Hug the Monkey

Conference with Victor Carrion on Child Trauma

Victor Carrion is a Stanford researcher who's shown via brain imaging how trauma affects the brains of children. This is the cutting edge of psychiatry; the work of Carrion and others shows that the roots of criminal or antisocial behavior may be in damage to the normal development of the brain.

For more on this, see Gray and White Matters.

Dr. Carrion will give a two-day seminar at Chico State University, in Chico, California in early January. This is an annual conference on children in trauma, designed to educate those who work in the social and legal systems. I attended the conference last year, when Allan Schore presented, and it was a valuable opportunity to learn about advanced brain science presented in an understandable way.

Here are details about the 2008 Children in Trauma conference:

California State University, Chico Continuing Education, in partnership with Butte County Family Court Services, Superior Court of California, presents Children in Trauma 2008: Helping Children Survive Trauma: Early Life Stress, Brain Development and Effective Interventions. The two-day professional development conference will be held January 11-12, 2008 at the Bell Memorial Union Auditorium on the CSU, Chico campus.

The 6th annual Children in Trauma Conference will provide an intensive two day practicum focusing on how traumatic stress can alter early child development and how professionals working in the field can recognize this problem and learn how to apply the emerging intervention and treatment protocols.

The conference will feature internationally recognized researcher and educator, Victor G. Carrion, MD, Associate Professor, Stanford University School of Medicine, Department of Psychiatry and Behavioral Sciences and Director of the Stanford Early Life Stress Research Program.

Victor Carrion’s research looks at the interplay between brain development and stress vulnerability via a unique multi-method approach that includes psychophysiology, neuroimaging, neuroendocrinology and phenomenology. Dr. Carrion is a noted practitioner, known for his development of successful individual and community-based interventions for stress related conditions in children and adolescents that experience traumatic stress and post-traumatic stress disorder (PTSD).

Marriage and family therapists, social workers, psychologists, educators, school and family counselors, attorneys, law enforcement professionals, mediators, child custody evaluators, behavioral health professionals, nurses, physicians, psychoanalysts, emergency responders, children’s advocates and concerned individuals are encouraged to take advantage of this continuing education opportunity. In addition to learning from a recognized scholar and practitioner, participants will walk away from this conference with an array of professional contacts and practical treatment tools.

Participants may earn 12 hours of BBSE (Provider PCE 799), BRN (Provider 00656), MCEP (Provider CAL123), MCLE and CME continuing education credit.

In addition to the featured speaker, exhibitors from public service agencies and other resource providers will be on hand to share a wide array of information and discuss their services. Exhibitor space is available.

Early registration fee (received before Jan. 4, 2008) for the two-day conference is $279 per person (includes continental breakfast, lunch and materials). Group rate discounts are also available.

To enroll or for more information, please call CSU, Chico Continuing Education, 530-898-6105, email rce@csuchico.edu, or visit the conference website.

 

Gray and White Matters

There seems to be a flood of brain research lately that helps illuminate how the brain responds to social stimuli.

An intriguing new area is looking at two kinds of tissue in the brain: white matter and gray matter.  We usually think of gray matter as the stuff we use for cognition; more grey matter tends to equal a higher IQ, for example. White matter, on the other hand, is the connective nerve tissue thought to be used for "wiring together" different parts of the brain.

Of course, it's not that simple.  Too much gray matter in some regions has been linked to trauma.

Two studies released today looked at the relationship between volume of white or gray matter and behavior.

First, a team led by Manzar Ashtari of the Children's Hospital of Philadelphia in Pennsylvania looked at the brains of autistic kids. They found more gray matter than normal in parts of the brain dealing with social interactions. They think this could be related to abnormal function of the mirror neuron system.

Mirror neurons are thought to be special kinds of nerve cells that fire when we watch others. It's still speculative in humans, but they've found that monkeys have what they call mirror neuron regions that fire when the monkey watches a researcher pick up a cup. This might be related to empathy, the ability to literally put oneself in another's place. See Mirror Neurons, Oxytocin and Autism for more.

According to the Science Daily story,

"In the normal brain, larger amounts of gray matter are associated with higher IQs," Dr. Ashtari said. "But in the autistic brain, increased gray matter does not correspond to IQ, because this gray matter is not functioning properly."The autistic children also evidenced a significant decrease of gray matter in the right amygdala region that correlated with severity of social impairment. Children with lower gray matter volumes in this area of the brain had lower scores on reciprocity and social interaction measures.

Another study by James Cantor of the Centre for Addiction and Mental Health in Toronto  found significantly less white matter in the brains of pedophiles than in the brains of non-sexual offenders. The article says,

The study, published in the Journal of Psychiatry Research, challenges the commonly held belief that pedophilia is brought on by childhood trauma or abuse. This finding is the strongest evidence yet that pedophilia is instead the result of a problem in brain development.

I don't understand why they draw this conclusion. Plenty of studies have shown abnormalities in brain development in children who've been neglected, abused or traumatized. In fact, Victor Carrion of Stanford has found more gray matter in the prefrontal cortexes of the brains of children with PTSD. He's also found decreased total volume in the PFCs of adults and children with PTSD.

He recently told me that it's difficult to identify exactly what these differences mean when it comes to brain function and behavior. He said, "It seems like in some regions, there's a problem if you have more volume ...  in others, it's problematic if you don't have enough."

It seems to me that Cantor's study provides further evidence for two things: that early trauma affects brain development, and that this abnormal brain development leads to abnormal behavior later.

I've contacted the Centre for Addiction and Mental Health to more information on this statement. I'll post if and when they get back to me.

 

Retraining the RAD Brain

I published a story today in the East Bay Express, called When Love Is Not Enough.

The story uses the experiences of two local families who adopted children from overseas to discuss some of the therapies being used to retrain the brains of kids with attachment disorder, PTSD and other abnormalities of brain development.

I didn't get into the oxytocin response too much -- it's too complicated and not the focus of the story. But you can look at the therapies discussed -- attachment therapy, neurofeedback and neurodevelopmental reprogramming -- as ways of building the oxytocin response in the brain.

When Does Attachment Disorder Happen?

In an interview with Babble.com, Jane Aronson, the pediatrician known as the Orphan Doctor, talks about foreign adoption, something she strongly advocates. Aronson is pediatrician to movie star adopters including Angeline Jolie.

In the interview, Aronson points out that adoptions of older foreign children can be very successful when the child was raised by a family, but then lost his parents to AIDS, war or other misfortune. She gives a helpful analysis of adoption services in various countries.

Aronson certainly is highly experienced in overseas adoption, through her organization, Worldwide Orphans Foundation. She makes one strange and really inaccurate remark, however: She claims the science shows that attachment disorder is mostly the result of brain damage or brain chemistry imbalances in the womb.

She told the interviewer,

And attachment likely has more to do with brain damage that occurs during the pregnancy, due to malnourishment, exposure to toxins in the environment, infections during the pregnancy, exposure to alcohol and drugs and smoking. All of that conspires to cause damage to brain structures that are involved in the actual chemistry and physiology of attachment. So when people use this sort of artificial convention of saying, you know, "You gotta get 'em by three, or else they're ruined," I think that's also not taking into consideration that attachment likely has to do with brain chemistry during pregnancy.

While it's accepted that a hostile womb environment -- a mother who takes drugs, who doesn't want the baby, who's being abused -- can make the baby hyper-vigilant and hyper-reactive before he's born, neuroscientists like Bruce Perry who study disordered kids are convinced that not only abuse but also neglect and simple lack of attention after birth can create post-traumatic stress disorder, or PTSD.

In the comments on a blog summary of the interview, most people think Aronson is full of it.

For the perspective of a neuroscientist who studies traumatized children, read this interview with Michael de Bellis of Duke University.

See also RAD Epidemic in Russian Adoptions?

Saving a Troubled Adoption

When I started this blog more than two years ago, the severe behavioral problems that adopted kids and their parents struggle with was really under the radar. Reactive attachment disorder, PTSD and other ills that affect children who were traumatized by, if nothing else, being separated from their mothers, are becoming mainstream concerns, thanks to articles like this one from the Boston Globe.

In "Choices of the Heart," Patricia Wen tells the story of a family that almost relinquished their son when he was 15. Luckily, as a last resort, they found an attachment therapy center that, after months of intensive work, allowed him to heal -- and return to the family.

The Foster System Damages Kids' Brains

The CBS affiliate in Miami, Florida, has an excellent story today about the problems created by our foster care system.

Reporter Michelle Gillen writes about  the growing awareness in the Miami court system that efforts to help kids by taking them out of abusive or danger situations can be permanently damaging their brain development, and to conditions such as reactive attachment disorder, or RAD.

Cindy Lederman and Steven Leifman, two Miami court judges, are using new information about brain development and how important connection with the mother or other primary caregiver is, to help kids at risk for this.  According to the story:

Leifman says the latest research is staggering because it means juvenile court systems around the country have unwittingly damaged children in foster care by purposely preventing attachments.

“It is particularly acute in the foster care system and one of the things that we realized, again, the court in advertently contributed to the problem, because we felt that we didn’t want children to become too attached, that it would do more harm than good if they got attached then we’d move them. So for a long time we kept moving the kids around the foster care system.”

Miami is trying to intervene early to help kids at risk that come through the court system with an early intervention center. It's opened the the Linda Ray Intervention Center, a therapeutic home where babies up and toddlers up to three years old can attach to a warm and caring person.

In Miami alone, some 9,000 children enter the foster care system each year.  And 27 percent of the children in foster care are under five years old.  As the article points out, this is many more children than can be helped by the Center but at least it's a start.

Generation Alienation Is a World-Wide Problem

It's easy for those of us living in the dysfunctional United States to blame our indigenous culture on the growing crisis in attachment. But this story from the Bay of Plenty Times in New Zealand shows that country is experiencing a similar attachment crisis.

Writer Elaine Fisher quotes psychotherapist Augustina Driessen, who predicts that child abuse will worsen in New Zealand as kids who have been neglected, abused or ignored grow up to become parents themselves. Driessen says,

  "To break the cycle we must teach many parents how to parent, to stop them bringing up their children as they were brought up.

  "It is a privilege to have children. In extreme cases, some parents should never be allowed to have children again."

I agree. In modern society, having children shouldn't be considered a human right. It should be a privilege reserved for those who can prove they can provide for a child's emotional needs, as well as the most basic physical needs, that is, enough to eat and secure shelter.

For more on this, see "A Generation in Pain."

Did Hitler Have RAD?

How do human monsters get that way? Most of us can't imagine how anyone could create the evil and pain that Adolph Hitler did.

We like to think of Hitler and others like him as aberrations of nature, pure evil somehow come into human form. But monsters like Hitler are created by other humans; most often, they're made by their parents.

Alice Miller

In an article about Hitler reprinted on NaturalChild.org, she writes,

In order not to die, all mistreated children must totally repress the mistreatment, deprivation, and bewilderment they have undergone because otherwise the child's organism wouldn't be able to cope with the magnitude of the pain suffered. Only as adults do they have other possibilities for dealing with their feelings. If they don't make use of these possibilities, then what was once the life-saving function of repression can be transformed Into a dangerous destructive, and self-destructive force.

Hitler was beaten severely and regularly by his father; to protect himself, he learned to repress all feeling. But, Miller writes, his rage and pain remained. Her book, "For Your Own Good," explains how his childhood experiences caused him to become the man he was, as well as how German society created a generation with many people who were ready to follow him. The book is a polemic against the cruelty we inflict on children in the name of discipline and socialization.

Reactive attachment disorder, or RAD, is a diagnosis given to people -- most often children -- who are unable to bond with others. They show little or no empathy, they are often violent and destructive, and they can be very cruel. It's very likely that today, Adolf Hitler would be diagnosed with RAD.

Miller is very clear that Hitler is still responsible for his actions, as we all are. And she is NOT justifying what he did in any way. She says,

What point is there for us today in learning about Hitler and his history? For me, the main point is this: our knowledge will serve as a warning against our blindness and encourage us to give it up once and for all and to struggle against collective repression. This is what I do consistently in all my books in order to help people understand the psychodynamics of the mistreatment of children and its immeasurable danger for society, as demonstrated by Hitler's case. My explanations are by no means intended to suggest pity for a man as merciless as Hitler.

For other psychologically oriented analyses of Hitler, see posts in this forum:

http://www.behavior.net/bolforums/archive/index.php/t-372.html

RAD Becoming Recognized

The horrible stories about the abuse of children with reactive attachment disorder in the foster and adoption system just keep coming.

Therefore, I'm especially happy to read this story from the UK of a woman who's had success in mothering RAD kids.

Sue Clifford began adopting traumatized children in 1991. She intuitively developed parenting styles that help them, in advance of the new understanding neuroscience has provided in the last ten years.

Book Review: The Connected Child

Karyn Purvis, David Cross and Wendy Lyons Sunshine have written a handbook for parents of at-risk kids that's vitally needed. With the rise in international adoptions and adoptions of kids in foster care has come a mostly unacknowledged crisis. Unprepared and unsupported families are finding themselves unprepared for the task of parenting children with severe emotional problems.

The Connected Child helps parents put some of their therapeutic techniques into practice; more important, it helps them understand their kids in a new way.

Dr. Purvis is the director of Texas Christian University's Institute of Child Development; Dr. Cross is associate director of the institute and a TCU psychology professor. They treat kids with attachment and other behavioral disorders, and they run a summer camp for kids.

The book explains to parents how their assumptions of normal and acceptable behavior may be completely foreign to their children. Not being touched, not having enough to eat, not having toys or stimulation can create a worldview that's totally out of synch with the parents.

That's why setting rules for behavior or other cognitive approaches may not work with these kids. When parents understand that so-called bad behavior comes from fear or self-protection, they can find strategies that address the underlying fear and thereby change behavior.

For example, stealing or hoarding food is common among children from orphanages. They had no choices about when or what they could eat, and often didn't get enough to eat. Instead of demanding that the behavior stop, or that kids hew to mealtimes, the authors offer techniques to maintain a healthy, regular diet while increasing feelings of security about food.

For example, if a child asks for an energy bar a few minutes before mealtime, instead of saying, "No, we'll be eating in ten minutes," they advise giving her the bar and letting her choose whether to keep it in her pocket or by her plate to eat after dinner. Another option is letting the child keep a basket with healthy snacks in her room that she can eat whenever she wants.

Even sending a kid to her room for a time-out can hurt more than it helps, they write. If a child already feels cut off from the family, this isolation seems to reinforce that belief. Instead of dealing out consequences for misbehavior that may seem arbitrary and unrelated to the misdeed, Purvis, Cross and Sunshine illustrate how to help a child understand the real consequences of his behavior. For example, if a kid mistreats a dog, parents are advised to sit down with him and brainstorm the negative consequences of the behavior, such as, "If I hit the dog, it will run away from me." Next, they should make a list of positive consequences that might occur if the dog is treated kindly, such as, "It will like me."

They write,

"Adopted and foster children deserve deep compassion and respect for what they may have endured before they were welcomed into your home. Some of these little ones have survived ordeals that defy the imagination. … the difficult history of these children means that you, as a caretaker, have to work harder to understand and address their unique deficits and make a conscious effort to help them learn the skills they need at home with a caring family."

Parents need to respond to acting out, tantrums and other dysfunctional behavior with love and understanding. Over and over, the book helps parents understand the roots of misbehavior, so that they can respond with love instead of anger.

At-risk kids need to be told directly and simply what's expected of them, according to Purvis and Cross. Parents should identify specific behaviors or values they want to enable, and name them, for example, "asking with respect." If a child asks for something demandingly, the parent says, "Is that asking with respect? Can you ask me with respect?" Throughout, the book provides clear strategies and scripts for handling a wide variety of problems and behaviors.

Finally, The Connected Child includes a chapter called "Healing Yourself to Heal Your Child." Without judgment and with much compassion, the authors point out how much any child, and especially a traumatized child, needs to feel secure and loved by her parents. If a parent hasn't dealt with his or her own grief, anger or emotional dissociation, it will be difficult for that child to heal. If the child does begin to open up, it may actually make her parents uncomfortable.

They offer some advice for such parents, which tends to be on the cognitive side, such as reflecting on their own attachment styles and practicing identifying and articulating their own feelings. Of course, this isn't always so easy, and parents with attachment issues may benefit more from the same kinds of experiential therapy that kids get.

In fact, guiding a child with an attachment disorder toward healing could be exactly the kind of experience that could help a parent heal -- as long as it's done consciously and carefully. The Connected Child is a wonderful guide.

For background on the work of Dr. Purvis and Dr. Cross, see this article from the Texas Christian University magazine.