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.

Optimum Learning Environments for Traumatized Children—How Abused Children Learn Best in School

 By Dave Ziegler, Ph.D.

Introduction 

A great deal of attention has been given to our educational system and much of it has not been complementary.  Issues such as student progress, drop out rates, competencies in math, science and geography have all been the source of criticism and concern.  National initiatives have been implanted with reviews that have been more negative than positive.  Some have gone as far as to say that our public educational system in the United States is in chaos.  However, one area that has received little or no attention has been the ability of our educational system to meet the needs of children who are living with the effects of trauma in their past or present.  Some might say that the attention given to special needs children through special education services should address these children.  However, special education attempts to cover a host of causes related to learning difficulties and most of the time services focus only on the symptoms rather than on the problems themselves. 

Handicapping conditions that are observable such as blindness, physical disability, deafness, autism, and even dyslexia are much better understood in educational settings than emotional disturbances and learning disabilities that come from trauma in the child’s life.  For these children the answer is often a referral to the school counselor for the emotional issues that cannot be addressed in class.  But this separation of the emotional and the academic challenges faced by traumatized children is not getting the job done.  A child cannot compartmentalize emotions, thoughts, and behaviors as some adults can.  The whole child comes into the classroom and either succeeds or fails based upon whether all aspects are engaged in the learning process rather than impeding it. 

Some might say that a focus on traumatized children is spending valuable resources on a small group of children.  However, it is important that we learn from disciplines outside of education to get a better sense of the magnitude of the problem of trauma in our society.  It makes logical sense that the majority of children presenting for mental health concerns have histories of trauma.  After all, psychological problems must have some cause.  It may also be commonly known that the majority of incarcerated teens and adults have been abused and traumatized in their past.  Once again, it makes sense that an anti-social disposition toward other people and society as a whole must come from some damaging experiences in life.  It is less known that no less authority than the Center for Disease Control has determined that the primary cause for physical disease in America is early childhood trauma.  According to the CDC, trauma is the primary cause of: obesity, addictive behavior, suicide, chronic employment problems, and the ten leading medical conditions leading to premature death in this country.  It seems that when one stands back and looks at all the representations of failure and not reaching one’s full potential in our culture, trauma stands out as the most significant common factor across settings. 

To those who consider the population of traumatized children in our educational settings too limited to receive significant attention, another look at the data is indicated.  Trauma comes in many forms from child abuse, life threatening car accidents to any serious life event that overrides the child’s ability to cope with the experience.  Every year it is estimated that 5,000,000 new children are added to this list of significantly traumatized children.  Of these children, up to 50% will develop long-term debilitating after-effects of the trauma, including learning problems in school.  Some of the most serious effects of trauma come from child abuse, or betrayal by adults who a child must rely upon for basic needs and even survival.  Of the children who are abused, 94% know the abuser and generally have to rely on the person for protection, producing what some have called the ‘ultimate betrayal.’  When all forms of abuse are considered (physical, sexual, emotional, and neglect) perhaps 1 in 3 children are victimized by abuse during their childhood years.  Not only is the population of traumatized children in educational settings not a small number, trauma may constitute the greatest cause of underachievement in schools. 

What is needed in education, when it comes to traumatized children, is to bring together the substantial new information on trauma, brain development and the causes and solutions to emotional disturbance that exists in psychology and psychiatry and to weave this information into learning theory and progressive academic strategies.  We need conceptual and practical applications of learning approaches and environments where traumatized children succeed rather than fail.  This document will attempt to provide a conceptual framework leading to practical implementation in our experimental learning settings. 

How traumatized children perform in educational settings and why 

Trauma and learning in school do not mix well together.  This is not to say that trauma does not result in significant learning for the child.  The child learns not to trust, learns to be anxious around adults, and learns to be vigilant of the motivations of others.  What a child learns from trauma negatively impacts learning in an academic setting.  If the goal is for a child to come into an academic setting ready to learn, ready to emotionally experience the enjoyment and excitement of discovery, then the effects of traumatic experience will hinder learning in a variety of ways. 

Many traumatized children fail in school, and failure can take many forms.  Children can externalize their difficulties in emotions/behaviors and find themselves in constant trouble and the subject of behavioral restrictions.  Extreme examples of this are children who attempt to get expelled from school thus eliminating the problem of having to face the many challenges of going to school.  Some children sit quietly and can dissociate (day dream) in the classroom and not learn.  An extreme example of the internalizing child is the one who pretends to be ill, doesn’t come to school, or when they are old enough drops out of school altogether.  There are many impacts of trauma that often block a child’s ability to learn in the classroom. 

Trauma produces hypervigilence in children.  This is a survival skill to the child in a setting where basic needs are not provided, but it is not a functional skill in school.  Hypervigilence is often viewed as distractibility.  In part this is due to the child focusing on aspects of the environment that are not part of the learning plan.  The child in science class who is watching the non-verbal messages of a larger boy, wondering about safety during the coming recess break, is not hearing the science lesson. 

Trauma produces serious self-regulation deficiencies.  Often viewed as the most pervasive result of trauma, the lack of self-regulation causes these children not to have the inner understanding, inner strength, or desire to monitor emotional and behavior reactivity to events around them.  This is often observed as intense emotional expression due to challenges in the classroom. 

For reasons that will be explained in the next section, many traumatized children have difficulty putting what they learn into context.  An example of this concept can be seen in the child who can connect the dots that are numbers but cannot see that the dots eventually form a horse.  Being able to put learning into context is an essential aspect of educational advancement.  It means little if the child learns that slaves in early American history were sad and oppressed if they do not understand that slavery was wrong and a violation of human rights.  The common expression ‘not seeing the forest for the trees’ suggests that the many facts, figures and ideas in school must be able to be integrated into understandable and usable information for learning to be sustained. 

Trauma impacts the ability to trust others.  A lack of trust often results in a child misreading the motivations of others, both other students and adult teaching staff.  Some children believe that a difficult learning task was specifically designed to harm them.  Other traumatized children believe that when they are chosen second rather than first, this as a statement of how the teacher values or believes in them.  With peers, these children often presume negative motivations when this is not the case.  Misreading the intentions of others makes it very difficult to find social success. 

In some ways the most important success a child needs in school is social success. School is the first place out of the family that a child begins to develop self-image and understands others and how to interact with the larger world.  A great deal of success in school comes down to the ability to get along with others and to form relationships that can help provide support.  If this first journey into the larger world outside the family ends in failure and conflict, the child’s view of the world can be quickly established in a negative context.  With this in mind, some of the most important learning opportunities in school are at recess, lunch, and in the hallways.  It is in these settings that traumatized children have the most difficulty in school. 

Expecting a child to give their full attention in the classroom is like asking someone who just received a very disturbing phone call to go on with their day unaffected.  The problem with both situations is the affects of anxiety on our ability to focus on the task at hand.  Our emotions are ready to provide us with critical information to inform our decision-making process.  However, our emotions can also run wild with fear and anxiety in situations we either do not understand or believe we cannot handle.  School can produce debilitating anxiety for the traumatized child resulting in the child’s lack of focus and inability to learn. 

Traumatized child often expect the worst and many times experience just what they expect.  In part this comes from the child’s experience that events seldom go the way the child would like and many times the child is powerless and victimized by events and people.  This can produce a negative expectation of experiences in school and a self-fulfilling prophesy of failure.  As the saying goes, ‘If you think you can or can’t, you are right.’ Negative expectations develop into negative self-esteem and the internal belief that internal personal power and interpersonal skills are insufficient to influence one’s life for the better. 

How the traumatized brain functions 

Each of the above issues that are the result of trauma develop and persist in the brain.  Since the primary function of the brain is to maintain and protect the survival of the person, the brain is seriously altered by trauma.  Because trauma by definition is a situation that is beyond the ability of the individual to cope, the brain views traumatic events as a threat to its primary function of survival.  The brain has mechanisms to address threat and these parts of the brain will directly affect the traumatized child in the educational environment. 

The most primitive part of the brain is the brain stem located at the base of the brain.  The brain stem handles basic life support functions such as respiration, circulation and temperature regulation, and all of these bodily systems function without the need for our conscious oversight.  The brain stem also controls the autonomic nervous system which impacts all the other life support systems of the body (heart rate, blood pressure, rate of respiration, etc.).  Input from the environment can increase life support functions of the brain stem, which can adversely affect both personal comfort and a state of relaxed openness to learning.  The brain stem functions can be deescalated, but only when overridden by the neocortex, which will be addressed shortly. 

It can be argued that the section of the brain that is most impacted by trauma is the limbic system in the middle of the brain.  The limbic system has several physical components, but overall it controls emotions, arousal, sexuality, and attachment.  The limbic system includes the amygdala, the fear center or the ‘smoke detector’ of the body.  Whenever the individual perceives a threat of any kind, the amygdala sends out an internal shrill warning signal.  A traumatized child will have such an experience multiple times in a school day, and at times, multiple times in an hour.  The limbic system also plays a major role in distractibility by letting in too much sensory information causing a processing overload.  Trauma impacts on the limbic system also come into play because trauma memories are stored in this part of the brain.  After trauma, all future sensory input will be filtered through memories of trauma.  Such sensitivity can have ominous implications in a school setting. 

The top of the brain and most complex structures are in the neocortex.  This is the region of the brain that educational instruction most often targets.  Here is where the brain not only analyzes information but controls receptive and expressive language development and use.  Most students will come to school ready to process what they learn in this region of the brain.  Traumatized children can have serious neurological roadblocks to processing in the neocortex. 

One of the most important neurological deficiencies after trauma is the impact on mental organization or neuron-integration.  All of the above brain impacts of trauma affect the ability of the frontal lobes of the neocortex to organize input into useable and meaningful information and decisions.  In particular one region of the brain is responsible for overall integration of information and decisions from all parts of the brain and this is the orbitofrontal cortex.  Trauma can significantly degrade the ability of the brain from collecting, analyzing and using information the child learns either in the classroom or on the playgrounds of school.

Elements to avoid in school settings 

Understanding the above impacts of trauma on a student coming to school more concerned about safety and survival than learning math facts, can help us redesign the learning environment for these children.  It is time to get practical and address the do’s and dont’s of a school that provides an optimal educational experience for the traumatized child.  The first place to start is what to avoid in the learning environment for these special children. 

Stress and anxiety – research has determined that for most individuals either too much or too little stress do not promote optimal results.  This is somewhat different for traumatized individuals, but the question becomes how much stress can a traumatized student handle.  The answer is very little without substantial support.  The optimal environment would eliminate as much anxiety as possible because of how anxiety triggers hyper-arousal in the brain, decreasing focus and attention. 

Teaching to the bell shaped curve – traumatized children will be on the low end of the curve and efforts to ‘reach as many as possible’ will generally mean these children will not be reached.  Teaching these children means a specific focus on just those children who are not gaining from traditional teaching methods. 

Serious atmosphere where laughter and enjoyment are rare or discouraged – adults generally view learning as serious work, children view the best learning situations as fun and enjoyable.  Since adults run schools, they tend to be serious atmospheres with excitement, laughter and high energy kept in check.  Serious settings give traumatized children the wrong message that there is reason to be fearful. 

Unsupervised communication among peers – children can be brutally honest and can also be intolerant and hurtful.  Unless adults monitor what traumatized children hear from their peers, the setting will not feel safe to the child. 

Learning through criticism – people do learn from direct criticism but this is not an optimal strategy for the traumatized child.  Criticism is often amplified to give the child the message that they are incompetent or worthless if the child has received this message from adults in the past. 

Uneven competition – competition plays a major role in our culture and in our schools.  Competition can be a good experience for all concerned but special attention must be given to traumatized children.  Fair competition is not always even competition.  If the child is bound to lose, regardless of whether the rules are fair, it is not even competition and will not have a positive result for the traumatized child. 

A constricting environment – what many adults view as methods to maintain order, structure or decorum, many children experience as constricting.  Traumatized children respond to restrictive and constricting settings by fight (acting out) or flight (shutting down) and daydreaming.  Constricting environments are experienced by these children as a message that there is no room for you to be yourself in this setting. 

Rigidity – similar to constricting settings, rigidity is experienced by traumatized children as an authoritarian, inflexible and ‘mean’ atmosphere.  Rigidity is interpreted by these children into negative messages. 

An environment that can be easily disrupted – if a classroom is easy to disrupt, it will ultimately fail to meet the needs of traumatized students.  If by being expressive, questioning, or even acting out the classroom grinds to a halt, the child will either attempt to exert inappropriate power and control over others as a distraction or the child will be fearful that adults can be overcome by children in the setting. 

Elements to enhance in school settings 

Expressive learning – children best learn by doing, not listening or even watching.  Traumatized children bring into the classroom many fears and emotions as well as poorly self-regulated excitement and activity levels.  Expressive learning channels mental, emotional and behavioral energy into learning. 

Predictable structure – while avoiding rigidity, the optimal learning environment for the traumatized child must have comforting structure that signals to the child that safety is assured, adults are appropriately in charge, and students can focus full time on being interested learners in their own childlike fashion. 

More successes than failures – when people try something new they fail many times before they master the task.  Traumatized students give up long before the mastery stage and therefore decline or even refuse to take the risk to do something new.  The child must experience many more successes than failures in small and large ways. 

Adult mediated peer interaction – adults must monitor what is going on among the children because while ‘kids will be kids,’ the traumatized student will experience a lack of physical or interpersonal safety with ‘normal’ communication among children that is negative, teasing, bullying, or demeaning. 

External cognitive structure – instructors must overcome the brain deficits of traumatized children by providing the meaning, planning and connections from outside the child’s brain.  The adults must help the child understand the mental processing steps as well as the end result of higher order reasoning. 

The ‘unschool’ – most traumatized children have been in school before and many times it was a negative experience.  Since their brain filters new experiences through past negative memories, it may be helpful to shed the trappings of “school.”  The unschool looks different, feels different and is different.  What does the child experience walking into the environment?  Is there color, energy, interesting things, and space to be expressive, or is there rigid order, regimentation, posted rules and regulations and constrictions on movement and activity? 

Encouragement through relationship – traumatized children need social support but seldom know how to ask or how to accept such support.  Adults cannot wait until the child is receptive to relationship, the adult must meet the child much more than halfway.  Relationship with a safe adult addresses much of what the child needs in order to begin to open up to the risks of learning and trying new tasks. 

Teaching to the child’s individual learning style – children learn differently and the specific learning style of each traumatized child must be identified to help overcome the many hurdles to learning identified above.  Multidimensional instructional approaches that include auditory, kinesthetic, and visual components can be very effective. 

Even competition – as mentioned earlier, competition can be a learning tool if not overdone and if it is even.  Even competition ensures that any of the competitors have a good chance to win.  If the outcome is predictably determined, it may be fair competition but it is not even and will not be a positive learning experience for the traumatized child. 

Internalized goal setting – although mental reasoning must come from the outside at first, efforts must be put toward the child setting reachable internal goals.  The adults must insure that goals are not only reachable but are also successfully reached before the child can set additional goals.  When children with a losing attitude either win a competition or reach a goal, they seldom know how to handle this experience and initially can be tiresome and demanding of constant attention.  This is attention they need to make up for the past and they will need help to be a good winner and appropriately proud of an accomplishment. 

Enjoyment and fun – if learning is not fun then it will not be sustainable for the traumatized child.  The two primary jobs of a child are to learn and have fun.  It is optimum to do both at the same time when possible.  The optimum learning environment is learning in an enjoyable and fun setting. 

Variety of activities and help with transitions – the opposite of a constricting/rigid learning setting is one that has a variety of interests and activities.  Traumatized children are often poor at self-regulating high energy so they will need outside help even with positive emotional expression.  These children will also need adults to help them prepare for and initiate transitions from one activity to another. 

Choices in areas of the child’s interests – children will have more investment in learning things they are interested in and have some role in choosing.  With creativity, nearly any subject area can be learned through nearly any topic or interest the child has.  An optimum learning environment has room for the child to pursue chosen interests. 

Group/cooperative efforts promoting teamwork – because traumatized children live in a solitary world, positive social experiences are critically important.  These children will not initiate or even willingly participate initially in group learning, but this is a very potent and important way to gain social success and support.  Group efforts must be monitored closely by adults, encouraging of all participants and resulting in a successful outcome for the child to receive the optimal gain. 

School as the doorway to social and personal success in life 

For the traumatized child success in school carries more weight than for other students.  For these children school will either confirm that the world is filled with unresponsive, threatening adults and peers or these children learn that there are places that are safe, stimulating and even fun.  With the vast numbers of traumatized children in our society, it is time that we take a very close look at how to facilitate learning for these children.  One size does not fit all in education, particularly for traumatized children.  The time and effort put into developing an optimal learning environment has the potential to reap huge rewards for children who deserve the very best education we can provide them.  We may need to start small in this endeavor with limited experiments in centers of learning that show educational success with traumatized children.  Simultaneously, our educational system will need to take a critical look at the numbers of children who are being left behind with the educational system currently in place.