.
  • Help the child learn self-regulation.  The reactivity caused by trauma overrides the child’s internal ability of the child to use self-control.  The regulation of behavior and emotions do not come naturally after trauma and must be taught.  Teach the child to identify feelings and use skills to modify these feelings.  When the child experiences strong negative emotions, help him or her to reduce the intensity of the feelings through relaxation methods.  Before the child acts impulsively, help the child to think about what he or she is about to do.
  • Teach relaxation. Perhaps the most important single step you can take to help a traumatized child is to teach relaxation.  This skill involves the use of mental abilities to calm down, stop intrusive thoughts, take deep breaths, and dozens of other strategies that children can learn to help relax.  With practice the child can become proficient at turning down the volume of internal stress.
  • Provide structure.  Predictable rules and daily order to life help everyone get through the day more smoothly.  Structure for traumatized children provides an external order that eliminates the pressure of internal chaos and is comforting.  It is important to ignore the child’s protests to the contrary.  Traumatized children often fight against the very help they need.
  • Communicate predictions. An easy tool to use in helping children think is to tell them your prediction of what they will next feel and how you anticipate they will act in certain situations.  For example you could say something like, “When it is bath time you probably won’t be ready so I will give the first bath to your sister.” This use of predictions has the common outcome of disrupting the habits of reactivity.
  • Develop a stress plan.  Depending upon the age of the child, a stress plan can be simple or complex.  A stress plan begins with an acknowledgement (usually from the parent) that reactivity to stress is beginning to occur.  Aspects of the above interventions that have shown some success can be built into the plan.  The dilemma for the child is that it is normal for the limbic region to react, often in unproductive ways, so the child does not immediately recognize that reactivity is a problem.  It may help to have a signal (a word, hand signal, or other sign) to institute the plan.  It may also help to have a place to implement the steps in the plan, such as the child’s room, a favorite chair or some other positive location (this is not a time out).  If you and your child can catch the reactivity early and successfully implement the stress plan, the child can have a voice in when the plan is no longer needed.  However, if the child is in full reactivity, the parent must determine when to extend the plan.

When the above limbic interventions work they automatically become interventions directed at the neocortex.  This is because at the moment the child turns his or her awareness away from reacting and toward a conscious plan of action, the neocortex has now been engaged, which is the primary goal of all interventions to impact the brain of the traumatized child.  At the point the child moves away from reacting to the situation the following interventions can promote even higher order brain functions.

  • Provide executive functions. All interventions that encourage use of higher reasoning centers of the brain promote executive functions.  It is essential to understand that initially the adult must provide higher order reasoning until the child internalizes the skill.  One of the best ways to provide executive function thinking for the child is to think out loud so that he or she can hear how this works.  Keep in mind that unless the child has moved beyond the reactivity phase, you will not be able to help the child think in this way. Examples of assisting the child by thinking out loud might be: “If you let your brother have this turn then you can have the next one,” or “If you get along with your friend he will want to play with you more.”
  • Encourage thinking.  Basically anything that encourages the child to think is a good strategy.  Having the child write something requires higher order reasoning.  This can include drawing feelings, an activity which requires making choices of what to include and it involves planning.
  • Use your words. When children are encouraged to verbalize thoughts and feelings they must use their neocortex to do this.  Yes, even if they are arguing with you, they must think about the next thing they want to say to minimize or justify their behavior.  First get them to talk to you and then work on less reactive communication.
  • Teach self-mastery skills.  Learning how to have some internal control over internal thoughts and feelings can be a powerful experience in self-understanding and self-control.  Children can be taught to visualize calming images, train their brain on a thought or image.  These exercises are the beginning of meditation and concentration skills.  Physical activities such as yoga, breathing exercises, and even aerobic activities such as rapid walking or jogging can help the child experience self-mastery.
  • Use repetition. Any helpful intervention to impact either the limbic system or neocortex must be repeated many times to be effective.  It is the repetition that builds capacities within the brain by literally forming new neurological structures in the child’s brain that over time can replace negative habitual patterns where the child has become stuck.

The above strategies are only a few of many possible examples.  Avoid the tendency to view altering the child’s brain as an overwhelming task that requires complicated steps beyond what you can do in your home.  The truth is that interventions at home can be the most helpful and effective for the child.  Pick one or two of the above interventions and stick with it through repetition.  You can always add something new as the child improves in an area.  The important thing is to know that these steps help, and to have at least a general understanding of why.  This goal has been the purpose of this article.

If you want to know more about how the brain works and how to help it work even better after trauma, my book Traumatic Experience and the Brain can help you take the next step.  Just remember that every traumatic experience has a negative influence on the brain but also remember that every successful experience of coping has a significant impact on the brain as well.  The ideas and examples provided here are doable and they work with some of the most damaged children.  Therefore I am confident that with practice these concepts and approaches can work with your child as well.

Promoting Healthy Sexuality After Sexual Abuse

By Dave Ziegler, Ph.D.

(The following article is dedicated to a friend and colleague Jan Hindman, who enriched the field of sexuality and trauma treatment before her untimely death in 2007)

I need to make you uncomfortable for a bit, but it is for your own good and the good of the sexually abused child you are trying to raise.  I say this because I need to talk about S..E..X., the most difficult topic for nearly everyone to talk about.  But the problem is that we have to talk about it if we want to raise a sexually healthy child.  Why human sexuality is so difficult to talk about in polite company is a topic for another day, but our starting place is that most of us would rather face any other issue than sexual issues with our children.

If you have a sexually abused child in your home that you are trying to parent, then you have a challenge on your hands that not even the experts have been willing to directly address—how does a parent promote healthy sexuality for a child who has already had sexual experience in the form of abuse?  If you have attempted to find some good books on the topic, which you probably haven’t, you found that there are none.  Yes, you heard me correctly; there are many good books on most every topic related to sexuality except how the help a child develop a healthy view of sexuality after the very unfortunate experience of sexual abuse.   In part this is an oversight, but even more so this lack of resources for parents is symbolic of our collective cultural neurosis that the less said about sex the better (unless the task involves advertising).

I want to begin our discussion with a quote from my friend Jan Hindman who wrote in her last book, “Of course we love our children.  We teach them what they need to know.  But when it comes to sex, we do nothing and hope the Sex Fairy will zap them in the crotch when they walk down the aisle to get married and magically, they will turn into sexually healthy adults” (Hindman, 2006).  This quote sums it up pretty well for our culture.  We avoid sex education because it might encourage children to act in sexual ways.  We put off talking to our children about sex, “until they are old enough to handle it,” meaning when the child is seventeen and has learned all they needed to know from other sources such as peers or the media (both excellent sources of healthy sexual information, right?).

The principle barrier to our culture helping children to become sexuality healthy is that we deny the fact that children are sexual beings.  We have body parts that perform a myriad of functions, but it is only the sexual body parts of our children that we hope will lie dormant in the dark recesses of their bodies only to awaken with enthusiasm on their wedding night. Enough said about how messed up our culture and most of us are regarding sexuality, we need to change the focus to discuss how we can help sexually abused children have a chance at a life that moves sex from a curse to a blessing.

I have started our discussion this way because we cannot give to a child what we do not possess ourselves.  If we want to raise a sexually healthy child we need to have some measure of healthy sexuality ourselves.  If we want our children to have some comfort with the topic of sex then we must model comfort.  Alright, you may have to fake it a little.  But seriously, we need to start the process by looking inward at ourselves.  Consider the following questions and how you would rate yourself:

  1. Do I live in a way to acknowledge that I am a sexual being?
  2. Am I comfortable with my own sexuality?
  3. Do I value and respect this important part of who I am?
  4. Am I aware of the important part my sexuality plays in forming who I am?
  5. Do I act in harmony with my sexual beliefs?
  6. Am I respectful of the above in others?

As you read further, you will see that respect will be a cornerstone of our journey.  Few of us are statements of full health so we all have to start where we are.  However, we need to realize that with the difficult road ahead we need to first acknowledge, respect and value our own sexuality if we are to impart healthy sexuality with our child.  Here are a few general suggestions from the Advocates for Youth when it comes to addressing sex with all children:

  • Examine your own beliefs and values before teaching a child.
  • Assert your own personal privacy boundaries; decline to discuss private sexual behavior with the child.
  • Use accurate language for body parts and functions.
  • Discuss sexuality at times that work best for connecting with your child.
  • Clarify relationships and how people are related to others.
  • Use photos, pictures, and visual materials.
  • Use teachable moments that come up in daily life.
  • Be honest in answering questions.
  • Value the child’s feelings and experience.
  • Offer praise and support.
  • Repeat information over time as needed.
  • Take advantage of available resources.

One of the ways we discourage rather than promote healthy sexuality in children is to deny their sexual interest and curiosity.  Take a moment and ask yourself the following question–since my child is a sexual being what are the ways he or she can appropriately express this sexuality? We all know many ways children can be sexually inappropriate, but are there appropriate sexual expressions in your home?  If there are none, like most families, then you fit right into the prevailing culture, but your child will remain confused about sexual thoughts, feelings and behavior both internally and with others they encounter.  Remember that most sexually abused children have a heightened interest and sensitivity to sex, even if you don’t hear about it you can trust that there is a lot going on inside the child’s biggest sex organ—the brain.

Promoting healthy sexuality is more than a two-week plan of action and hoping your job is done.  Sexuality will come into play at every developmental age of the child.  The older the child gets the more complex it becomes, and the more vulnerable you will have to be to model being an “ask-able parent.” This meaning someone the child knows he or she can go to for answers to their questions and receive support for their confused feelings.  The child will know you can be approached because of the many times you approach them first on this topic (I know this is not your favorite discussion topic, so to get some practice give your mother-in-law a call and have a sexual conversation, or if you prefer then call a friend).

So armed with as much internal comfort as we can muster and ready to take the next step, where do we go from here?  I would suggest relying on some suggestions from Jan Hindman’s book There is No Sex Fairy To Protect Our Children From Becoming Sexual Abusers (Hindman, 2006) or what she calls the Ten Commandments of raising sexually respectful children:

  1. Start young to teach biology as well as respect.
  2. Communicate–Children are learning from many sources, they need to learn from you.
  3. Teach logic–rules, robbery, and rescue.  Everything in life has rules that need to be followed. Do not let someone take something precious from you against your will, and remember to always ask for help when you need it.
  4. Don’t keep children from the world–teach children healthy information and critical thinking.
  5. Teach gender equality and the meaning of consent.
  6. Sexual respect goes beyond biology and nature. Respect is not automatically learned.
  7. People don’t end up bad if bad things are done to them. Teach resiliency and personal responsibility.
  8. Teach delaying gratification and self-esteem.
  9. Teach RESPECT—the vulnerability of others, healthy guilt, restitution, the feelings of others, and anti-bullying.
  10. Teach touching and tenderness through your modeling at all ages.

As you are probably aware, sexual abuse can distort a child’s interest and curiosity.  Although not all interest in sex is a sign of pathology, in the same way not all interest in sex is normal and natural.  Therefore you as the parent must distinguish between healthy and unhealthy interests along with thoughts, feelings and sexual behavior.  Fortunately there are some resources in this area.  One is my own measure called the Inappropriate Sexual Behavior Scale, which can be found in my book Raising Children Who Refuse To Be Raised (Ziegler, 2000). Another resource is the booklet Understanding Children’s Sexual Behaviors (Cavanaugh Johnson, 2004). Both resources can help you distinguish from a wide range of healthy and unhealthy sexual themes in children.

Example of unhealthy themes that point to concern are the following: preoccupation with sex, sex play with much younger children, precocious knowledge beyond the child’s age, unusual sexual interests, drive to act out sexually, sex play that has a negative impact on other children, seeing others as sex objects, violating the rights and boundaries of others,  adult-like sexual activity, directing sexual behavior toward adults, sexual activity with animals, the use of sex to hurt others, bribery, threats, force to engage other children in sex play (Cavanaugh Johnson, 2004).

Now that your blood pressure was raised by the above list, some suggestions to handling sexual behavior may help calm you down.  The following are eight general principles for working with sexual behavior in all children:

  1. Remove the aura of sex and consider it as behavior, nothing more/nothing less.
  2. Work on being more comfortable talking about sexual issues.
  3. See the child and not just the behavior.
  4. Translate the meaning to the child of the sexual behavior, some sexual behavior is about attention not about sex.
  5. Consult with a partner, we often need a reality check when dealing with sexual behavior.
  6. Don’t minimize and don’t catastrophize.
  7. Don’t expect children not to be sexually curious at every age.
  8. Be sure to replace every problematic behavior with an alternative appropriate behavior.

Raising the sexually abused child can make your job even more difficult than the child who has not been abused. Sexual abuse often causes children to view sex as bad and yet they are attracted to it.  When adults view sexual themes as bad, this reinforces the problem. The answer to this dilemma is to transform sex into something positive.  Remember the goal is to promote healthy sexual interest, not stamp out all sexual interest.

Perhaps the most that can be done on this topic in a brief way is to provide a road map for the journey.  There will undoubtedly be some twists and turns along the way and a few surprises as well.  Here are some final practical suggestions to help guide you on this complex journey toward healthy sexuality for your child (and for you as well).

  • Go over rules of touching, space, and consent.
  • For young children use the language of playing games, “We don’t play the penis touching game in our home.”
  • Teach the child that our bodies are like our other important possessions, we care for them and protect them.
  • In teaching the child to be safe, he or she has already found the dangers, help the child learn how to determine the good from the bad.
  • Teach critical thinking, “In the story I just told you who was right and who was wrong?”
  • Talk to the child about the dangers in the world and how to avoid them, don’t pretend they are not there.
  • Explain to the child the people and places to avoid and why. Don’t teach fear, explain the hazards.
  • Your home must be an environment of respect in all areas.
  • Respect starts with people and objects then moves to sexuality.
  • You must specifically teach respecting boundaries to children who have had their private space violated.
  • Help children separate who they are from what was done to them.
  • Realize that many abused children have negative views of self and the future, you need to help them alter these views.
  • Teach children how to bounce back from adversity not only with sexual abuse but with all challenges in life.
  • Point out when the child overcomes difficult challenges and reinforce these small successes.
  • Responsibility must be specifically taught, it does not come naturally.
  • Sexuality is an extension of many aspects of life–respect, caring, intimacy, equality, and consideration.
  • Reframe the meaning of touch to include caring and loving touch.
  • Touch must be a communication of a positive message, not exploitation and abuse.

This has been a considerable amount of information in a few short pages and there is obviously a great deal more that could be said.  There is no quick and easy way to handle one of the most difficult aspects of the world’s most difficult job—parenting a healthy child, particularly when the child has been traumatized.  Becoming overly stressed will work against you, so do your best to relax and take it one step at a time.  The beauty of parenting is that there is little you can do wrong that can’t be fixed with time and effort.  There is no way to avoid the fact that parents must be the message they want their children to understand and internalize—teaching is fundamentally about modeling.  However, you are not expected to be an expert at either parenting the traumatized child or helping sexually abused children develop healthy sexuality.  In fact, there are no experts at this very challenging task, we are all early explorers of a complex and uncharted terrain.  Along the way make sure you take advantage of your personal support system and do not be reluctant to ask for help and some directions from time to time.  And good luck on your pioneering journey, both you and your child will gain from your efforts.

_______________________________

Advocates for Youth.  Sex Education for Physically, Emotionally, and Mentally Challenged Youthhttp://www.advocatesforyouth.org.

Cavanaugh Johnson, T.  (2004).  Understanding Children’s Sexual Behaviors.  What’s Natural and Healthy.  San Diego:  Family Violence and Sexual Assault Institute.

Hindman, J.  (2006).   There is No Sex Fairy To Protect Our Children from Becoming Sexual Abusers.  Lincoln City, OR: AlexAndria Associates.

Ziegler, D.L.  (2000).  Raising Children Who Refuse To Be Raised, Parenting skills and Therapy Interventions For The Most Difficult Children.  Phoenix: Acacia Publishing.

Understanding and Treating Attachment Problems in Children: What Went Wrong and How Problems Can Be Fixed

By Dave Ziegler, Ph.D.

This somewhat complex article reviews the basic tenets of traditional attachment theory and describes both its strengths and weaknesses. Revisions to attachment theory are suggested and detailed explanation is provided of both the causes and treatment of various types of attachment problems. It is both a technical road map and a practical guide to the journey.  Although complex, It has been written to be understandable to professionals and parents alike. (31 pages)   Link to full article here.

Neurological Reparative Therapy: The Treatment Model of Jasper Mountain

By Dave Ziegler, Ph.D.

It is the human brain that enables individuals to adapt to the world either in optimal or destructive ways.  The choice of a positive or negative direction of adaptation depends on a variety of factors related to both nature and nurture.  The nature element includes epigenetics or the genetic codes that lay dormant or become operational.  The nurture involves the influence of the environment, which is substantial particularly related to adaptations to maximize safety.  Most mental health therapy must take on the challenge of facilitating modifications of the brain’s negative adaptations that take the form of cognitive patterns getting in the way of a functional life.  Effective therapies make an impact at the operational level of the brain, which includes individual neurons and neuro-templates (families of neurons that perform a function).

Altering the brain’s cognitions at the most basic level involves impacting the cellular neurology of brain development.  Psychotherapies attempt to change cognitions or what could be called cognitive mental maps or inner working models.  Both terms describe how the brain understands the conditions of the environment it operates in.  How the brain perceives a situation says a great deal about how it responds. Another way to change the brain is through pharmacological interventions that change the brain on a chemical level, specifically the neurotransmitters of individual neurons.

When the brain is allowed to develop optimally it strives for positive adaptations to the challenges of daily living.  However, when trauma or deprivation become part of the individual’s experience, the brain makes radical adaptive alterations focused primarily upon surviving rather than thriving.  These negative adaptations become the symptoms of most mental health problems such as: anxiety, depression, fear, hypervigilence, trouble connecting with others due to mistrust, inability to properly read social cues, addictions, aggression, and a large variety of behaviors associated with the autonomic fight or flight response to stress.

The brain’s primary function is to promote the survival of the individual. An important additional function of the brain is to successfully negotiate the world it finds itself in. Successful mental health treatment involves the repair of the brain’s adaptive functions and optimal neurological processes to put more focus on thriving and not just on surviving.  Brain research has found that the malleability of the brain works both in causing problematic symptoms due to negative adaptations as well as creating the conditions of health and self repair through the right external guidance.  Such support and assistance from the outside forms the core of Neurological Reparative Therapy.  This is a research based approach to making positive changes in the thinking, emotional expression and behaviors of young children.  It can be described as the facilitation of nerve functioning to optimize integrated cognitive processes, thus an approach that impacts the refocus of brain systems on positive adaptations to self, others and the world the individual functions in.  This approach is less an intervention than an orientation of holistic, ecological and environmental conditions needed to return the brain to its natural state of optimal adaptive functioning.  Brain research has identified that unless damaged in some way, the brain strives for success and even happiness in life.  Once damaged, the brain often needs external intervention to move beyond becoming stuck in negative patterns or putting exclusive focus on survival and reactivity to stress.

The Ten Fundamental Premises of NRT

The ten premises include both goals of this approach and steps that must be integrated into the treatment process.  The first five premises are goals and the last five are intervention steps. Each goal and step will be explained in brain terminology and then in more practical language:

Five Goals

The Five Goals toward neurorepair are general in nature and are not necessarily sequential as the steps that follow the goals.  One or more of the goals are addressed in each step of the process.  The combination of the goals and steps constitute the ten premises of NRT.

1.   Facilitate perceptual changes of self, others and the child’s inner working model

The individual’s experience in life is directly connected to his or her perceptions based upon the inner working model or how the person views self and others.  Based upon the individual’s perceptions the cognitive mental maps plot a course the individual will take including emotions and behaviors.  The first goal is to impact perceptions through altering cognitions in order to provide a more positive and optimistic orientation rather than a negative and depressive mind set.  Therapeutic work is directed toward developing a sense of self efficacy and helping the individual view others as resources for support and assistance.

The individual must experience some successes, however small they may be in the beginning.  The person must experience making a positive impact, having some positive influence on others, and is helped to begin to see the world as a more friendly and supportive place.  An example would be to help a child see school as a fun place to learn rather than a scary place where social and academic problems produce failure.

2.   Enhance neuro-integration

Executive functions of the frontal lobes of the neocortex require integration of functions in all parts of the brain.  Neuro-integration is the brain’s ability to access component parts to be integrated into an understandable whole that promotes good decision making.  Enhancing neuro-integration is also strengthening the hemispheric communication between the left (logical, analytic, verbal) and right (intuitive, artistic, emotive) hemispheres of the brain.

In the beginning the higher order thinking must come from the outside, from supportive people.  The individual must learn to combine the logical and emotive regions of the brain through activities that simultaneously involve both hemispheres of the brain.  For example, having a child listen to music and seeing a mental image (right hemisphere) while describing the image (left hemisphere).

3.   Alter the region of the brain’s processing information system

A primary goal of all psychotherapy is to promote functioning of the higher reasoning centers of the brain.  Many traumatized individuals primarily use the limbic region of the brain in daily life.  This region contains the brain’s fear center, as well as traumatic memories and emotional response system.  Combining these factors produces an individual reacting with fear and emotionality to reminders of previous negative experiences.  The much more functional alternative is for the higher reasoning centers of the neocortex to access information from all aspects of the brain and process the information to inform decisions and choices.

The individual must learn to think first, feel second and act third and not the reverse order.  The reactive limbic region of the brain cannot be the primary part of the brain used.  The person must learn to act rather than react in all areas of living.  For example, teaching a child when frustrated to go through a process such as – stop, take a deep breathe and make a request.

4.   Facilitate Orbitofrontal Cortex activation

The optimal goal of brain processing is to activate the Orbitofrontal Cortex in the frontal lobes of the Neocortex.  It is this complex part of the brain that accesses information from all other parts of the brain and enables deliberative and proactive mental activity.  This is the opposite of the reactivity of the limbic brain region.  This region of the brain can be viewed as the chief executive officer because it is the most complex and potentially productive neurological process that can result in effective consideration, planning, goal setting and accurately perceiving challenges, all of which are higher order executive functions.

Over time the goal is to have the individual process most information in the most advanced area of the neocortex.  It is this region that optimally provides goal setting, delaying gratification, moral and ethical reasoning and empathy for others among many other executive functions.  Every intervention that promotes thoughtful consideration, exercises the Orbitofrontal Cortex.

5.   Neuro-template development through repetitive practice

Networks of communication in the brain are made possible by neuro-templates and their individual component parts—neurons.  Neurons have a use dependent developmental process where neurons that are frequently used become larger and stronger as well as do more work and do this work faster.  In contrast, neurons that are never used may atrophy and die, and if seldom used they gradually deteriorate.  One key goal of exercising the brain is repetition, since it is in repeated use that neurons and neuro-templates, composed of millions of individual neurons, get more frequent use.  The more use, the stronger and more capable the brain functioning.

The expression ‘practice makes perfect’ refers to the importance of repetitive efforts to improve the results.  The brain changes gradually over time through the repetitive use of families of neurons that help us to do daily tasks such as: play the piano, type on the computer, or hear critical feedback without reacting with anger.  The more practice the brain has, the more the brain changes.

Five Steps

The Five Steps toward neurorepair are outlined below and provide a process where each step builds upon another.  It is important that each step occur in the proper order to enable the process to build in an optimal healing fashion.

1.   Assess the extent and causes of neurological impairment

All information available should be used to determine the extent of neurological impairment as well as the primary causes.  Traumatic events are the most common causes of serious impairment.  It is not essential to use complex medical scans to identify impairment.  Most problem areas have identifiable symptoms that point to both the level of intensity and the causal factors.  A good evaluation and history will normally provide sufficient information.  A variety of psychological rather than medical instruments are available to assist in the assessment phase.

Start at the beginning with a good assessment of history and current functioning in all areas.  There are a variety of formats and approaches to a good assessment and this model has room to approach this step in multiple ways.

2.   Identify specific cognitive, emotional and behavioral problematic symptoms

This is an extension of Step 1.  When specific problem areas are identified it is critical to accurately identify the right problem rather than the most obvious problem and consider the likely causes. Frequently with neurological impairment the representation of the problem area on the surface can look like an entirely different issue than it really is.  For example, the symptoms of ADHD are nearly identical to the observable impacts of trauma on young children.  To have the right problematic symptoms is important to be able to link these symptoms with the interventions in the next step.  This is the second part of the initial neurological assessment.

Insure that the initial assessment includes a careful focus on what the real issues are and what has caused them.  Only when we know the right problem do we have a chance at finding the right solution.  For example, most fire setters have problems other than pyromania (fascination with fire) such as needing attention, expressing a cry for help or reflecting unresolved anger.

3.   Implement interventions addressing the identified problematic emotional and behavioral symptoms

Once it is clear what the causes of the neurological impairment are, the next step is to design interventions that address the emotional and behavioral symptoms. Since behavior is an observable sign of the individual’s perceptual beliefs, or inner working model, cognitions are the focus of treatment as well as emotional and behavioral interventions.  There are many possible approaches that can be used for specific interventions including a large number of evidence based practices.

While behaviors are the most observable problem areas, they arise from how the child thinks and feels about everything in the environment.  The best way to make lasting change is to start with perceptions, and then move to emotional responses and the combination of these two result in externalized behaviors.  Interventions can include a wide range of approaches including many evidence based practices.  This model allows for a multiple of approaches to specific interventions.

4.   Decondition the child’s stress response cycle through multiple forms of relaxation and allostatic training

The most common problems associated with neurological impairment are the wide range of negative influences of neurological adaptations to traumatic experiences. A fundamental negative adaptation is hyperarousal and loss of self-regulation due to the stress response leading to a systemic fight/flight activation of the autonomic nervous system.  Research has identified that many forms of relaxation are the most effective tools to decondition the overactivation of the stress response cycle.  Allostatic training involves assisting the individual to return to a state of calm after arousal, which is the allostatic response.  Stress is a constant in life and the ability to self soothe and regain an inner state of calm is critical to handling the ever present stresses of life.

Reactions to stress are the key factors in emotional and behavioral problems.  Turning down the volume and learning how to produce a state of calm is the brain’s best weapon in the life long struggle with stress.  Find one or more of the many methods of relaxation that will fit best with each individual.

5.   Environmental enhancements promoting the building blocks of brain development

The most effective external impacts on neurological functioning are environmental in nature.  Every aspect of the child’s world should support the goals of enhancing neurological repair including: family, school, community, church, and youth activities among others.  Environmental supports should be in place to provide the building blocks of: safety, security, acceptance, belonging, trust, relationship, self understanding and personal worth throughout the environment the child is working within.  These building blocks enable the child to build personal growth on a predictable and solid personal foundation.

The individual either reacts to or asks for support from the world they experience.  The best interventions to produce the all important building blocks of social success are not individual, isolated and brief approaches, but instead are multi-faceted and coordinated approaches that involve all aspects of the individual’s world.  Environmental interventions for a child might include adjustments at school, at home, expanding involvement in community activities like sports/crafts/hobbies, assigning a mentor, or providing individual and family therapy.

Conclusion

Neurological Reparative Therapy has assisted Jasper Mountain to understand and help some of the most damaged and neurologically impaired children in our system of care.  Outcome data from our work has shown that the vast majority of children reduce serious external behavioral problems, modify emotional disorders, and after leaving our treatment the children usually get much better over time.  We believe these atypical results of intensive treatment are the result of significant impact on the brain’s processing system enabling the individual to successfully face the challenges and stresses of life.  Due to a change in the cognitive mental maps of the child, it becomes possible to rely on others rather than push others away.  Said another way, Neurological Reparative Therapy can return the brain to its natural state of health and thriving.

For additional information about Neurological Reparative Therapy, please refer to Dave Ziegler’s newest book Neurological Reparative Therapy: A Roadmap to Healing Resiliency and Well-Being.

Adoption and Attachment

By Dave Ziegler, Ph.D.

 The Adoption Courtship Model

Out of necessity, Jasper Mountain Center (JMC) staff have attempted to isolate why some adoptions worked during the first five years of our program and why most didn’t.  The result of two years of considering this question has been the development and implementation of an adoption model for children who

  • are emotionally disturbed;
  • are hard to place; and/or
  • have single or multiple adoptive failures

The operating principles for our Adoption Courtship Model are the following:

  • Standard adoptive procedures are insufficient for special-needs children and their prospective families.
  • The odds are often against a successful adoption with these children, without preparation, training, and professional support.
  • The child and the family must be prepared for the reality of this adoptive relationship.
  • The adoption commitment must be made by both the child and the family and can only be made based on a relationship, not on information or interest.

The model has three phases:

  1. Phase I.  The child is prepared for the adoption by understanding his or her role in making it work or not work.  The child’s considerable power in the situation is made clear.  The family goes through the regular certification steps and is selected by the adoption committee.  The family meets with the caseworker and JMC staff to learn what to expect from the initial meeting.  The child is also prepared for this meeting.  The two sides meet with the caseworker and family therapist.  The child begins to build trust by getting to know the family as a unit, then the family members as individuals, and finally in the home environment.
  2. Phase II.  This is where the reality must begin to come in.  Both sides have an image of what they are doing and who they are doing it with, but it must become very clear and very real.  This phase is characterized by extended visits and family counseling.  The process starts with a focus on the strengths and positive attributes of both sides, moves to the faults and flaws of both sides, and finally underscores the realities of the combination of strengths and weaknesses of the adoption.
  3. Phase III.  There are three necessary commitments for the adoption to work.  The initial commitment on the part of both child and family is a commitment of interest, time and effort in regard to adoption.  The second is a commitment to relationships with the child, and the child to the family.  The final commitment is to family for life.  The last commitment is the final step in a successful adoption of special-needs children, not the first step as in regular adoptions.  This commitment must be made to a person, not a concept.  This is important for these children because the reality of how difficult adoption is with disturbed children must be stronger than the commitment to the adoption as a concept.

Suggestions and Techniques

PHASE I. 

Preparation.  Phase I starts long before the family and the child meet.  One of the keys here is preparation.  There is an important question to ask before the specific adoption work begins:  “Has everyone received some preparation for the adoption?”  Too often the family receives more preparation than the child.  Preparing the child for an adoptive placement should ideally begin a year prior to meeting family, with specific counseling on the issues that will come up.  Along with adoption classes, it is valuable to have the prospective parents meet with the adoption worker or counselor who will work with the transition process to prepare the family for the probable struggles that are ahead.

Initial meeting.  After the adoption committee gives its blessing to a match and the Adoption Courtship Model is decided on, it is then important for the family to meet with the adoption worker(s) and the counselor who will provide the transition counseling and discuss the model, the process, and the goals.  Keep in mind that most adoptive families are in a mild to huge rush to have the child.  A rushed courtship is almost always problematic.  Gain the family’s agreement and commitment to the process or don’t use this model (in general, the bigger the rush the family is in, the more concerns there are about their readiness).

The initial meeting of child and family.  Again the suggestion is for the worker(s) and counselor to be actively involved.  Often for this population, meeting the parents alone before children are involved is less complex and overwhelming for the adoptive child.  There should be informal time between the child and the parents, as well as the worker and counselor outlining what will be happening over the next few months and why.  Keep the meeting from being stuffy or too formal.  Make it clear that the goal is to see if in the long run this is a good match for everyone concerned.  All sides will have a voice (empower the child to influence his or her future and you will have a much better response).

Process.  Start with meetings in counseling to get to know each other.  Have the whole family come the second time.  Use techniques to rapidly point out the different personalities in the family (who is the clown, who is grumpy in the morning, etc.)  A technique here is to have the members of the family write on a sheet of paper the things they like and dislike about the family member to their left and right.  The counselor reads the items and has the family guess whom it was written about.  Start with afternoon visits away from the family home.  Go to daylong visits and then an overnight visit, again away from the family home.  This is to equalize the playing field.  In the family home only the adoptive child is unfamiliar with the environment.  In a park, restaurant, or motel at the beach, the focus is on the relationships, not on getting used to the family’s turf.  The adoptive child should have a chance to get to know all family members at least a little, both individually and together, before going to the family home.

Counseling.  The initial meetings and discussions should take place in the counselor’s office.  After each visit there should be a session.  The counselor plays the role of bringing the family and child together and facilitating the process so both sides know that the situation is organized and under control.

PHASE II.

Counseling.  Counseling continues to be frequent but not necessarily occurring each time.  Involve foster care providers to help make the child’s strengths and weaknesses clear.

Process.  GET REAL!  Arrange extended visits, primarily in the home environment.  Get away from special events and get down to everyday life.  The goal of this phase is to make it clear what this adoptive combination will really be like.

Techniques.  Stress the strengths and weaknesses of the match, the family, and the child.  It may be difficult or embarrassing, but it is time to air everyone’s strong points as well as dirty laundry.  Use techniques like having everyone answer such questions as “When I get really angry, I …,” “I show sadness by …,” “When I am grumpy, the best way to deal with me is …,” etc.  Role-play some of this.  Have children act like Mom in the morning before coffee.  How do the parents fight with each other?  Have the adoptive child act out some of his less impressive qualities, such as being rude, disrespectful or hurtful.  Whatever family members will see later should be talked about, even acted out, now.

PHASE III.

Process.  Now that everyone has met and should know a lot about one another, the emphasis shifts to commitments.  There are three levels of commitment:  (1) time and effort, (2) relationship, and (3) life commitment.  Commitment 1 should have long since been made and operationalized.  It will be important to review and evaluate how everyone has handled this commitment because it will be an indicator of the next two.  How interested is everyone in a commitment to relationship?  In the case of attachment-disordered children, this must be reviewed carefully to have realistic expectations.  It is clearly time to begin putting out on the table the issue of life-long commitment.  Again, the commitment must be to people, not to the concept of adoption.

Counseling.  Here is where the skill of the counselor is most needed.  There is much complexity in commitments.  There may be resistance on everyone’s part to addressing this.  If things are going smoothly, why upset the apple cart?  No one really wants the final analysis to be halting the adoption because it is not overall a good match, but this may be the case.  The counselor must be firm and willing to be the bad guy.  The capacity of the child to commit himself may be problematic, and the parents may have better intentions than abilities.

Ritual.  If the adoption gets a green light, then some have found a formal recognition of the adoptive commitment an important step.  Consider having a ceremony.  Invite friends and throw a party.  Our culture does this for most important events.

A Final Thought

Adoptions can work with special-needs children, but the work is never completed (yet when is any parent’s job done?).  Despite an excellent placement for both the child and the family, the work has only begun.  The transition into the home will set an all-important tone, but don’t fool yourself that the job will get easier.  Our experience is that new struggles come up with each physical and developmental stage of the child.  But that just makes adoption like life—a new challenge around every corner.